Impact of renal function on antidiabetic drug selection in Japan: A real-world analysis using the J-DREAMS database.

Abstract

Aims: To describe renal function-specific prescribing patterns of antidiabetic drugs in Japanese patients with type 2 diabetes using real-world data and to identify selection trends up to the second therapy.

Materials and methods: We retrospectively analyzed data from the J-DREAMS registry (2015-2023) to evaluate the proportions of first and second drug classes stratified by renal function (eGFR ≥60 vs <60 mL/min/1.73 m²) and to examine temporal changes across registration periods. Prescription proportions by renal function were also compared using propensity score matching.

Results: Among 24,868 patients, 36.1% had an eGFR <60 mL/min/1.73 m². DPP-4 inhibitors were the most common first agents regardless of renal function, followed commonly by metformin and insulin. The use of SGLT2 inhibitors and GLP-1 receptor agonists increased as second-line therapies; in more recent periods, SGLT2 inhibitors were most frequently selected in the normal renal function group (25.6%), while GLP-1 receptor agonists ranked third in the reduced renal function group (15.9%). After matching, prescription proportions of SGLT2 inhibitors were similar between groups, whereas sulfonylureas (SUs), metformin, and thiazolidinediones were less frequent in the reduced renal function group.

Conclusions: Prescribing patterns in Japan have shifted toward earlier use of SGLT2 inhibitors and GLP-1 receptor agonists, with medications appropriately tailored to renal function.