Abstract: Objective：To analyze the use of dipeptidyl peptidase-4 (DPP-4) inhibitors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with renal insufficiency. Methods：From January 2014 to November 2018, 700 T2DM patients aged over 65 years and complicated with renal insufficiency, who were treated with DPP-4 inhibitors (including vildagliptin, saxagliptin, alogliptin, sitagliptin, and linagliptin) in Zhongshan Hospital, Fudan University were retrospectively enrolled in this study. The application of DPP-4 inhibitor in patients with different age groups, different degrees of renal insufficiency, and different glycosylated hemoglobin (HbA1c) levels were analyzed. Results：Among the 700 patients, a total of 278 cases (39.71%) had moderate or severe renal insufficiency. There was no significant difference in the distribution of DPP-4 inhibitors among different ages. Among the 315 patients treated with linagliptin, 123 cases (39.05%) had moderate renal insufficiency, and 53 cases (16.83%) had severe renal insufficiency. The proportion of linagliptin was highest in patients with moderate to severe renal insufficiency (176 cases, 63.31%), more than the other 4 drugs (P<0.01). Among the poor glycemic control patients with moderate to severe renal insufficiency, linagliptin (100 cases, 65.36%) and sitagliptin (39 cases, 25.49%) were mainly used. Conclusions：Among the DPP-4 inhibitors, linagliptin is most frequently used in the patients aged over 65 years with moderate to severe renal insufficiency, and linagliptin and sitagliptin are most frequently used in the poor glycemic control patients, which is in compliance with the guidelines.