Background and purpose: The imidazoline-type a 2 -adrenoceptor antagonists (±)-efaroxan and phentolamine increase insulin secretion and reduce blood glucose levels. It is not known whether they act by antagonizing pancreatic b-cell a 2 -adrenoceptors or by a 2 -adrenoceptor-independent mechanisms. Many imidazolines inhibit the pancreatic b-cell K ATP channel, which is the molecular target of sulphonylurea drugs used in the treatment of type II diabetes. To investigate the mechanisms of action of (±)-efaroxan and phentolamine, a 2A -adrenoceptor knockout (a 2A -KO) mice were used. Experimental approach: Effects of ( ± )-efaroxan, 5 mg kg À1 , and phentolamine, 1 mg kg À1 , on blood glucose and insulin levels were compared with those of the non-imidazoline a 2 -adrenoceptor antagonist [8aR,12aS,13aS]-5,8,8a,9,10,11, 12,12a,13,13a-decahydro-3-methoxy-12-(ethylsulphonyl) , 1 mg kg À1 , and the sulphonylurea glibenclamide, in a 2A -KO and control (wild type (WT)) mice. Key results: In fed WT mice, ( ± )-efaroxan, phentolamine and RS79948-197 reduced blood glucose and increased insulin levels. Fasting abolished these effects. In fed a 2A -KO mice, (±)-efaroxan, phentolamine and RS79948-197 did not alter blood glucose or insulin levels, and in fasted a 2A -KO mice, blood glucose levels were increased. Glibenclamide, at a dose only moderately efficacious in WT mice (5 mg kg À1 ), caused severe hyperinsulinaemia and hypoglycaemia in a 2A -KO mice. This was mimicked in WT mice by co-administration of RS79948-197 with glibenclamide. Conclusions and implications: These results suggest that (±)-efaroxan and phentolamine increase insulin secretion by inhibition of b-cell a 2A -adrenoceptors, and demonstrate a critical role for a 2A -adrenoceptors in limiting sulphonylurea-induced hyperinsulinaemia and hypoglycaemia.