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Paper on Diabetes,” an online survey of physicians involved in diabetes treatment over the past 10 years.
In addition, CareNet also planned an academic paper, titled “Trends in Antidiabetic Medication Prescribing: A Review of the Past 10 Years among Specialists,” which analyzed the results of the “White Paper on Diabetes” survey and was published in 2022.

The second issue focuses on the “Percentage of use for Different First-Line Prescriptions of Antidiabetic Medications.”
We plan to introduce the trends in prescriptions over the past 10 years based on a survey of “first-line medications prescribed to patients with inadequate glycemic control in connection with dietary measures and exercise therapy.”

Percentage of First-line Prescriptions of Antidiabetic Medications

In this paper, the following medications are discussed as “first-line medications prescribed to patients with inadequate glycemic control in connection with dietary measures and exercise therapy.”

(1) Sulfonylureas (SU)
(2) Rapid-acting insulin secretagogues (glinides)
(3) α-glucosidase inhibitors (α-GI)
(4) Biguanides (BG)
(5) Thiazolidines
(6) Dipeptidyl-peptidase 4 inhibitors (DPP-4 inhibitors)
(7) Sodium-dependent glucose transporter 2 inhibitors (SGLT2 inhibitors)
(8) Glucagon-like peptide-1 agonists (GLP-1 agonists)
(9) Insulin
(10) Other (e.g., combined use)

The top three medications prescribed as first-line medications in 2009 were BG (31.6%), SU (24.1%), andα-GI (18.3%), but in 2021, BG (39.4%), DPP-4 inhibitors (32.2%), and SGLT2 inhibitors (11.2%) were the top three. The percentage of prescribed medications varied significantly.

SU and α-GI, which were widely used in 2009, have seen a sharp decline in use; SU have been used less than 5% of the time since 2015, whereasα-GI have been used less than 5% of the time since 2013—and are rarely used as of 2021. A similar decreasing trend can be observed for thiazolidines and glinides.

On the other hand, BG has remained on top among medications, accounting for more than 30% of the total use, unchanged from 2009 to 2021. Metformin, a BG, has long been the gold standard for antidiabetic medication because of its efficacy, safety, long-term clinical experience, and affordability1).

DPP-4 inhibitors accounted for 12.6% of prescriptions when they were added in 2010 and have increased significantly since then, remaining in the 30% range, along with BG (Figure 1).
One reason for the growth in the use of DPP-4 inhibitors is that Japanese people have a weaker insulin secretion capacity than Westerners and are more susceptible to the effects of a reduced insulin secretion capacity, even with mild obesity.
DPP-4 inhibitors are used more frequently in Japan because of their suggested benefits for Asians with low body mass index (BMI)2).
In addition, their effects are blood glucose-dependent, and the risk of hypoglycemia is thought to be low.

The use of SGLT2 inhibitors has been on the rise since their addition to the list in 2015 and were the most commonly used medications in 2021, followed by BG and DPP-4 inhibitors.
When first launched, SGLT2 inhibitors attracted attention for their weight-loss effects through urinary glucose excretion. However, in recent years, their effectiveness in preventing recurrent and renal events in patients with a history of cardiovascular events has attracted significant attention.

1) Davies, M. J., D’A1essio, D. A. et al. : Management of Hyperglycemia in Type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 41 ; 2669–2701, 2018.
2) Yabe, D., Seino, Y., et al. : β Cell Dysfunction Versus Insulin Resistance in the Pathogenesis of Type 2 Diabetes in East Asians. Curr Diab Rep, 15 : 602, 2015.


【Figure 1】 Yearly changes in the percentage of first-line prescriptions

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