Glucose control remains the cornerstone of therapeutic strategies designed to reduce the risk of long-term complications in patients with type 2 diabetes. This article reviews a growing body of evidence suggesting that post-mealtime glucose spikes may exert an independent effect on diabetic complications, and discusses how a more effective strategy requires better focus on the regulation of mealtime glucose. New treatment options, specifically designed to restore a more physiological post-mealtime insulin profile, may provide better tools to ensure more comprehensive glycaemic control, which will allow for better prevention of micro- and macrovascular complications in type 2 diabetic patients.