Risk assessments are important for all patients when considering initiation of a new drug. In particular, vulnerable populations are at the highest risk, including older T2DM patients with multiple co-morbidities who often suffer higher rates of adverse medication effect. Likewise, patients diagnosed with T2DM at a younger age are likely to receive these drugs for very long duration, which heightens concerns about long term drug toxicities. Therefore, it is critical that selection of antidiabetic medications account for both short term and long term consequences.