OBJECTIVES: Previous studies have investigated changes in risk factor (RF) variables on cost and outcomes in the IMS-CORE-Diabetes-Model (CDM) using UKPDS-68 (UK-68-RE) and UKPDS-82 risk equations (UK-82-RE). The objective of this study was to project health benefits and total lifetime costs (TLC) associated with a range of selected RF changes utilizing UK-68-RE versus recently implemented RE within the CDM: the Swedish-National-Diabetes-Registry (S-NDR) and the ADVANCE-Risk-Engine (ARE). METHODS: The CDM was applied to project the lifetime benefits (life years (LYs), quality adjusted life years (QALYs)) and TLC ($US) associated with baseline RF changes for HbA1c (+/-1%), body-mass-index (BMI) (+/-1 Kg/m), systolic-blood-pressure (SBP) (+/-20 mmHg), total-cholesterol (TC) (+/-10 mg/dl), (high-density-lipoprotein (HDL) (+/-5 mg/dl) and low-density-lipoprotein (LDL) (+/-10 mg/dl). An intermediate risk type-2 diabetes cohort (age 52 years, HbA1c 8%, SBP 140 mm-Hg, BMI 30 Kg/m2, HDL 50 mg/dl and LDL 150 mg/dl) was projected over lifetime to explore the sensitivity of discounted (3%) LYs, QALYs and TLC per unit RF variation. RESULTS: When UK-68-RE were applied, projected changes in LYs were: 0.096, 0.045, 0.013, 0.071, -0.183 and 0.0 and QALYS: 0.156, 0.067, 0.065, 0.051, -0.121 and 0.0 for RF variations in HbA1c, SBP, BMI, TC, HDL and LDL, respectively. This compared to changes of 0.103, 0.032, 0.004, 0.070, -0.195, 0.044 (LYs) and 0.150, 0.049, 0.054, 0.050, -0.132, 0.025 (QALYs) utilizing S-NDR-RE and 0.103, 0.030, 0.001, 0.065, -0.093, 0.0 (LYs) and 0.163, 0.057, 0.056, 0.048, -0.062, 0.0 (QALYs) utilizing ARE-RE. TLC decreased by $3'479, $1'065, $69, -$414, $1'263, $0, (UK-68-RE); $2'829, $852, $81, -$289, $910, -$347 (S-NDR-RE ) and $3'488, $1'196, -$10, -$182, $694, $0 (ARE-RE) for RF variations in HbA1c, SBP, BMI, TC, HDL and LDL, respectively. CONCLUSIONS: The degree to which RF changes are translated into benefits and costs may change considerably dependent on the choice of selected risk equations.