Introduction: Diabetic Retinopathy (DR) is an important cause of visual impairment among persons with diabetes mellitus (DM). Therefore, it is important for nonophthalmologists to recognize the importance of eye disease in patients with DM. There are no recent studies on the prevalence of DR across all the geographical divisions of India. This makes it difficult to identify where DR screening and treatment programs are most needed. Aim & Objectives: Comparative study on DR severity, treatment requirement and progression amongst type 2 diabetic patients on insulin and those not on insulin. Methods: A prospective comparative study was carried out in Department of Ophthalmology at Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh among 150 patients visiting OPD with clinically diagnosed Type 2 DM, on insulin therapy or on other treatment, after considering the inclusion and exclusion criteria. The subjects were equally distributed into two groups i.e. insulin and noninsulin group. Results: In present study frequency of DR was 37.33% in non-insulin group and 57.33% in insulin group at baseline, it increased to 44% and 68% after 9 months respectively. Which shows DR is more common in subjects on insulin therapy when compared to other study group, and rate of progression of disease is more in subjects on insulin therapy. The frequency of subjects with Diabetic Macular Edema (DME) was 29.33% in insulin group and 10.67% in non-insulin group, at baseline, and it increased to 38.67% in insulin group and 17.33% in non-insulin group, showing a statistically significant difference at 9 months interval. Conclusion: This study suggest that insulin treatment may be associated with DR, DR severity and DME in T2DM patients belonging to a developing country like India.