The patient is a 73-year-old male with type 2 diabetes (T2D) and hypertension, treated for years with various oral hypoglycemic agents (OHAs) and an anti-hypertensive agent (AHA). His HbA1c levels were unstable during 2020-2022, during which time he was prescribed linagliptin, voglibose, and metformin. In 2023, his HbA1c increased to 8.4%, and imeglimin (Twymeeg) was initiated. This resulted in an acute reduction of HbA1c to 6.5% over 5 months. A pulse wave velocity (PWV) examination, using a sphygmograph, showed stable values for the cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) over 4 years. Consequently, this patient has maintained a low level of arteriosclerosis, associated with the effective treatment using imeglimin.