OBJECTIVES: Based on diabetes guidance from NICE (UK) and the German Diabetes Association (DDG) on treatment targets virtual type 2 diabetes patient cohorts were simulated over 10 years using the EAGLE model. Development of long-term complications and associated costs of both guidance were compared from a German perspective. METHODS: The Economic Assessment of Glycemic Control and Longterm Effects (EAGLE) model provides micro-simulations of virtual patients in 1-year cycles. Outcomes presented as cumulative incidence include micro- and macrovascular complications and death. Subsequent cost calculations are constructed from the results. Main factors driving the development of complications are HbA1c, blood pressure, lipids, age, diabetes duration and treatment. Baseline characteristics of each cohort (1000 patients) were: age 64±11 years, diabetes duration 10±8 years, 49% male, hypertension prevalence 80%, mean HbA1c 7.7±1.8%, HDL 1.11 mmol/l, LDL 3.84 mmol/l. For comparison a) HbA1c treatment targets of 7.0% (UK) and 6.4% (DDG) were simulated. For comparison b) additionally control of LDL, HDL and blood pressure was simulated according the two guidelines. All cost data were provided by CoDiM study. Long-term outcomes, risk reductions and costs were compared from the German perspective. RESULTS: More strict glycemic, blood pressure and lipid control according to the DDG guidance reduces longterm complications substantially compared to the UK guidance: incidences for proliferative retinopathy, ESRD and MI were lower by 14%, 23% and 11%. Accordingly, associated cost savings were 26T€, 366T€ and 148T€ following the DDG guidance. Savings in the treatment of complications amount to 965 T€. Inclusion of diabetes treatment cost results in overall savings of 186 T€. CONCLUSION: Guidance for diabetes treatment vary between EU-countries. The simulation analyses from the German perspective demonstrated that preferably a more stingent guidance should be applied with respect to long-term outcomes and costs.