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Title Real-World Effectiveness of Oral Hypoglycemic Agents in Young Adults with Type 2 Diabetes in Northern Chile Abstract Background/Objectives: The rising prevalence of type 2 diabetes mellitus (T2DM) among adults aged 25–40 years in Latin America has emerged as a significant public health challenge, driven by lifestyle and metabolic risk factors. Evaluating the real-world effec-tiveness of oral hypoglycemic agents within primary health care (PHC) systems is essen-tial to inform therapeutic strategies and improve glycemic control in this population. This study aimed to assess metabolic outcomes and treatment associations among young adults with T2DM managed in PHC settings in northern Chile. Methods: A retrospective longitudinal cohort study was conducted using 500 electronic medical records from pa-tients aged 25–40 years diagnosed with T2DM and treated between 2021 and 2023 across eight family health centers (CESFAM) in Antofagasta, Chile. The primary outcome was glycosylated hemoglobin (HbA1c). Secondary analyses examined relationships between treatment type, body mass index (BMI), and comorbidities including dyslipidemia, hy-pertension, and depression. Results: Among all patients, 71.6% were overweight and 28.4% obese. Comorbidities were documented as 57.4%, predominantly dyslipidemia (43.5%), hypertension (27.9%), and depression (18.8%). The most common therapies were metformin monotherapy (84%) and metformin plus glibenclamide (14.8%). Mean HbA1c values remained unchanged between 2021 (8.91 ± 0.57) and 2022 (8.92 ± 0.55) but im-proved significantly in 2023 (7.41 ± 0.28), although international glycemic targets were not met. Conclusions: Oral hypoglycemic therapy in PHC settings was partially effective in improving glycemic control among young adults with T2DM. These findings underscore the need for broader pharmacological options, enhanced follow-up, and reinforcing pa-tient education within Chile’s primary care system. Keywords: pharmacoepidemiology, type 2 diabetes mellitus, primary healthcare, meta-bolic control, oral hypoglycemic agents