OBJECTIVES: It is important to understand diabetes treatment patterns over time. This study compared changes in comorbidities, treatment patterns, and costs among newly-diagnosed T2D patients in 2007 and 2012.   METHODS: Separate cross-sectional analyses of medical treatments, diagnoses, and pharmacy claims in the Truven Health MarketScan® Database were conducted for 2007 and 2012. Criteria for newly-diagnosed T2D were enrolment 6 months prior to index, ≥2 diagnoses for T2D (ICD-9 codes), ≥18 years old, and continuous enrolment in a plan with prescription benefits for ≥1 year.   RESULTS: Comparing 2007 with 2012, T2D incidence rate decreased from 1.1% to 0.65% of all enrolled patients. Hyperlipidemia (46% and 57%) and hypertension (55 % and 62%) were the 2 most prevalent comorbidities. 46% and 57% of patients in 2007 and 2012 used only oral anti-diabetic drugs (OADs). Single OAD use increased from 68% to 77% of these patients. Metformin (Met) was the most prevalent OAD monotherapy, amounting to 75% and 90% of single OAD prescriptions. SU monotherapy fell from 14% to 6%. Met+SU, the most widely used dual OAD combination, grew from 48% to 57% of dual users. Met+TZD use fell from 30% to 0%, replaced by Met+DPP-IV (34%). An insulin-only regimen was used by 1.4% and 1.6% of patients for 2007 and 2012, and insulin+OADs were used by 2.5% and 3.7% of patients, respectively. Basal insulin was the predominant type and increased from 38% to 48% of patients taking insulin alone or combined with OADs. Patients without prescription claims for T2D medication dropped from 48% to 36%. Overall annual costs/T2D patient rose by $1466, from $13,743 to $15,175, adjusted to 2012 dollars. CONCLUSIONS: For patients in this database, T2D incidence rate decreased from 2007 to 2012, but increased pharmacy claims, comorbidity rates and resource utilization expanded the clinical and economic burden of managing T2D.