Background: Epidemiologic data suggest that anti-DM medications may impact overall survival (OS) in CRC pts who have type 2 DM. Although type 2 DM and CRC are major health problems in the Middle East, little data exist on pts with both conditions from this region. Methods: Medical records from 1,898 CRC pts seen at King Hussein Cancer Center, between 1/1/2004 and 12/31/2012 were evaluated for prevalence of type 2 DM; those with both conditions were evaluated for anti-diabetic therapy and treatment outcomes (OS and progression-free survival (PFS)). Results: 355 type 2 DM CRC patients were identified (prevalence 18.7%); 25 pts were censored as their anti-DM medications were not known. Median age of 355 pts analyzed was 62 years (36-88), Male: Female ratio 1.5:1, non-metformin (n = 140, 42%), metformin only (n = 56, 17%), metformin + insulin (n = 15, 5%), metformin + another oral agent (n = 119, 36%). Metformin use increased over time (24% in 2004 to 79% in 2012). Adjusting for age, gender, body mass index, and stage, type 2 DM pts treated with metformin had a 40% improvement in OS (hazard ratio 0.6, 95% confidence interval (CI) 0.38-0.81). Conclusions: These data support previous findings that metformin use in CRC pts with type 2 DM is associated with superior PFS and OS. There was a statistically significant OS benefit in stage I-II and stage III pts, while the trend towards OS benefit in stage IV pts was not statistically significant. The benefit in PFS was statistically significant only in pts with stage III disease (see table). This study was supported by the King Hussein Cancer Center/MD Anderson Sister Institution Network Fund.