OBJECTIVES: To assess the predictors for the initiation of a basal supported oral therapy (BOT) in type 2 diabetics (T2D) under real-life conditions in Germany.  METHODS: This historical cohort study included T2D who started an oral antidiabetic drug (OAD) treatment between January 1995 and June 2006 and whose records were eligible at least 12 months before and 36 months after OAD initiation. Data were extracted from a representative real-life database (IMS® Disease Analyzer). BOT initiation was defined according to the ATC code of the European Pharmaceutical Market Research Association, with A10C2 (NPH insulin) and A10C5 (long-acting insulin analogues) prescribed additionally to OADs. The time-dependent rate of T2D starting BOT was calculated by use of the Kaplan-Meier method. Uni- and multivariate Cox regression analyses were applied to identify predictive associated factors. RESULTS: A total of 9028 T2D on initial OAD therapy were included, of whom 1450 patients have been switched to BOT during the observational period. The probability of BOT initiation was associated with poor metabolic control, midlife age and OAD therapy before insulinization. The combined Cox regression analysis identified three groups of particular importance: group I (hazard ratio [HR]=2.72; p<0.001): HbA1c>8%, age 51 – 60 years, and sulfonylurea (SU), alpha-glucosidase inhibitor (AGI) or glinide (GLI) as last OAD prescribed, group II (HR=2.62; p=0.032): HbA1c>8%, age≤50 and pre-treatment with at least three OADs, and group III (HR=2.10; p=0.019): HbA1c>8%, pre-treatment with a combination of at least three OADs and SU, AGI or GLI as last OAD prescribed. The HbA1c threshold of 7.5% led to comparable results, although only group I reached significance. CONCLUSIONS: The probability of BOT initiation for T2D under real-life conditions in Germany was associated with poor metabolic control, midlife age and pre-treatment with SU, AGI or GLI. This knowledge may help to identify patients who might benefit from an early initiation of BOT.