OBJECTIVES: To analyze the pharmacy and medical care costs of using different insulin-delivery methods, including pen-injectors, disposable syringes, and traditional injection; and examine the prevalence of hypoglycemic and hyperglycemic events among patients on different delivery methods. METHODS: Utilizing pharmacy and medical claims from a managed care plan of over two million members, this study selected continuously enrolled patients who received insulin or insulin delivery products between July 1, 2000 and June 30, 2001, but did not have claims for these products in the six months prior to the index date. The patients were divided into three analysis groups based on initial insulin delivery method: pen-injector, disposable syringe, or traditional injection. Pharmacy and medical utilization, costs, and prevalence of hypoglycemic or hyperglycemic events in the 18 months following index date were compared among the three groups. RESULTS: Among the 3278 patients who received insulin products in the 12 months from July 1, 2000 to June 30, 2001, nearly 88% took the traditional injection approach, only 12% adopted the delivery devices, including 146 patients (4.45%) who used pen injectors and 250 patients (7.63%) who used disposable syringes. Log-transformed linear regressions showed that pen-injector and disposable users cost 58.5% and 50.3%, respectively, more than patients using traditional injections in pharmacy expenditures, but not in medical services expenditures, controlling for patient demographics, comorbidities, community characteristics, and type of health plan. Controlling for the same covariates, a logistic regression indicated that the likelihood of having hypoglycemic or hyperglycemic events was similar between traditional injection and the devices (p > 0.05). CONCLUSION: This study did not find significant difference in medical costs and insulin-related health events between patients who took insulin via traditional injection and those adopted pen injectors or disposable syringes, although traditional injections were less costly.