There has been a significant increase in the choice of agents to control blood glucose levels recently. Although the National Institute for Health and Clinical Excellence gives a recommendation for what to use at each step of the glycaemic pathway, practitioners have a choice at each step. Recent controversies about the safety of intensifying glycaemic control, the cost of new therapies and the drive to achieve tighter targets through the Quality and Outcomes Framework need to be taken into account when prescribing the most appropriate medication for each individual. This article discusses the options for the prescriber when supporting those with type 2 diabetes to achieve target blood glucose levels.