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

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.

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.

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.

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