OBJECTIVES: We evaluated treatment patterns, hypoglycemic events, glycemic control  and medical costs for patients >60y with type 2 diabetes mellitus (T2DM) newly initiating treatment on exenatide BID (ExBID) or insulin glargine (IG). METHODS: Medical, pharmacy and lab data for commercial and Medicare Advantage enrollees were obtained from administrative claims from a large, national health plan. Subjects were identified from May 2005 to Dec 2008 with 6-mo baseline and 12-mo follow-up periods. Subjects with any insulin treatment during baseline were excluded. Propensity score (PS) matching (1:1) of ExBID and IG subjects was used to create balanced cohorts. Logistic regression models were used to analyze medication adherence (Medication Possession Ratio (MPR) >=80%), therapy persistence (gap of 60 days in treatment = discontinuation), any acute hypoglycemic event, and glycemic control (follow-up A1C levels of <7%). RESULTS: The final matched study sample included 3,263 subjects per cohort; average age was 65y (SD 4.9); 48% were female; 83% were enrolled in a commercial health plan. In the follow-up period, ExBID patients experienced significantly fewer hypoglycemic events compared to IG patients (15 vs. 40, p<0.001). Subjects in the ExBID cohort were also more likely to obtain an MPR>=80% (Odds Ratio (OR) =1.93, CL 1.72-2.17), less likely to discontinue therapy (OR=0.28, CL 0.25-0.31) and less likely to have any acute hypoglycemic event (OR=0.48, CL 0.26-0.88) during the follow-up period. For those with valid A1C levels in both baseline and follow-up periods (N=669; ExBID=359, IG=310), ExBID subjects were more likely to achieve A1C <7% (OR=1.62, CL 1.11-2.35) compared to IG subjects. Associated medical costs were similar for both groups. Results were comparable for patients > 65y. CONCLUSIONS: Older ExBID subjects were more likely to adhere to therapy and achieve A1C <7% and less likely to discontinue therapy or experience any acute hypoglycemic event than older IG subjects.