OBJECTIVES: Diabetes mellitus type 2 is a chronic disease, with many issues both in terms of pathophysiology and therapy; its incidence is steadily increasing, in line with the increase of the aging population. For this reason, diabetes could be considered an emergency also for its economic burden.  METHODS: We performed a cost minimization analysis to evaluate the impact of different treatments on patients with type 2 diabetes, kidney failure, on dialysis, from moderate to severe stage, who failed  monotherapy with metformin. We considered direct and indirect costs: the resources consumed in providing facilities and those used to counter the negative effects of the different treatments, and production losses of patients.  RESULTS: We compared the following hypoglycemic molecules: Pioglitazone (15, 30), Repaglinide (0.5, 1, 2), Vildagliptin50 and Linagliptin5. Regarding insulin therapy, we consider the following classifications: Insulins human, Basal analogs and Fast analogs. An analysis of the direct medical costs of treatment and loss of production shows an average annual cost per patient treated with insulin between € 1,005.63 - € 1,098.34, with differentials cost vs. other hypoglycemic strategies between € 174 and € 203. The cost for the management of hypoglycemia is greatest with the insulin treatment but with a limited impact on the total cost of health care and treatment. The loss of working days due to treatment and to hypoglycemic episodes have a considerable impact (71% of the total cost). The total cost related to a treatment with of Vildagliptin is in line with that of other strategies. Furthermore Vildagliptin has a lower economic impact, if taken into account indirect costs.   CONCLUSIONS: The cost analysis of therapy applied to diabetes demonstrates that the use of Vildagliptin represents a choice, that is economically favorable if we consider the whole diabetic population costs, including renal insufficiency patients.