OBJECTIVES: In type 2 diabetes patients, micro- and macrovascular complications has been associated with poor glycemic control.  The progressive nature of type 2 diabetes mellitus will necessitate for most patients to intensify their therapies in order to maintain good glycemic control in the longer term.Thus the present study was aimed to evaluate the efficacy of biphasic insulin plus metformin regimen among the type 2 diabetes patients who failed to achieve glycemic control with two oral agents’ regimen. METHODS: It is prospective observational study conducted at Asir Diabetes Center from June 2013 to June 2014.The present study was approved by research ethical committee of King Khalid University. Total of 76 patients who were initiated with biphasic insulin and metformin were followed for four subsequent visits with three months interval. The glycemic control has been compared in between these follow up by estimating HbA1C, FBG and PPG level by using one way Anova, where p value <0.05 was considered significant.  RESULTS: The mean age of the present study population was found to be 54.1 years, of these most of them were males (60.5%). The mean duration of diabetes for the present study population was found to be 11.3 years. Statistically significant improvement in terms of glycemic control (HbA1c, FBG and PPG) was noted in comparison to base line and follow up visits in the patients who were on the combination of metformin and biphasic insulin  with minor hypoglycemic events (23.7%).  CONCLUSIONS: Biphasic insulin plus metformin appears to be more effective and safe treatment regimen and a reasonable choice to initiate insulin therapy in insulin-naive subjects with type 2 diabetes who were not optimally controlled on OHA therapy.