Abstract: Background Patients' medication preferences directly affect adherence. Although prior studies have examined attitudes of Chinese patients with type 2 diabetes mellitus (T2DM) toward specific drugs or drug attributes, most have been limited by small sample sizes, narrow scope, and a lack of indepth analysis of preference differences across patient subgroups. Objective To characterize medication preferences among Chinese T2DM patients and to provide empirical evidence to inform clinical practice, market decisions, and health policy. Methods From April to June 2025, a nationwide survey of T2DM patients was conducted using a multistage stratified random sampling design. A total of 857 questionnaires were collected from40 counties/districts across 9 provinces and 2 municipalities. After logical consistency quality control, 845 valid responses were retained (valid response rate 98.6%). Data were analyzed using both counting methods and modelbased methods (conditional logit model, CLM) for Best-Worst Scaling (BWS1). Standardized best-worst (BW) scores were used to rank attribute priorities, and subgroup analyses compared BW scores across patient characteristics. Results Among the 11 attributes included, the top three preferred attributes were glycemic control efficacy, cardiovascular and cerebrovascular health, and low risk of hypoglycemia. The three least prioritized attributes were weight change, outofpocket monthly cost, and convenience of drug acquisition. Results from the counting method and the modelbased method were largely consistent. While the top three priorities were broadly similar across subgroups, significant subgroup differences were observed (P<0.05): females scored edema/bonemetabolism risk higher than males; patients aged 30-49 scored edema/bonemetabolism risk higher and weight change higher, and convenience of drug acquisition lower, compared with those aged ≥ 70; respondents in the central region gave higher scores to glycemic control efficacy and edema/bonemetabolism risk than those in the western region;urban patients placed greater weight on monthly outofpocket cost than township patients; respondents with monthly income <2,000 RMB rated outofpocket monthly cost higher than other income groups, and those with monthly medication expenses >500 RMB scored outofpocket cost higher than the group. Conclusion Chinese T2DM patients prioritize therapeutic effectiveness (especially glycemic control) first, safety second, and are relatively more tolerant of factors related to quality of life, cost, and convenience. Preferences vary by sex, age, region, and economic status. Clinical prescribing and drug development should prioritize core therapeutic attributes such as glycemic control while taking subgroup needs into account to improve adherence.

Key words: Type 2 diabetes mellitus, Best-Worst Scaling (BWS), Medication preferences

摘要： 背景 患者用药偏好直接影响其用药依从性，虽然目前已有部分研究探讨了我国2型糖尿病（T2DM）患者对特定药物或某类药物属性的态度，但多数研究样本量较小、范围较局限，且缺乏针对不同特征患者用药偏好差异的深入分析。目的 分析我国T2DM患者用药偏好，为临床、市场决策及卫生管理决策提供实证依据。方法 2025年4月—2025年6月，在全国范围内，以T2DM患者为研究对象，采用多阶段分层随机抽样方法，在9个省份2个直辖市40个县（区）共收集857份问卷。采用模型法与计数法进行数据分析，进而明确各属性的优先级顺序，同时进行不同特征亚组优劣（BW）得分差异分析。结果 857份问卷中12份未通过逻辑质控，有效问卷845份，问卷有效回收率为98.6%。根据标准化优劣得分排序，在纳入的11个属性中，患者偏好的前3位属性为血糖控制效果、心脑血管健康、低血糖风险，患者最不看重的前3位属性为体重变化、自付费用/月、药物购买便利性。计数法与模型法的分析结果基本一致。各亚组患者的前三位偏好与总体基本一致，但亚组间存在一定差异：女性水肿/骨代谢风险得分高于男性；30~49岁水肿/骨代谢风险得分高于70岁以上人群，体重变化得分高于其他年龄组，购药便利性得分低于其他年龄组；中部地区血糖控制效果、水肿/骨代谢风险得分高于西部；城市患者自付费用/月得分高于乡镇；2000元以下患者自付费用/月得分高于200元以上患者，月花费500元以上组自付费用/月得分高于100元以下组（P<0.05）。结论 T2DM患者在药物选择中优先关注治疗有效性，其次为安全性，而对与生活质量相关的次要因素或经济、便利性因素容忍度更高，同时受性别、年龄、经济状况等因素影响呈现一定亚组差异。建议临床用药及药物研发应优先关注血糖控制等核心属性，兼顾不同亚组需求，提升患者依从性。

关键词: 糖尿病, 2 型；优劣尺度法；用药偏好