Patient description: The patient is a 24-year-old man who has had type 1 diabetes for 11 years. He presents to the emergency room with hyperglycemia and concern for possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient reports that he is currently homeless and has lost his supply of insulin, syringes, glucometer, and glucose testing supplies. The patient states that at the time of his initial diagnosis with type 1 diabetes he was hospitalized with a glucose value >1000 mg/dL. At the time, he was experiencing polyuria, polydipsia, and polyphagia. He reports that he has been on insulin since the time of his diagnosis, and he has never been prescribed oral agents for diabetes management. Most recently, he has been using insulin glargine 55 units once daily, and insulin aspart sliding scale 3 times daily. The patient has had previous episodes of diabetic ketoacidosis, for which he was hospitalized. With this episode of hyperglycemia, he is not experiencing any nausea, vomiting, or abdominal discomfort, and he appears well. His lab studies showed: A1c: 11.3% Creatinine: 0.9 mg/dL with eGFR >60 mL/min Aspartate aminotransferase (AST): 17 U/L Alanine aminotransferase (ALT): 14 U/L Beta-hydroxybutyrate: 0.1 mmol/L Bicarbonate: 25 mEq/L Anion

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Diabetes Mellitus, Type 2 Have type 2 diabetes mellitus based on the World Health Organization (WHO) classification Had diabetes ≥1 year Have a hemoglobin A1c (HbA1c) value ≥7.0% and <12.0% at screening Have a body mass index (BMI) ≤45.0 kilograms per square meter (kg/m^2) Participants on any glucose lowering regimen that contains at least 1 daily insulin injection This criterion applies ONLY to women of childbearing potential Are not breastfeeding Test negative for pregnancy at screening and randomization Do not intend to become pregnant during the study Have practiced a reliable method of birth control for at least 6 weeks prior to screening  Continuous subcutaneous insulin infusion therapy prior to screening Are using twice daily insulin glargine prior to screening Excessive insulin resistance defined as having received a daily dose of insulin ≥2.0 units per kilogram (units/kg) at the time of pre-randomization Glucagon-like peptide-1 (GLP-1) receptor agonist (eg, exenatide, exenatide once weekly, or liraglutide), thiazolidinedione (rosiglitazone, pioglitazone), or pramlintide, used concurrently or within 90 days prior to screening Are using niacin preparations as a lipid-lowering medication and/or bile acid sequestrants within 90 days prior to screening; or, are using lipid-lowering medication at a dose that has not been stable for ≥90 days prior to screening Have fasting hypertriglyceridemia (defined as >4.5 millimoles per liter [mmol/L], >400 milligrams per deciliter [mg/dL]) at screening Are currently taking, or have taken within the 90 days preceding screening, prescription or over-the-counter medications for weight loss Have had any episode of severe hypoglycemia (defined as requiring assistance due to neurologically disabling hypoglycemia) within 6 months prior to entry into the study Have had 2 or more emergency room visits or hospitalizations due to poor glucose control within the 6 months prior to screening Have had 1 or more episodes of ketoacidosis or hyperosmolar state/coma requiring hospitalization within 6 months prior to screening