OBJECTIVES: The likelihood of reaching A1C treatment targets using monotherapy with antihyperglycemic agents (AHAs) is low in patients (pts) with type 2 diabetes (T2DM) and moderately elevated A1C levels. AACE/ACE guidelines recommend initiating dual therapy (DT) with AHAs in untreated pts with an A1C 7.6 – 9.0%. This analysis was to estimate the proportion of treatment-naïve pts with T2DM and an A1C 7.6 – 9% who initiate AHA treatment with DT and associated pt-related factors. METHODS: Using GE EMR database, pts included had a T2DM diagnosis from 2003 to 2010, ≥1 A1C measurement 7.6 – 9.0% (first instance = index date), continuous enrollment for ≥12 months before and ≥6 months after index date, and no AHA prescriptions in one year prior to index date. Pts receiving AHA prescriptions for DT within 30 days of index date were considered to have initiated DT at index date. Logistic regression identifies factors associated with initiating DT. RESULTS: Of the 30,501 selected pts, 8% initiated AHA DT and 36% initiated monotherapy within 30 days of the index date. After adjusting for baseline, pts with T2DM and an A1C 7.6 – 9.0% were more likely to initiate AHA DT if they had higher A1C (adjusted OR = 1.78 [95% CI: 1.61, 1.97]). Pts were less likely to be prescribed AHA DT if they were older (per 5-year OR = 0.95 [0.92, 0.97]), lived in regions outside of the South (ORs ranged from 0.44 – 0.68 for different regions compared to South), or had chronic renal disease/renal failure (OR [95% CI] = 0.46 [0.28, 0.76]). CONCLUSIONS: In summary, in a cohort of untreated pts meeting AACE/ACE guideline recommendation for initiating DT, the proportion of pts initiating DT (8%) or any AHA regimen (44%) was low. More strenuous efforts are needed to address underutilization of AHAs and appropriate use of DT.