Type 2 diabetes is a complex and heterogeneous metabolic disorder with a continuously growing prevalence worldwide. Thus, the need to prevent diabetic complications by maintaining better metabolic control has become a common goal for health practitioners. Elevated fasting plasma glucose concentrations, frequently observed in Type 2 diabetic patients, are a marker for disturbances in glucose control which can lead to subsequent complications. However, such levels may be considered an incomplete index of glucose control in light of the fact that mealtime glucose excursions are also responsible for overall glucose control. Recently, studies have underlined the fact that plasma glucose fluctuations, such as those occurring in an absorptive state, may not only be an important determinant of overall glucose control and risk of diabetic complications, but they may also exert an independent negative effect on the long-term outcome of diabetes. Many mechanisms have been described by which mealtime glucose excursion could pose a potential risk factor for cardiovascular disease in diabetic patients. Acute elevations of plasma glucose concentrations trigger an array of tissue response that may contribute to the development of vascular complications. Therefore, we will discuss how post-prandial glucose excursions are a fundamental risk factor for the development of cardiovascular disease, especially in older persons with Type 2 diabetes.