Tehran University of Medical Sciences Journal of Pharmacoeconomics and Pharmaceutical Management 2383-4498 11 2 2025 11 07 1 6 EN MANJU C S https://orcid.org/0000-0003-0292-869X Greeshma Gireesh College of Pharmaceutical Sciences, Government Medical College, Kozhikode Hasna A Govt Medical College, Kozhikode, affiliated to Kerala University of Health Sciences, India 2025 06 15 2025 10 20 Diabetes is a major lifestyle disorder and its prevalence is increasing with a huge economic burden to countries. Patients with Type 2 diabetes suffers a lot of vascular complications and die earlier with cardiovascular diseases. Proper glycemic control is needed to prevent the development of these complications. Glimepiride is a second-generation sulphonyl urea with better safety and efficacy is commonly prescribed comparing to other drugs of that class. teneligliptin is relatively newer dipeptidyl peptidase inhibitor with proven clinic with metformin. More cost-effective treatment option is important in case of people with poor economic background for better adherence and thereby preventing complications and economic burden. A comparative evaluation of these combination based on cost effectiveness analysis will help to prioritize resource allocation. A prospective observation study in a tertiary care hospital and further cost effectiveness analysis revealed that glimepiride metformin combination shown better effectiveness in terms of both FBS and PPBS reduction. Teneligliptin and metformin therapy shown satisfactory reduction in blood glucose levels, but is much costlier. Compared to teneligliptin, glimepiride is a better choice as an add on drug in the absence of any contraindication in patients who are highly concerned about cost, to reduce economic burden and to improve adherence, when used as an initial combination in patients with Type 2 diabetes mellitus. https://jppm.tums.ac.ir/index.php/jppm/article/view/230