A Study of Insulin Efsitora Alfa (LY3209590) Compared to Degludec in Adults With Type 2 Diabetes Who Are Starting Basal Insulin for the First Time

Prior treatment

• Have a history of greater than (\>) 1 episode of ketoacidosis or hyperosmolar state or coma requiring hospitalization within 6 months prior to screening. Have had severe hypoglycemia episodes within 6 months prior to screening. Have a history of renal transplantation, are currently receiving renal dialysis, or have an estimated glomerular filtration rate.
• Have had New York Heart Association Class IV heart failure or any of these cardiovascular conditions within 3 months prior to screening
  • Acute myocardial infarction
  • Cerebrovascular accident (stroke), or
  • Coronary bypass surgery.
  • Have had gastric bypass (bariatric) surgery, restrictive bariatric surgery, for example Lap-Band, or sleeve gastrectomy within 1 year prior to screening
  • Have had significant weight gain or loss within 3 months prior to screening, for example, greater than or equal to (≥) 5%.

Other illness

• Have a diagnosis of Type 1 diabetes (T1D), latent autoimmune diabetes, or a specific type of diabetes other than T2D, for example, monogenic diabetes, diseases of the exocrine pancreas, or drug-induced or chemical-induced diabetes.

Lab values

• Have known hemoglobinopathy, hemolytic anemia or sickle cell anemia, or any other traits of hemoglobin abnormalities known to interfere with the measurement of HbA1c.

• Have diagnosis of Type 2 diabetes (T2D) according to the World Health Organization Criteria
• Have an Hemoglobin A1c (HbA1c) of 7.0 percent (%) - 10.5% inclusive, at screening
• Are on a stable treatment with 1 to 3 antihyperglycemic medication for at least 3 months prior to screening and willing to continue the stable treatment for the duration of the study
• These antihyperglycemic medications are accepted in the study
  • dipeptidyl peptidase-4 (DPP-4) inhibitors
  • sodium-glucose cotransporter 2 (SGLT2) inhibitors
  • biguanides, such as metformin
  • alpha-glucosidase inhibitors
  • glucagon-like peptide-1 (GLP-1) receptor agonists, oral or injectable
  • Sulfonylureas, or
  • Thiazolidinediones.
• Are insulin naïve.
  • Exceptions:
• short-term insulin treatment for a maximum of 14 days, prior to screening, and prior insulin treatment for gestational diabetes
  • Have a body mass index of less than or equal to (≤) 45 kilogram/square meter (kg/m²).