Type II diabetes and metabolic syndrome are 2 intertwined conditions that are critical to the healthcare landscape in the United States and abroad. Patients with either diabetes or metabolic syndrome can have a dramatically increased risk of developing cardiovascular disease. Numerous treatment options have existed for some time, which include nonpharmacologic and pharmacologic therapies. In addition, within the last decade, a multiple of novel treatment options have emerged for the management of hyperglycemia in particular. By targeting novel pathways beyond the secretion and supply of insulin, these new therapeutics provide a valuable adjunct to the currently available therapies for diabetes and metabolic syndrome. Here we discuss the current guideline-driven usage of standard therapies with some novel indications. In addition, we discuss the novel therapies for the treatment of hyperglycemia, their mechanisms of action, and appropriate therapeutic indications.