This is a single arm, prospective, real-world interventional study evaluating the efficacy and safety of Imeglimin 500 mg twice daily as an add-on therapy in South Indian patients with uncontrolled type 2 diabetes mellitus (T2DM), despite being on a stable oral antidiabetic regimen. Participants with HbA1c greater than 7.5% will be enrolled. Mitochondrial dysfunction is a key contributor to both impaired insulin secretion and insulin resistance in T2DM. Imeglimin acts by improving mitochondrial bioenergetics, enhancing ATP production in pancreatic beta cells to restore glucose stimulated insulin secretion. Additionally, it improves insulin sensitivity in peripheral tissues, thereby addressing both core defects of T2DM. With a favorable safety and tolerability profile and limited data in South Indian populations, this study aims to generate real-world evidence on its effectiveness and safety. The primary endpoint is change in HbA1c at 3 and 6 months. Secondary endpoints include changes in fasting and postprandial glucose levels, weight, BMI, lipid profile, tolerability, and adverse drug reactions (assessed using the Naranjo scale). The study will be conducted at a tertiary care hospital in South India, with drug and laboratory support provided by Sans Labs LLP.