Background and Purpose: Costs for diabetes treatment burden statutory health care systems. Aim of the LIVE-COM study (Long Acting Insulin Glargine versus Insulin Detemir Cost Evaluation Comparison) was to assess resource utilization and costs of diabetes care as well as patient reported outcomes in a random sample of type 2 diabetes patients treated with either insulin glargine (GLA) or detemir (DET) as part of a basal-bolus regimen in a primary care setting. Patients and Methods: LIVE-COM is a non-interventional, cross-sectional study performed between April and September 2008 in 138 randomly selected centers of primary care physicians in Germany. From 1731 type 2 diabetes patients (GLA: n = 1150; DET: n = 581) with statutory health insurance status and pretreatment with either GLA or DET for at least 6 months as part of a basal-bolus therapy, total direct costs of diabetes care (for insulins, oral antidiabetic drugs, test strips, needles, lancets, Hypokits®) were calculated from total recorded expenditures, for a period of six months, from the perspective of statutory health insurance. Patient-reported outcomes were assessed using validated questionnaires (SF-12, DTSQs, ITEQ). Results: Mean total costs per patient over six months were lower with GLA based therapy compared with DET based therapy (972 € ± 374 € vs. 1135 € ± 477 €, p < 0.001). Adjusted by ANCOVA: 932 € (95% CI: 905, 957 €) vs. 1.061 € (95% CI: 1025, 1099 €, p < 0.001). The adjusted mean single costs for basal insulin (223 € vs. 246 €), bolus insulin (241 € vs. 289 €), test strips (347 € vs. 393 €) and needles (67 € vs. 80 €) were significantly lower in the GLA group (p < 0.001, each), whereas costs of OAD (36 € vs. 35 €), lancets (14 € vs. 15 €) and Hypokits® (1.9 € vs. 1.0 €) did not differ significantly. Glycemic parameters (HbA1c, fasting blood glucose) were better on GLA based therapy (p < 0.01) and associated with lower daily total insulin doses (68 U vs. 79 U). Furthermore, slightly better results in patient-reported outcomes were found in GLA patients. Conclusion: In a head-to-head comparison over six months a glargine vs. detemir based basal-bolus therapy in type 2 diabetes patients was associated with lower total costs of diabetes care (Ä: -128 €/patient) mainly caused by savings of consumables. Further health services research with larger sample sizes should be conducted to obtain a more comprehensive analysis of economic aspects of insulin analogs or other innovative drugs in routine practice.