Management of type-2 diabetes (T2D) should be individualised given recent increase in treatment options. There is a spectrum of phenotype of T2D from thinner patients who may be more insulin deficient to those who are overweight/obese and insulin resistant. We hypothesized that, if we are personalising treatment, thinner patients would be more likely to be treated with insulin secretagogues. To compare the management between these phenotypes, we reviewed 1007 patients with T2D consecutively attending for annual review. Patients were divided into quartiles by body mass index and those in the lowest (n=252, age 63±13 years) and highest (n=252, age 60±12) quartiles were compared (data are mean±S.D. P=0.001 for comparison of age). Phenotypic and biochemical data were compared using t tests and proportions on different treatments were compared using χ2 test. Systolic blood pressure, total and LDL cholesterol and eGFR, calculated using the MDRD equation, were not different between the groups. The mean BMI in the lowest quartile was 25.1±2 kg/m2 compared to 40.2±5 kg/m2 in the highest quartile, P<0.001). Mean HbA1c was 54±15 mmol/mol in the lowest quartile compared to 59±19 mmol/mol in the highest, P=0.001. In the lowest quartile, 14% of patients were on insulin, 28% on sulfonylureas and 71% on metformin, compared to 25, 37 and 81% in the highest quartile, respectively, P<0.05 in each case. More patients in the highest quartile were on GLP-1 agonists (13% vs 2% in the lowest quartile) but DPP4 inhibitors use was similar. In summary, thinner patients were slightly older and had slightly better glycemic control, despite less aggressive glycemia management. We believe that this reflects a different underlying pathophysiology of diabetes between these phenotypes and highlights the need for a personalised approach to T2D management.