Background: The Optimizing Control in Diabetes (OPTIMIZE) survey was conducted to understand the patients' perspective to achieving good glycemic control and to determine how patients' perceptions of insulin may affect their decisions to initiate or intensify their insulin therapy. Methods: A total of 1,444 subjects with type 2 diabetes, at least 25% of whom were currently using insulin, were recruited from an online patient database and via physicians. Results: Duration of diabetes was >= 2 years in 1,243 (86%) respondents. Two-thirds (975 [67%]) of respondents were not using insulin, of whom 111 (11%) were using diet and exercise alone and 864 (89%) were receiving oral agents, and 469 (32%) were using subcutaneous (SC) insulin. Overall, 823 of 1,444 (57%; 95% confidence interval [CI], 54% to 60%) individuals were not aware of their most recent hemoglobin A1c (HbA(1c)) test results or declined to answer. Of those using SC insulin, 120 of 175 (69%; 95% CI, 61% to 75%) reported HbA(1c) levels >= 7%. This was unrelated to whether they used pens or syringes. The majority of respondents "wished there was another way to take insulin" whether they were using insulin (371 of 469 [79%]; 95% CI, 75% to 83%) or not (782 of 975 [80%]; 95% CI, 78% to 83%). When patients not currently using insulin were questioned how they felt about requiring SC insulin in the future, 445 of 975 (46%; 95% CI, 42% to 49%) indicated they would avoid it if at all possible. The majority (71%) cited injection-related factors as the main reason for their apprehension. Conclusions: In this survey, the majority of patients reported that they wished there was another way to take SC insulin regardless of whether they were currently using SC insulin or not. Improving patients' perceptions and acceptance of insulin could encourage earlier insulin use and assist in achieving and maintaining long-term appropriate glycemic control.