Glycemic Treatment Research Articles

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Virtual clinic for young people with type 1 diabetes: a randomised wait-list controlled study

BackgroundThe transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1.Methods79 participants with type 1 diabetes aged 18–25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months.ResultsBaseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life.ConclusionsThe implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management.Trial registrationISRCTN number: 73,435,627 (registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627. The performance and results of this trial adhere to the guidelines outlined in the CONSORT 2010 (Consolidated Standards of Reporting Trials) recommendations.

Association between glycemic control and patient-reported outcomes in adults with type 1 diabetes in Japan: the SAGE study subanalysis.

Psychosocial aspects and the quality of life (QOL) of individuals with diabetes are important for achieving glycemic control and treatment goals. Here, we describe patient-reported outcomes (PROs) of Japanese adults with type 1 diabetes (T1D) and evaluate the association thereof with glycemic control. This subanalysis of a subgroup of 528 Japanese participants in the SAGE study of adults with T1D used data on glycosylated hemoglobin (HbA1c) and PRO scores [Hypoglycemia Fear Survey-II (HFS-II), Problem Areas In Diabetes (PAID), Insulin Treatment Satisfaction Questionnaire (ITSQ), and Audit of Diabetes-Dependent QOL (ADDQoL)] and summarized the score by the predefined age groups (26-44-years: n = 208, 45-64-years: n = 217, and ≥ 65-years: n = 103). The association between PROs, achieving HbA1c < 7.0%, and individualized targets was explored using multivariate logistic regression analysis. The HFS-II and PAID scores were lower, and the ITSQ score was higher in the ≥ 65-years group than in the younger groups with a linear trend of better scores with increasing age (P for trend < 0.05). ADDQoL scores were similar across the age groups, and present QOL (ADDQoL subscale) tended to improve with age (P for trend < 0.05). Achieving HbA1c < 7.0% and individualized targets were associated with satisfaction with insulin treatment regarding glycemic control. In Japanese adults with T1D, the impact on psychosocial aspects and QOL varied across age groups, with a trend of improving scores with age, potentially in relation to the less stringent glycemic control targets adopted in older individuals. Glycemic control was significantly associated with treatment satisfaction. The online version contains supplementary material available at 10.1007/s13340-023-00668-4.

Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty

AimThis work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. MethodsThis cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. ResultsA total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12–1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. ConclusionsPatients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.

Cost per Patient Achieving Treatment Targets and Number Needed to Treat with Tirzepatide Versus Semaglutide 1mg in Patients with Type 2 Diabetes in the United States.

Achieving glycemic control can help reduce complications of type 2 diabetes (T2D). This study compared the pharmacy cost per responder and number needed to treat (NNT) of tirzepatide 5mg, 10mg, and 15mg versus semaglutide 1mg to achieve glycemic, weight loss, and composite treatment endpoints in patients with T2D in the United States. The proportions of patients achieving glycemic, weight loss, and composite treatment endpoints were obtained from the phase 3 SURPASS-2 randomized clinical trial which compared tirzepatide 5mg, 10mg, and 15mg to semaglutide 1mg. Annual pharmacy costs were calculated using 2022 wholesale acquisition costs. Cost per responder and NNT were calculated along with 95% confidence intervals and tests for statistical significance (P ≤ 0.05). Tirzepatide had a lower cost per responder to achieve glycated hemoglobin A1c (HbA1c) endpoints of ≤ 6.5% (10mg and 15mg doses) and < 5.7% (all doses) and weight loss endpoints of ≥ 5% (10mg and 15mg doses), ≥ 10% (all doses), and ≥ 15% (all doses). The cost per responder to achieve HbA1c < 7% (all doses of tirzepatide) and ≤ 6.5% (5mg tirzepatide) were not statistically significantly different between tirzepatide and semaglutide 1mg. The cost per patient to achieve the composite endpoints (HbA1c < 7.0%, ≤ 6.5%, or < 5.7%/weight loss ≥ 10%/no hypoglycemia) was statistically significantly lower for all doses of tirzepatide than for semaglutide 1mg. The NNTs for all doses of tirzepatide were statistically significantly lower than that for semaglutide 1mg to achieve all individual and composite endpoints, with the exception of the 5mg dose for HbA1c < 7.0% and HbA1c ≤ 6.5%, where tirzepatide had numerically lower NNTs that were not statistically significant. Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) that may offer the potential to achieve stringent glycemic goals, weight loss targets, and composite treatment goals at a lower cost per responder compared to semaglutide 1mg among people with T2D.

