Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion. Objectives and MethodologyThe aim of this review is to raise awareness of the status of insulin-treated type 2 diabetes mellitus (T2DM) in Europe. An extensive literature research was conducted on insulin therapy in T2DM, glycaemic targets according to national guidelines, barriers to the initiation of and adherence to insulin therapy as well as costs associated with specific insulin regimens. Country specific data was obtained for six European countries relating to the use of specific insulin regimens in T2DM and the proportion achieving national targets in order to estimate the extent of people inadequately controlled with insulin. Finally, we refer to devices and technologies aimed at improving insulin delivery which may reduce the burden of insulin therapy in those persons sub-optimally controlled.