Comparing treatment intensification and clinical outcomes of metformin and dipeptidyl peptidase-4 inhibitors in treatment-naïve patients with type 2 diabetes in Japan.

Japan's guidelines emphasize tailored therapy, but do not guide physicians on the use of a specific regimen in drug-naive patients. The role of long-term initial therapy could be important in key elements of diabetes treatment, such as continuation of the initially prescribed drug. We investigated the frequency of occurrence to treatment intensification after the initiation of metformin or dipeptidyl peptidase-4 inhibitor treatment. In multivariable-adjusted Cox proportional hazards models, initiation of dipeptidyl peptidase-4 inhibitor was associated with a low hazard of intensification. The findings of this survey showed that dipeptidyl peptidase-4 inhibitors were the preferred first-line treatment in Japan because of the high continuation rate of the treatment and hemoglobin A1c-lowering effect. This information would provide guidance in selecting initial hypoglycemic drugs to optimize the treatment of type 2 diabetes mellitus patients in Japan and Asia.