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Aims/Introduction: Type 2 diabetes mellitus is caused by a relative imbalance between insulin secretion and sensitivity related to the body mass index (BMI). Seven categories of oral antidiabetic drugs (OADs) are available in Japan. It is important to assess the OAD utilization patterns based on patients' BMI levels. Materials and methods: OAD prescribing patterns from 2002 to 2019 were analyzed using the data collected in the computerized diabetes care database provided by the Japan Diabetes Clinical Data Management Study Group; OAD utilization patterns in 25,751 OAD‐treated type 2 diabetes mellitus patients registered in 2019 were analyzed after classifying them into five categories of BMI. Results: Comparing OAD usage between 2002 and 2019, sulfonylureas decreased from 44.5 to 23.2%, and biguanides (BGs) increased from 19.3 to 50.3%. Dipeptidyl peptidase‐4 inhibitors (DPP4is) increased to 56.9% in 2019. Sodium–glucose cotransporter 2 inhibitors (SGLT2is) increased to 23.6% in 2019. About 90% of type 2 diabetes mellitus patients had BMI < 30 kg/m2. DPP4is were the most used OADs in 2019. When BMI exceeded 30 kg/m2, use of BGs and sodium–glucose cotransporter 2 inhibitors increased, and use of sulfonylureas and DPP4is decreased. Although DPP4is were the most used OADs for patients with BMI <30 kg/m2, they were the third most prescribed OADs for patients with BMI >35 kg/m2 after BGs and sodium–glucose cotransporter 2 inhibitors. Conclusions: DPP4i usage was as high as that of BG in the analysis of Japanese type 2 diabetes mellitus patients with relatively low BMI. This was considered to be a treatment option appropriate for the pathophysiology in Japanese patients. [ABSTRACT FROM AUTHOR]