OBJECTIVES: We aimed to (1) describe the real-world treatment of UTIs in a T2DM population, (2) investigate UTI related healthcare resource use, (3) assess treatment costs associated with UTI, and (4) identify factors which may predict UTI-related treatment costs. METHODS: We analysed an anonymized dataset from a regional German healthcare fund (AOK PLUS) including all continuously insured T2DM-prevalent patients from 2010-2012. Health care resource use was reported per UTI episode. A UTI episode was identified through coded outpatient/inpatient UTI diagnoses (ICD-10 N39.0) and, in case of recurrent diagnoses, prescribed antibiotics for UTI treatment. RESULTS: A total of 456,586 T2DM patients (mean age of 73.8 years, 56.3% female, mean CCI of 7.3, mean observational period of 665.5 days) was included. We identified 48,337 UTI episodes. During an observed UTI episode, patients visited with a median/mean of 1.0/0.8 times a GP and 0.0/0.3 times an urologist. In 6.7% of the cases, an inpatient treatment was caused by a UTI with a median/mean length of stay of 7.0/8.7 days. In 74.8% of the observed UTI episodes, antibiotics labelled for this disease were prescribed (mean prescribed DDD 10.5 days). Mean/median costs directly associated with UTI treatment (bottom-up costs) were 315.90€/102.28€ per UTI episode. Factors significantly increasing UTI-related direct bottom costs were age, female gender, worse CKD status (5/5), CCI, and at least one previous UTI infection in the reference period. In an additional top-down cost analysis, annual all-cause cost per patient year were 5,519 € higher in the UTI group compared to T2DM patients not having experienced an UTI. This translated into a UTI-related marginal cost-increasing effect of 3,916€ per patient year in a multivariable Gamma regression analysis.  CONCLUSIONS: Given that worldwide increasing prevalence of T2DM, the incidence of UTI infection in T2DM represents substantial resource use/cost burden for healthcare systems.