OBJECTIVES: Describe, in usual care, health care resource utilization and costs associated before and during the first 6 months of insulin therapy in patients with type 2 diabetes (T2D). METHODS: Pan-european observational study. Here results for France are reported. The direct costs of diabetes care include costs of visits to healthcare professionals, antidiabetic medications, glucose testing and hospitalizations linked to diabetes. Costs were calculated by collecting individual resource use and assigning local units costs (2006). RESULTS: Of the 177 T2D patients initiated with insulin, 152 (85.9%) patients were followed to 6 months. Enrolled patients (male 57%) had mean age of 64.8 years ± 11.3 (SD) and mean BMI of 29.4 kg/m2 ± 6.2 (SD). They had been diagnosed with diabetes 13.0 ± 8.1 (SD) years ago and had a mean HbA1C at insulin initiation of 9.6% ± 1.9 (SD).Long/intermediate insulin only was the most common therapy initiated (80.8% of patients). 50.3% of patients were hospitalized for insulin initiation.At 6 months 86.2% of patients were taking oral antidiabetics; metformine and sulfamide (31.6%), metformine only (14.5%) or sulfamide only (13.2%). During the 6 month follow up, 81.6% of patients visited a general practitioner, 71.1% a diabetologist and 14.5% had a hospital admission due to diabetes (median stay  = 3.0 days).The median number of visits to diabetologists was 1 in the 6 months prior to insulin initiation and 2 in the 6 months following initiation, the median costs of diabetes specific specialist care increased from 41 € to 83 €.Median total costs (interquartile range) for the 6 months prior to as well as after insulin initiation were €647 (421-1373) and €805 (579-1213), respectively. CONCLUSIONS: Half of the patients were hospitalized for insulin initiation.The median cost of diabetes care increased in the 6 months following insulin initiation.