Racial/ethnic and socioeconomic disparities in achievement of treatment goals within a clinical trial: a secondary analysis of the ACCORD trial.

Clinical trial participation should theoretically reduce barriers to care by ensuring medication and healthcare access. We aimed to evaluate disparities in achieving diabetes treatment targets by race/ethnicity and educational attainment within the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (ClinicalTrials.gov NCT00000620). The ACCORD trial included three interventions of varying participant burden: glycaemic (high burden), blood pressure (medium burden) and triglyceride-lowering (low burden). We examined adjusted odds ratios (aORs) for achievement of glycaemic targets, blood pressure targets and a ≥25% reduction in triglyceride levels (a proxy for adherence to fenofibrate therapy) in the first year, and for hypoglycaemia requiring medical assistance at any time, by treatment arm, race/ethnicity and educational attainment using multivariable models adjusted for demographics and clinical characteristics. We explored whether disparities in glycaemic goal achievement were mediated by hypoglycaemia, medication use, change in BMI or number of study visits attended. Compared with White participants, participants who identified as Black, Hispanic and Other race/ethnicity were less likely to achieve glycaemic targets (aOR [95% CI]) 0.63 [0.55,0.71], 0.73 [0.61, 0.88], 0.82 [0.71, 0.96], respectively); Black participants but not Hispanic and Other race/ethnicity participants were less likely to achieve blood pressure targets (aOR [95% CI] 0.77 [0.65, 0.90], 1.01 [0.78, 1.32], 1.01 [0.81, 1.26], respectively); and Black, Hispanic and Other race/ethnicity participants were equally or more likely to achieve triglyceride reduction (aOR [95% CI] 1.77 [1.38, 2.28], 1.34 [0.98, 1.84], 1.43 [1.10, 1.85], respectively). Differences in goal achievement by educational attainment were generally not significant after adjusting for baseline characteristics. Rates of hypoglycaemia requiring medical assistance were highest among Black individuals and those with lower educational attainment. Associations between race/ethnicity and glycaemic control were partially mediated by differences in insulin dosing and oral medication use. Racially/ethnically minoritised participants in the ACCORD trial were less likely to achieve high-burden (glycaemic) treatment goals but were generally similarly likely to achieve goals of less intensive interventions. Differences in glycaemic treatment goal achievement were partially mediated by differences in medication use but not mediated by hypoglycaemia, change in BMI or study visit attendance.

Diabetes and pregnancy study (DAPSY): a 10-year single-center cohort study of pregnancies affected by diabetes.

The aim of our study was to investigate to what degree clinical characteristics can contribute to incidence and structure of pregnancy and childbirth complications in women with diabetes, and to reveal key risk factors for adverse outcomes. We conducted a retrospective single-center cohort study from January 2008 through December 2017, including 3069 singleton pregnancies, affected by type 1 diabetes (T1D, n = 498), type 2 diabetes (T2D, n = 214), and gestational diabetes mellitus (GDM, n = 2357). More than 10years duration of T1D associated with increased risk for preterm birth (RR 2.03, 95% CI 1.28-3.20) and preeclampsia (RR 1.57, 95% CI 1.09-2.26). Diabetic nephropathy, same as diabetic proliferative retinopathy, was associated with increased risk of C-section, preeclampsia development, SGA delivery. In patients with T1D who received CSII (12%), we do not report superior outcomes compared to MDI. Pre-pregnancy HbA1c level less than 6.5% reduced the risk of preeclampsia for T1D (RR 0.28, 95% CI 0.19-0.67) and risk of LGA birth for T2D (RR 0.43, 95% CI 0.19-0.92). Achieving glycemic target values by full-term pregnancy reduced the risk of excessive fetal adiposity (RR 0.81 for T1D, RR 0.39 for T2D). For T2D and GDM, the leading risk factors were obesity and chronic hypertension. For patients with GDM, insulin administration and early diagnosis of GDM were the significant risk factors for adverse outcomes. Diabetes during pregnancy is challenging for the clinician, but optimizing glycemic control, treatment regimens, and close attention to comorbidities can help to reduce the risks and ensure appropriate quality diabetes management.

The Impact of Pigment-Epithelium-Derived Factor on MCF-7 Cell Metabolism in the Context of Glycaemic Condition.

