Sulphonylureas are well established in the treatment of type 2 diabetes mellitus. They are effective in improving glycaemic control and preventing microvascular complications. Side effects that can restrict use include hypoglycaemia and weight gain. Although there is no clear evidence for reduction of cardiovascular disease from randomised-controlled trials, follow-up data from the United Kingdom Prospective Diabetes Study (UKPDS) shows reduced cardiovascular risk. Concerns about sulphonylureas causing inhibition of ischaemic preconditioning are relevant in primary angioplasty, but there is a lack of clear evidence, with a need for randomised-controlled trials to investigate this further.