Type 2 Diabetes Mellitus (T2DM) and its complications are more prevalent in the elderly. As the general population worldwide is ageing, effective and safe treatment of older T2DM patients is becoming more important in clinical practice. Elderly T2DM patients should be carefully evaluated for functional, mental, geriatric and medical disorders before the initiation of antidiabetic drug therapy and regularly monitored thereafter. Treatment strategy and goals should be individualized based on patient comorbidities and drug pharmacokinetic and pharmacodynamic properties. This narrative review discusses the use of antidiabetic drugs in the elderly T2DM population.