OBJECTIVES: The primary objective of the INSTIGATE study is to assess the direct costs of care for type 2 diabetes in the 6 months before and after insulin initiation. This abstract presents data for patients enrolled in Germany and UK. METHODS: INSTIGATE is an ongoing prospective European observational study investigating patients with type 2 diabetes who have initiated insulin during usual care. The direct costs of diabetes care over the 6 months prior to and after insulin initiation were calculated by collecting data on individual resource use and assigning local unit costs. Data collected included; number of consultations with health care professionals, details of oral anti-diabetic medications and insulins, hospitalisations for diabetes care or complications, and frequency of blood glucose monitoring. RESULTS: Five hundred and nine patients were enrolled in Germany and UK, and 6 month follow-up data was collected from 457 patients. In Germany the median costs per patient for diabetes care in the 6 months prior to and after insulin initiation were 406€ and 893€ respectively. In the UK the median costs per patient for diabetes care in the 6 months prior to and after insulin initiation were 596€ and 707€ respectively (2006 costs). CONCLUSION: For German and UK patients included in this study the median cost of care for diabetes in the 6 months following insulin initiation is higher than in the 6 months prior to insulin initiation. Differences in types of resource use pre and post insulin initiation have been observed and further analysis is underway to investigate how these differences, and the cost of insulin, are impacting costs of care. Outcomes following insulin initiation will also be investigated.