Older adults with diabetes constitute a rapidly increasing population in the United States. Cardiovascular diseases occur at higher frequency in this population. Until recently, optimal goals of glycemic control as well as risk factor management (hypertension and lipids) to prevent cardiovascular morbidity and mortality in older adults with diabetes were unclear. Several clinical trials in recent years have shown minimal benefits and in certain populations (e.g. with high co-morbidities), increased risk for poor cardiovascular outcomes with tight glycemic and blood pressure control. Further analysis of these data has suggested that cardiovascular benefits are likely to be present in younger and healthier cohort. Thus management of chronic diseases in older adults with diabetes begs for moderation and individualized planning to gain benefits and avoid harm.