As the percentage of elderly persons in Japan increases, so do the rates of overweight, insulin resistance, and elderly onset diabetes. Elderly onset diabetes is characterized by postprandial hyperglycemia, lower HbA1c levels, and less frequent retinopathy. The treatment of elderly onset diabetes involves numerous challenges, such as cognitive impairment, depression, vision/hearing impairment, and difficulty performing activities of daily living. One of the medical treatments, glinides and alpha-glucosidase inhibitors, must be taken before every meal. However, dipeptidyl peptidase 4 inhibitors need to be taken only once or twice daily and are well tolerated by older adults. The target HbA1c should be individualized, and a reasonable goal for HbAlc(NGSP) in healthy adults with good functional status is 7% to 9%.