The elderly has become the population at high risk for diabetes mellitus (DM). Since the old people are characterized by organ function decline, complex co-morbidities, individual differences, high risk of complications and so on, individualized treatment strategy and blood glucose target should be established for different patients. No matter the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), or our expert consensus on senile DM, all recommend that the blood glucose target should be kept in a wider range for the frail elderly patients with multiple comorbidities, and the treatment needs to be well-targeted, safe, reasonable, and easy to operate. At present all these guidelines emphasize the importance of hypoglycemic safety. Among all the anti-diabetic agents, metformin is the first choice and initial medication for the elderly, and can be continuously used after dose decrement for those with glomerular filtration rate of 45?60ml/(min·1.73m2). Since α-glycosidase inhibitor causes less hypoglycemia than other anti-diabetic drugs, it should be used in the elderly with carbohydrates as the main energy source. More types of insulin preparations can be selected according to the blood glucose in the elderly.