Purpose: The purpose of this study was to determine the use of clinical guideline–recommended antidiabetic therapies among whites and blacks with uncontrolled type 2 diabetes. Methods: A secondary data analysis based on NHANES 2003-2012 cohort data including non-Hispanic black and white adults with uncontrolled (A1C ≥6.5%) type 2 diabetes. Results: Blacks were more likely to have the highest levels of A1C compared to whites (A1C >9% = 29.8% vs 16.2%). There was no statistical difference in the use of recommended regimens across racial group (blacks 60.5% vs whites 66.0%). Blacks and whites who were most uncontrolled were least likely to be on recommended regimens (A1C 6.5%-7.4%: 78.5%, A1C 7.5%-9%: 57.2%; and A1C >9%: 54.1%). This pattern was most pronounced among blacks compared to whites but was not statistically different. Use of recommended therapies decreased 29.0 percentage points for blacks and 20.1 percentage points among whites from an A1C level of 6.5% to 7.4% to >9%, respectively. The total proportion of blacks and whites on intensified non-insulin triple or insulin-based therapies were 38.9% and 41.8%, respectively. Conclusions: Even though blacks were more likely than whites to have the highest A1C, no significant differences were found in the use of clinical–guideline recommended regimens or other regimen use outcomes. Along with lifestyle modification, further intensification of antidiabetic regimens may help improve glycemic control and other disparities between blacks and whites.