The potential cardiovascular risks that are associated with drugs for type 2 diabetes have recently raised considerable clinical and regulatory concerns. As some risk factors for cardiovascular disease and type 2 diabetes are related, identifying agents that target shared underlying pathways and processes is an attractive therapeutic strategy. In this article, we review the background to and the implications of recent regulatory guidance on the development of new drugs for diabetes, and discuss the potential cardiovascular effects of selected classes of diabetes drugs that are currently being investigated.