Objective: Differences between patient-rated importance of insulin delivery system (IDS) features and patient evaluation of those features in current IDS may contribute to patient satisfaction. This study aimed to examine: 1) the importance of 12 IDS features to patients with type 2 diabetes (T2DM); 2) the discrepancies between feature importance and patient evaluation of those features in current IDS; 3) the relationship between discrepancies and IDS satisfaction. Methods: Patients with T2DM currently using insulin were administered a web-based survey including questions on demographics, insulin therapy, and a modified Insulin Injection Preference questionnaire (mIIP-q). The mIIP-q asks patients to evaluate the extent to which they agree their current IDS has each of the 12 features representing 3 components (“ease of use,” “activity interference,” and “social acceptability”). Patients were also asked to rank and rate the importance of the 12 IDS features. Discrepancy scores were calculated by subtracting the feature importance score from the feature evaluation score. Correlation and stepwise linear regression analyses were conducted to assess the relationship between discrepancy scores and IDS satisfaction. Results: A total of 681 patients (48% male, mean age=57) participated in the survey. All IDS features in the mIIP-q were considered important (mean rating >50 on a 0-100 scale). The feature “easy to control blood sugar” showed the highest discrepancy score, followed by all “activity interference” features (P<.01). Discrepancy scores for all 12 features were associated with IDS satisfaction (P<.01), but only discrepancy scores for “easy to control blood sugar,” “reduces my reluctance to use insulin,” “easy to get insulin dose needed,” and “convenient to use” were significant predictors of IDS satisfaction, as were HbA1C and health status (R2=0.31; P<0.05). Conclusion: IDS features are important to patients with T2DM; therefore resolving discrepancies between feature importance and patient evaluation of IDS features may improve patient satisfaction and facilitate diabetes management.