OBJECTIVES: To evaluate and compare the total costs relevant to diabetes care in patients with type 2 diabetes mellitus (T2D) treated with either Insulin glargine- or conventional basal insulin (NPH) -based therapies from the perspective of the German statutory health insurance (SHI). METHODS: LIVE-SPP (Long acting Insulin glargine Versus NPH Cost Evaluation in SPecialised Practices) Study is a naturalistic, retrolective, multicenter study of adult patients with T2D. Costs were evaluated from the German SHI perspective in 2005. Average total costs per patient for Insulin glargine-based vs. NPH-based therapies were compared over the 20-month period using multivariate general linear modelling (GLM). Potential confounders tested were age, gender, BMI, HbA1c, FBG, duration of diabetes, duration of insulin pre-treatment, and number of diabetic complications at baseline. Sensitivity analyses were performed by varying the main cost factors by ±25%. RESULTS: Patients (n=1024, 512 patients per cohort) were on average 62 years old, with an average BMI of 30.5 kg/m2. Average duration of diabetes history at study start was eight years with an average duration of insulin pre-treatment of seven months.The average unadjusted total costs per patient from the SHI perspective per 20-month period were €3114.02 [95% CI 2907.12-3320.93] for Insulin glargine-based vs. €3439.54 [95% CI 3204.85-3674.23] for NPH-based therapies. The major cost drivers for both cohorts were insulin utilization, physician visits and blood glucose monitoring. Average adjusted total costs per patient were statistically different between Insulin glargine-based (€2068.55) and NPH-based therapies (€2679.77), 20-month period, p=0.0004, resulting in adjusted savings of €611.22 in favor of Insulin glargine based therapies. The economic advantage for Insulin glargine -based therapies remained stable in sensitivity analyses. CONCLUSIONS: LIVE-SPP cost analyses indicate that Insulin glargine-based therapies offer an economic advantage over NPH-based therapies, resulting in potential cost savings.