OBJECTIVES: To assess and compare per-day anti-diabetic medication cost among Chinese type-2 diabetes mellitus (T2DM) insulin naïve patients who initiated premixed insulin analogs (premix) or long-acting insulin analogs (long-acting). METHODS: Data were obtained from an electronic medical record database between 2010.01.01~2015.06.30 covering medical encounter records from all general hospitals in a district from Shanghai, China. Insulin naïve T2DM patients who aged ≥ 18 years, were treated with oral anti-diabetic drug (OAD) only during baseline period (3 months prior to insulin initiation), and initiated premix or long-acting were included. Patients were followed until index insulin discontinuation or 12 months after initiation, whichever came first. T-test and generalized linear models adjusting for propensity score (PS) (including baseline demographics, number of OAD classes, comorbidities, costs, and healthcare resource utilization) were used to test the difference between two insulin groups. RESULTS: A total of 570 and 185 patients were identified for premix and long-acting groups, with mean (SD) age 63.0(12.8) and 61.1(11.9) (p=0.08) and male 47.4% and 51.4% (p=0.35), respectively. During baseline, 19.3% premix users and 12.4% long-acting users had T2DM-related hospitalizations (p=0.03); the average number of T2DM-related outpatient visits were 0.98 and 1.23 times for premix and long-acting groups, respectively (p=0.07). During the follow-up period, per-day insulin dose averaged 31.7 and 15.3 international unit for premix and long-acting groups, respectively. Compared with premix users, mean per-day cost for long-acting users was 37.3% higher (15.3 vs 11.2 Chinese Yuan (CNY), mean difference (MD)[95% CI]): 4.2[3.2,5.1]) for overall anti-diabetes medication, 81.3% higher (3.3 vs 1.8 CNY, MD[95% CI]: 1.5[0.8, 2.2]) for OAD, and 28.6% higher (12.0 vs 9.3 CNY, MD[95% CI]: 2.7[2.1, 3.3]) for insulin. Results were consistent after PS was adjusted. CONCLUSIONS: Among Chinese T2DM insulin naïve patients, those who were initiated premix insulin had lower per-day antidiabetic medication cost than those initiated long-acting insulin.