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PURPOSE The objectives of this study were to examine the patterns of antihyperglycemic drug (AHD) therapy among patients with newly diagnosed type 2 diabetes mellitus (T2DM) in the general Chinese population, stratified by initial hemoglobin (Hb) A1c level, and to assess whether treatment patterns are consistent with the recommendations published in the China Diabetes Society's clinical treatment guideline. METHODS A retrospective database analysis was conducted, and data were obtained from the SuValue database. Prescribing patterns for diabetes treatments were determined from data obtained from the Nanhai District-based electronic medical records database, a subset of the SuValue database. Data from patients newly diagnosed with T2DM who also had at least 2 prescriptions for AHD medications after diagnosis and at least 1 HbA1c test result during the 12 months prior to AHD treatment initiation, between January 1, 2004, and July 22, 2018, were included in the analysis. ANOVA, χ2 test, and Kaplan-Meier survival analysis were used to examine differences between 4 initial-HbA1c groups (<7%, 7%-<8%, 8%-<9%, and ≥9%). FINDINGS A total of 4712 patients were included, with women accounting for 47.8%; the mean age (SD) of the study population was 56.44 (12.57) years. Men were more likely to have had a higher HbA1c level at initial AHD treatment (P < 0.0001). The first-line therapies most frequently prescribed were metformin combination (29.5%), followed by insulin-including treatment (25.9%), and metformin monotherapy (19.2%). Metformin monotherapy (29.5%) was most commonly prescribed in patients with an HbA1c level of <7%; metformin combination (31.7%), in patients with an HbA1c level of 7%-<8%; and insulin-containing treatment, in patients with HbA1c levels of 8%-<9% (28.1%) and ≥9% (38.4%). Insulin-including treatment was more commonly prescribed than was metformin combination in patients with an initial HbA1c level of ≥8% after initial treatment. In third- and fourth-line treatments, patients with an HbA1c level of ≥8% more prevalently were prescribed metformin combination and insulin-including treatment, while metformin combination and "other" treatment were more generally prescribed in patients with an HbA1c level of ≤8%. However, 8.8% of patients with an HbA1c level of <7% were prescribed insulin-including treatment as first-line therapy. In all lines of treatment, the percentages of patients prescribed insulin were increased with initial HbA1c levels. A similar pattern was seen with dipeptidyl peptidase 4 inhibitors after first-line treatment. Overall, the median time to treatment switch was shorter than 3 months. IMPLICATIONS The findings from the present study depict a comprehensive overview of AHD-treatment patterns in patients stratified by HbA1c level. The current treatment practices observed were inconsistent the published guideline, in terms of recommendations on metformin monotherapy and insulin use in first-line therapy. (Clin Ther. 2019;41:XXX-XXX) © 2019 Elsevier Inc.