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Aims/Introduction  In treatment algorithms of type 2 diabetes mellitus in Western countries, biguanides are recommended as first‐line agents. In Japan, various oral hypoglycemic agents ( OHA s) are available, but prescription patterns are unclear.    Materials and Methods  Data of 7,108 and 2,655 type 2 diabetes mellitus patients in study 1 and study 2, respectively, were extracted from the Medical Data Vision database (2008–2013). Cardiovascular disease history was not considered in study 1, but was in study 2. Initial choice of  OHA , adherence to its use, effect on glycated hemoglobin levels for 2 years and the second choice of  OHA  were investigated.    Results  In study 1, α‐glucosidase inhibitor, glinide and thiazolidinedione were preferentially medicated in relatively lower glycated hemoglobin cases compared with other  OHA s. The two most prevalent first prescriptions of  OHA s were biguanides and dipeptidyl peptidase‐4 inhibitors, and the greatest adherence was for α‐glucosidase inhibitors. In patients treated continuously with a single  OHA  for 2 years, improvement in glycated hemoglobin levels was greatest for dipeptidyl peptidase‐4 inhibitors. As a second  OHA  added to the first  OHA  during the first 2 years, dipeptidyl peptidase‐4 inhibitors were chosen most often, especially if a biguanide was the first  OHA . In study 2, targeting patients with a cardiovascular disease history, a similar tendency to study 1 was observed in the first choice of  OHA , adherence and the second choice of  OHA .    Conclusions  Even in Japanese type 2 diabetes mellitus patients, a Western algorithm seems to be respected to some degree. The  OHA  choice does not seem to be affected by a cardiovascular disease history.

Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database