Studies have demonstrated that pigment-epithelium-derived factor (PEDF) is a robust inhibitor of tumour growth and development, implying that this may serve as a promising target for therapeutic intervention. However, the precise impact of PEDF on cancerous cell metabolic pathways remains uncertain despite ongoing research. In this light, this study aimed to employ a metabolomics approach for understanding the metabolic reprogramming events in breast cancer across different glycaemic loads and their response to PEDF. Gas chromatography-quadrupole mass spectrometry (GC/Q-MS) analysis revealed metabolic alterations in ER+ human cell line MCF-7 cells treated with PEDF under varying glycaemic conditions. The identification of significantly altered metabolites was accomplished through MetaboAnalyst (v.5.0) and R packages, which enabled both multivariate and univariate analyses. Out of the 48 metabolites identified, 14 were chosen based on their significant alterations in MCF-7 cells under different glycaemic conditions and PEDF treatment (p < 0.05, VIP > 0.8). Dysregulation in pathways associated with amino acid metabolism, intermediates of the TCA cycle, nucleotide metabolism, and lipid metabolism were detected, and they exhibited different responses to PEDF. Our results suggest that PEDF has a diverse influence on the metabolism of MCF-7 cells in both normo- and hyperglycaemic environments, thereby warranting studies using patient samples to correlate our findings with clinical response in the future.

Progress in the Study of Glycosylated Haemoglobin Variability Index in Relation to Chronic Complications of Diabetes Mellitus

Diabetes mellitus (DM) is a common endocrine disease that can cause damage to tissues and organs throughout the body. Glycosylated haemoglobin (HbA1c) is considered to be the gold standard for assessing glycaemic control and treatment outcomes in patients with diabetes, but there is individual variability that affects the accurate interpretation of blood glucose. The glycosylated haemoglobin variability index (HGI) is a measure of individual variability in HbA1c and can be used in the management and treatment of patients with DM. In this paper, the relationship between HGI and chronic complications of DM is reviewed and discussed, with the aim of providing a more individualized and accurate reference for clinical management of blood glucose and risk assessment of chronic complications in DM patients, reducing and delaying the occurrence of chronic complications of diabetes and improving the quality of life of DM patients.

Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review.

The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.

Impact of Intensive Glycemic Treatment on Diabetes Complications-A Systematic Review.

Diabetes complications can be related to the long duration of the disease or chronic hyperglycemia. The follow-up of diabetic patients is based on the control of chronic hyperglycemia, although this correction, if obtained rapidly in people living with severe chronic hyperglycemia, can paradoxically interfere with the disease or even induce complications. We reviewed the literature describing the impact of the rapid and intense treatment of hyperglycemia on diabetic complications. The literature review showed that worsening complications occurred significantly in diabetic microangiopathy with the onset of specific neuropathy induced by the correction of diabetes. The results for macroangiopathy were somewhat mixed with the intensive and rapid correction of chronic hyperglycemia having a neutral impact on stroke and myocardial infarction but a significant increase in cardiovascular mortality. The management of diabetes has now entered a new era with new therapeutic molecules, such as gliflozin for patients living with type 2 diabetes, or hybrid insulin delivery systems for patients with insulin-treated diabetes. Our manuscript provides evidence in support of these personalized and progressive algorithms for the control of chronic hyperglycemia.

Nephroprotective Properties of Antidiabetic Drugs.

Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already the presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention and treatment of CKD to slow its progression are of clinical importance. A significant nephroprotective effect of novel antidiabetic drugs, namely sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and glucagon-like peptide 1 receptor agonists (GLP1-RA), has been shown on top of their glucose-lowering effects and was confirmed in cardiovascular outcome trials. GLP1-RA mainly reduced the risk of macroalbuminuria, whereas SGLT2-I were also associated with a lower risk of declining glomerular filtration rate (GFR) over time. The nephroprotective effects of SGLT2-I are also evident in people without DM. According to current guidelines, SGLT2-I and/or GLP1-RA are recommended for people with DM who have chronic kidney disease and/or increased cardiovascular risk. However, other antidiabetic drugs offer nephroprotective properties, which will also be discussed in this review.

