OBJECTIVES: To quantify the true cost of insulin prescribing in type 2 diabetes (T2D) including insulin and insulin ancillary items. Few data on annual insulin cost exist. Insulin is difficult to cost due to the array of insulins, wide dosing ranges, prn usage following self testing and usage of insulin ancillaries e.g. lancets, needles and testing strips. METHODS: Prescribing data were collected from a longitudinal real patient database (the IMS UK Disease Analyzer database) showing prescribing data of 650 GPs within 130 practices across the UK providing access to 95m prescriptions. Costs were then assigned to the data. The population were existing T2D patients with incidence of insulin usage, defined as those patients: Prescribed insulin with a prescription for any oral antidiabetic drug prior to insulin and aged > 40y at first record of diabetes; With Read code of T2D (could include patients <40y); Additionally incident on insulin after January 1, 2002. Costs of insulin prescriptions and ancillaries were drawn from the database sourced from the UK drug tariff, BNF and MIMS (with appropriate assumptions where quantities were unclear). RESULTS: In total, 3581 patients met the inclusion criteria. The average dose of insulin in T2D patients within the study was 36IU/day at 12 months. The average yearly cost was £384 for insulin alone and ancillary item cost reached £223 increasing total annual cost of insulin and equipment to £607. CONCLUSION: Although clinically appropriate for some T2D patients, insulin is expensive, particularly when ancillaries are considered.This database study was a straightforward way of identifying and analysing not only drug costs but ‘hidden' costs of insulin ancillaries.This analysis only takes account of insulin and ancillary costs and does not account for visits to healthcare professionals. Initiation of insulin is often accompanied by extra visits to healthcare professionals, which would further increase costs.