Type 2 diabetes mellitus (T2DM) is prevalent in the Middle East and North Africa as a consequence of increasing aging populations, rapid urbanization, lack of physical exercise, and obesity. Our study objective is to explore glycemic outcomes in people with T2DM patients who initiated basal insulin treatment or who received a further adjustment of existing insulin treatment. Multinational, multicenter, non-interventional study was conducted in the Gulf region. The primary objective was to assess HbA1c reduction from baseline, to three and six months following treatment with insulin-based regimens. Secondary outcomes included the percentage of patients achieving the HbA1c target of <7.0% at 6 months, change in fasting, and postprandial blood glucose, insulin dose, body weight, the incidence of hypoglycemia, and patient characteristics associated with the success of glycemic control. Overall, 1196 patients from 102 centers were recruited and 1083 received a basal insulin-based therapy for six-months. Mean (SD) baseline characteristics were: age 56.2 ? 12 years, weight 82.7 ? 14.9 kg, BMI 29.8 ? 5.2 kg/m?, diabetes duration 11 ? 6.9 years, and 55% were male. Initiation or adjustment of basal insulin reduced mean HbA1c from 9.8% ? 1.6% to 7.6% ? 1% and mean FBG from 208.1 ? 70 mg/dl to 128.6 ? 32.3 mg/dl. At 6 months, 25.9% of patients achieved target HbA1c <7.0%. Predictors of glycemic control (HbA1c <7%) included age (OR = 1.01; p = 0.043), baseline HbA1c (OR = 0.68; p < 0.001), BMI (OR = 0.96; p = 0.012), and exercise (OR = 1.5; p = 0.036). Incidence of hypoglycemia was 5.3%, and no significant change in body weight was observed (p = 0.074). In conclusion, Basal insulin treatment with or without addition of prandial insulin is an efficacious and well tolerated regimen for T2DM patients from the Gulf regions inadequately controlled with oral antidiabetic drugs.