Identification of pathogenic GCK variants in patients with common type 2 diabetes can lead to discontinuation of pharmacological treatment

BackgroundFunctionally disruptive variants in the glucokinase gene (GCK) cause a form of mild non-progressive hyperglycemia, which does not require pharmacological treatment. A substantial proportion of patients with type 2 diabetes (T2D) carry GCK variants. We aimed to investigate whether carriers of rare GCK variants diagnosed with T2D have a glycemic phenotype and treatment response consistent with GCK-diabetes. MethodsEight patients diagnosed with T2D from the Danish DD2 cohort who had previously undergone sequencing of GCK participated. Clinical examinations at baseline included an oral glucose tolerance test and continuous glucose monitoring. Carriers with a glycemic phenotype consistent with GCK-diabetes took part in a three-month treatment withdrawal. ResultsCarriers of pathogenic and likely pathogenic variants had lower median fasting glucose and C-peptide levels compared to carriers of variants of uncertain significance and benign variants (median fasting glucose: 7.3 (interquartile range: 0.4) mmol/l vs. 9.5 (1.6) mmol/l, p = 0.04; median fasting C-peptide 902 (85) pmol/l vs. 1535 (295) pmol/l, p = 0.03). Four participants who discontinued metformin treatment and one diet-treated participant were reevaluated after three months. There was no deterioration of HbA1c or fasting glucose (median baseline HbA1c: 49 (3) vs. 51 (6) mmol/mol after three months, p = 0.4; median baseline fasting glucose: 7.3 (0.4) mmol/l vs. 7.0 (0.6) mmol/l after three months, p = 0.5). Participants did not consistently fulfill best practice guidelines for GCK screening nor clinical criteria for monogenic diabetes. DiscussionCarriers of pathogenic or likely pathogenic GCK variants identified by unselected screening in T2D should be reported, as they have a glycemic phenotype and treatment response consistent with GCK-diabetes. Variants of uncertain significance should be interpreted with care. Systematic genetic screening of patients with common T2D receiving routine care can lead to the identification and precise care of patients with misclassified GCK-diabetes who are not identifiable through common genetic screening criteria.

Research progress in the application of time in range: more than a percentage.

Glucose monitoring is an important part of medical care in diabetes mellitus, which not only helps assess glycemic control and treatment safety, but also assists with treatment adjustment. With the development of continuous glucose monitoring (CGM), the use of CGM has increased rapidly. With the wealth of glucose data produced by CGM, new metrics are greatly needed to optimally evaluate glucose status and guide the treatment. One of the parameters that CGM provides, time in range (TIR), has been recognized as a key metric by the international consensus. Before the adoption of TIR in clinical practice, several issues including the minimum length of CGM use, the setting of the target range, and individualized TIR goals are summarized. Additionally, we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes. As a novel glucose metric, it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c. It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management.

COVID-19 and Pre-existing Type 2 Diabetes Mellitus: A Retrospective Observational Study From Eastern India on the Association Between Glycaemic Control and Treatment Outcomes.

Diabetes has emerged as an important risk factor for causing severe illness and death from COVID-19. There is a paucity of structured data from the Indian subcontinent on the impact that glycaemic control (both immediate and remote) has on the degree of required medical intervention and mortality among hospitalized COVID-19 patients with type 2 diabetes mellitus (T2DM). To evaluate the differences in clinical characteristics and treatment outcomes between well-controlled and poorly controlled patients with T2DM and COVID-19. This was a retrospective observational study. Data on 177 patients who were hospitalized between February 2021 and July 2021 were categorized into four groups using a cut-off admission plasma glucose of <200 mg/dLand glycated hemoglobin (HbA1c) <7.5%. Patients with poorly controlled diabetes presented at a significantly older age than the other groups. Radiological findings suggested severe lung involvement in them. As a combined group patients with HbA1c ≥7.5% required more ventilatory requirement as compared with the group having HbA1c <7.5% irrespective of admission glucose. They also required prolonged hospitalization and intensive care unit(ICU) stays as compared with the well-controlled diabetes group. In this study, within similar ranges of HbA1cadmission glucose seemed to have a numerical impact on mortality without being able to achieve statistical significance. From the current study, it can be concluded that poor glycaemic control, particularly HbA1c ≥7.5%, is an important risk factor for the development of severe COVID-19and a predictor for the requirement of more intensive treatment and adverse treatment outcomes leading to increased hospital and ICU stay.

