Objective:

To investigate the factors influencing the selection between biguanides and SGLT2 inhibitors, and to compare their glycemic efficacy and medication persistence rates in patients with matched baseline characteristics.

Approach:

• Study Design: Retrospective cohort study using a clinical database, including adult patients aged 18 years or older who received a first prescription of either a biguanide or an SGLT2 inhibitor.
• Population: Patients were categorized based on their first prescription and divided into 1st-line and 2nd-line treatment groups.

Key Findings:

• Treatment selection was primarily driven by cardiovascular risk, contrasting with the BMI-based approach recommended in Japanese guidelines.
• Biguanides showed a more pronounced reduction in HbA1c at 24 weeks.
• SGLT2 inhibitors demonstrated higher treatment persistence over 48 weeks in the 1st-line cohort.

Interpretation:

Limitations:

• The study did not perform sample size calculations for exploratory purposes.
• Exclusion criteria may limit the generalizability of the findings.

Conclusion: