This retrospective observational analysis of the Optum Clinformatics database compared outcomes for adults (≥18y) with T2D who either continued treatment with the 2^nd-gen (longer-acting) BI, Gla-300, or switched to a 1^st-gen (long-acting) BI between Jan 1, 2017, and Apr 30, 2020. Cohorts were propensity score matched (PSM) on baseline characteristics and followed for 12 months. Outcomes included persistence, adherence, HRU, and hypoglycemia. During follow-up, a statistically significantly higher proportion of patients who continued Gla-300 vs. switched to 1st-gen BI were persistent with therapy, while adherence was similar. Hypoglycemia events (26.2 vs. 42.8 /100 person-years follow-up) and emergency room (ER) visits (all-cause: 100.5 vs. 146.8 per 100 person-years) were significantly lower for Gla-300 (p<0.01) , whereas hospitalization rates were similar (p>0.30; Table) . In adults with T2D, continuing treatment with Gla-300 vs. switching to a 1st-gen BI analog (Gla-100 or IDet) was associated with better persistence and lower overall hypoglycemia and ER visit events, but not hospitalizations, suggesting patients presenting at ER were treated, observed then discharged.