OBJECTIVES: To assess perceptions of insulin usage amongst pre-insulin and current insulin T2DM populations and establish differences in patient’s feelings between the cohorts. METHODS: Data were drawn from 2010-2014 Adelphi Diabetes Disease Specific Programmes (DSPs) in T2DM conducted across the USA.  The Diabetes DSP is a real-world, cross-sectional survey involving face-to-face interviews with endocrinologists (ENDOs),primary care physicians (PCPs) and completion of physician-reported forms for their next 10 consulting T2DM patients. The same patients are invited to complete a patient-reported form.  RESULTS: A total of 504 ENDOs, 626 PCPs, and 13,527 patients were included across 5 surveys. Pre-insulin patients reported much lower feelings of happiness about starting insulin, on a 4-point scale from very happy to very unhappy (very/fairly happy: PCP 5.17%; ENDO 7.28%)  Main barriers to insulin uptake amongst pre-insulin users included dislike of injections (PCP 73.94%; ENDO 63.56%), accepting diabetes is more advanced (PCP 52.86%; ENDO 50.49%) and failure to control diabetes (PCP 40.26%; ENDO 39.77%). Pre-insulin patients very unhappy starting insulin were less likely to be on injectable GLP-1 therapy, receiving fewer non-insulin products and had existing concerns around injections. However, 83.42% of patients taking insulin report feeling better since starting insulin citing improved blood glucose control (68.95%) and more energy (50.52%) as main reasons. Overall, patient’s feelings towards currently taking insulin were more positive (very/fairly happy: PCP 47.44%; ENDO 42.49%).   Patients happy taking insulin versus unhappy reported higher compliance (Morisky Medication Adherence Scale), improved well-being, fewer problems taking injections and fewer medications. CONCLUSIONS: Pre-insulin users have higher concerns towards taking insulin compared to those currently receiving insulin. Insulin patient’s concern levels around therapy improve due to positive experiences around feeling better. It would appear exposure to other injectable therapy ahead of insulin mitigates pre-insulin patient concerns towards insulinization. Positive insulin experiences result in improved adherence to medication.