OBJECTIVES: Diabetes represents a huge healthcare challenge for India.  Estimates suggest that there are over 61 million people living with diabetes in India (prevalence of 9.2% in adults), and diabetes caused approximately 983,000 deaths in 2011.  The aim of this study was to evaluate the benefits in long-term clinical and cost outcomes associated with improving glycemic control in type 2 diabetes patients in India. METHODS: Cohort characteristics were based on Indian patients in A1chieve, a global, observational, prospective study of insulin analogs in daily clinical practice.  At baseline, patients had a mean (standard deviation) age of 51.8 (10.1) years, duration of diabetes of 6 (4.6) years and glycated hemoglobin (HbA1c) of 8.3% (1.4%).  A published and validated model of type 2 diabetes (CORE Diabetes Model) was used to make long-term projections of clinical outcomes and direct costs (2011 Indian Rupees [INR], converted to Euros [EUR] at INR 0.015=EUR 1).  Future costs and clinical benefits were discounted at 3% annually. RESULTS: Over a 35-year time horizon, reducing HbA1c by 1% was projected to improve mean life expectancy by 0.64 years (10.95 versus 11.59 years) and quality-adjusted life expectancy by 0.53 QALYs (7.36 versus 7.89 QALYs).  Benefits were driven by lower complication rates with improved glycemic control.  End-stage complications such as myocardial infarction, end-stage renal disease, severe vision loss and lower limb amputation were reduced by 4%, 46%, 33% and 3%, respectively (relative risk).  Direct costs were reduced by INR 33,443 (EUR 502) due to complications avoided control (INR 256,101 [EUR 3,842] versus INR 222,659 [EUR 3,340]). CONCLUSIONS: HbA1c levels are above guideline targets in India.  Improving glycemic control is likely to substantially lower the risk of complications, improve survival and reduce complication costs.  Cost-effectiveness analyses of interventions/management programs designed to improve glycemic control are merited for the Indian setting.