OBJECTIVES:  Linagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor recently approved for T2DM treatment, which does not require dose adjustment in patients with renal or hepatic impairment. The patterns of treatment adherence among patients initiating linagliptin in routine care settings are largely unknown. METHODS:  Within a large, nationwide US health insurance database (Optum Clinformatics), we identified T2DM patients ≥18 years initiating linagliptin or other NIDMs from May 2011 through June 2012. Patients were followed for adherence measures for up to 12 months. Findings were replicated in a propensity score (PS)-matched population and in another US commercial health insurance database (MarketScan). RESULTS:  Of 155,345 T2DM patients initiating a NIDM, 46.8% initiated metformin, followed by sulfonylureas (21.8%), and sitagliptin (11.9%). Linagliptin was initiated by 2,820 patients (1.8%). Linagliptin and saxagliptin initiators had the highest proportion of days covered [PDC] (77.5% and 75.8%, respectively) and medication possession ratio [MPR] (0.67 and 0.66). Similarly, compared to initiators of other agents, these patients less frequently filled only one dispensing of their medication [1DISP] (15.0% for linagliptin and 15.7% for saxagliptin), and more persisted on therapy at 12 months [P12] (51.5% and 49.8%). Metformin initiators had PDC = 70.4%, MPR = 0.57, 1DISP = 23.0%, and P12 = 35.5%. The lowest adherence measures were observed among initiators of meglitinides (PDC 64.0%; MPR 0.46; 1DISP 32.4%; P12 22.6%), glitazones (PDC 68.8%; MPR 0.51; 1DISP 30.2%; P12 28.4%) and GLP-1 receptor agonists (PDC 68.3%; MPR 0.54; 1DISP 23.3%; P12 33.6%). These patterns of adherence were similar after PS-matching and in MarketScan data, suggesting differences in adherence were not due to patient or health insurer characteristics. CONCLUSIONS:  Compared to other NIDMs, patients initiating linagliptin (along with saxagliptin) exhibit greater adherence to therapy. The observed patterns of adherence are not likely to be due to patient or health insurer characteristics.