Abstract Following the rosiglitazone controversy there is a requirement from the licensing agencies that new antidiabetic drugs must be shown not to increase cardiovascular risk during phase 3 development. This includes studying patients with high cardiovascular risk, who were previously excluded from phase 3 studies. All of the currently available dipeptidyl peptidase (DPP)‐4 inhibitors (sitagliptin, vildagliptin, saxagliptin, linagliptin) have satisfied these safety criteria, with the suggestion that there might be some cardiovascular benefit with this class. Large randomised‐controlled trials are ongoing to assess safety as well as potential benefit. The results of these randomised‐controlled trials will influence the long‐term use of DPP‐4 inhibitors and their place in treatment guidelines. Copyright © 2013 John Wiley & Sons.