Impact of pharmaceutical teleconsultation on glycemic control of people with type 2 diabetes mellitus in a public pharmacy in Brazil: A randomized clinical trial protocol (TelePharmaceutical Care Diabetes Trial) – TPCDT

Telepharmacy is a fundamental tool to ensure glycemic control in patients who don’t access health services. The objective of this protocol is to report the procedures of a randomized clinical trial that will evaluate the impact and economic evaluation of a pharmaceutical teleconsultation service for patients using dapagliflozin, recently incorporated by the Brazilian public health system for the treatment of type 2 diabetes (T2D). Patients aged 65 years or older, with T2D, and who withdraw dapagliflozin in a public pharmacy located in southern Brazil will be recruited. They will be electronically randomized with allocation for intervention or control group. The intervention will be conducted out through three teleconsultations, one per month, with a pharmacist. The main outcomes will be glycemic control (hemoglobin A1c) and treatment adherence. Secondary outcomes will include lipid profile, blood pressure, and body mass index, number of hospital admissions, number of emergency room visits, number of medical consultations performed, number of problems related to pharmacotherapy identified and resolved, cost related to service and quality of life. The economic evaluation will be carried out using time-driven activity-based costing. Through this research, we will be able to identify whether pharmaceutical teleconsultation services can complement face-to-face consultations to improve health outcomes in T2D patients on dapagliflozin. The study was registered in Clinical Trials (NCT05380596).

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy?

The ketogenic diet (KD) is a widely used therapeutic option for individuals with medically refractory epilepsy. As the diet's name implies, ketosis is a historically important component of the diet, but it is not well understood how important ketosis is for seizure control. The ketogenic ratio is defined as the ratio of fat to carbohydrate plus protein by weight in the diet (grams). Traditionally, the classic KD contains a 4:1 ratio, and a very high proportion of fat in the diet. The classic KD, with its high proportion of fat and limited carbohydrate intake can be restrictive for patients with epilepsy. Recently, there is experience with use of lower ketogenic ratios and less-restrictive diets such as the modified Atkins diet and the low glycemic index treatment. In this narrative review, we examine the role of ketosis and ketogenic ratios in determining the efficacy of the KD in children with epilepsy.

A Patient with Doose Syndrome Who Received Low Glycemic Index Treatment

A Patient with Doose Syndrome Who Received Low Glycemic Index Treatment

Abstract 188

Aim: To evaluate the cost of control of insulin degludec/insulin aspart (IDegAsp) in people with T2DM from ARISE study as compared to previous therapy (OADs ± previous insulins ± GLP-1 RAs) based on Indian setting. Methods: ARISE was a ~26 weeks open-label, non-interventional study (NCT04042441) including 1102 T2DM adults on any anti-hyperglycaemic treatment initiating or switching to IDegAsp based on investigator’s discretion as per local practice in 6 countries, with 185 patients from India. For this post-hoc analysis, a short-term cost of control model developed in Microsoft Excel was used to estimate the difference in yearly cost of control for IDegAsp versus other therapies from a patient payer perspective. Data from ARISE study was used with regards to the baseline cohort characteristics, treatment effects and for the proportion of patients achieving treatment targets. Drug acquisition costs based on maximum retail price in India as of October 2022 were taken into consideration, and the healthcare resource utilization costs were derived from other published literature. Results: When assessing the Indian cohort, IDegAsp was associated with lower annual cost of control than all treatments towards achieving HbA1c &lt;7% (by JOURNAL/ijeam/04.03/02223308-202212008-00188/math_188MM1/v/2022-12-23T100831Z/r/image-tiff 9,86,738), and HbA1c less than pre-defined individual treatment target (by JOURNAL/ijeam/04.03/02223308-202212008-00188/math_188MM2/v/2022-12-23T100831Z/r/image-tiff 16,75,108). The difference in yearly total costs including that of medication and healthcare resource use was lower with IDegAsp as compared to all treatment (by JOURNAL/ijeam/04.03/02223308-202212008-00188/math_188MM3/v/2022-12-23T100831Z/r/image-tiff 2955.83). The number needed to treat to bring one patient to targets of HbA1c &lt;7.0% and less than pre-defined individual treatment target was lower with IDegAsp than continuation of all baseline treatment options, 11.24 vs 23.26 &amp; 10.53 vs 31.25, respectively. Conclusion: Under Indian setting, IDegAsp was shown to be a cost-effective treatment for people with type 2 diabetes not achieving glycemic targets on other therapies in routine clinical practice.