OBJECTIVES: To examine characteristics of patients diagnosed with type 2 diabetes mellitus (T2DM) initiated on three basal insulin regimens: long-acting basal insulins (LABI), ultra-LABI (ULABI), and LABI combined with any oral antidiabetic medications (LABI+OAD), using real-world clinical data. METHODS: This retrospective study used data (current to March 2016) from a US ambulatory electronic health records (EHR) database to identify patients ≥18 years old with International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes for T2DM who initiated ULABI (insulin glargine 300 mg or degludec; n=3,718), LABI (insulin glargine 100 mg or detemir; n=11,417), or LABI+OAD (insulin glargine 100 mg or detemir + OAD; n=4,922) ≤1 year prior to March 2016. Demographics and clinical characteristics were extracted from EHR ≤2 years prior. A multinomial logistic regression predicted ULABI and LABI+OAD vs. LABI treatment from patient characteristics and clinical characteristics at or prior to treatment initiation. RESULTS: Overall sample (N=20,057) age was 62.49; 49.7% female; 67.7% white. Significant (two-tailed, p<0.05) predictors of ULABI vs. LABI use included younger age (odds ratio [OR]=1.02), male gender (OR=1.11), white vs. black (OR=1.60) and unknown/other race (OR=1.94), overweight (OR=1.22) and obese (OR=1.31) vs. normal/underweight BMI, sleep apnea (OR=1.25), hypertension (OR=1.29), and higher prior HbA1c level (OR=1.04). Significant predictors of LABI+OAD vs. LABI included younger age (OR=1.01), unknown/other race vs. white (OR=1.70), overweight (OR=1.32) and obese (OR=1.38) BMI, and absence of dyslipidemia (OR=1.33), hypertension (OR=1.11), depression (OR=1.22), sleep apnea (OR=1.29), and microvascular (OR=2.19) and macrovascular (OR=1.35) disease. CONCLUSIONS: Higher prior HbA1c levels, overweight and obese BMI, and presence of sleep apnea and hypertension were associated with ULABI vs. LABI treatment. Overweight or obese BMI and absence of apnea, depression, and common diabetic comorbidities (dyslipidemia, hypertension, microvascular/macrovascular disease) were associated with LABI+OAD vs. LABI treatment. Findings may help inform physicians in deciding on the newer ULABI treatments in T2DM.