Long-Term Comparative Effects of SGLT-2 and DPP-4 Inhibitors on Lipid Profiles and Cardiometabolic Outcomes in Type 2 Diabetes: Real-World Evidence

Background: Dyslipidaemia represents a major contributor to cardiovascular morbidity in patients with Type 2 Diabetes Mellitus (T2DM). Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and Dipeptidyl Peptidase-4 (DPP-4) inhibitors are commonly prescribed antihyperglycemic agents; however, their comparative long-term effects on lipid and cardiometabolic parameters in real-world settings remain insufficiently explored. Objectives: This 12-month observational study compared the longitudinal effects of SGLT-2 and DPP-4 inhibitors on lipid profiles-total cholesterol, triglycerides, LDL-C, HDL-C, and VLDL-C-and assessed potential cardiometabolic benefits beyond glycaemic control. Materials and Methods: A prospective, real-world observational study was conducted at a tertiary care hospital over 12 months. A total of 252 patients with T2DM were enrolled; after excluding 52 patients lost to follow-up, 200 participants completed the study. Patients were divided equally into two groups: Group A (SGLT-2 inhibitors) and Group B (DPP-4 inhibitors). Lipid and cardiometabolic parameters were measured at baseline, 3, 6, 9, and 12 months. Statistical analyses were performed using SPSS version 31.0, employing paired t-tests, repeated measures ANOVA, and post hoc Bonferroni and Sidak tests, with p<0.05 considered significant. Results: Compared to DPP-4 inhibitors, SGLT-2 inhibitors produced greater reductions in total cholesterol (-20 mg/dL), triglycerides (-19.95 mg/ dL), LDL-C (-20.98 mg/dL), and VLDL-C (-8.04 mg/dL), along with a more pronounced increase in HDL-C (+8.02 mg/dL vs. +2.00 mg/dL). These changes, alongside modest improvements in anthropometric indices, suggest favourable cardiometabolic effects and a potential reduction in cardiovascular risk. Conclusion: SGLT-2 inhibitors demonstrated superior lipid-modifying and cardiometabolic benefits compared with DPP-4 inhibitors, reinforcing their dual role in improving both metabolic control and cardiovascular risk profiles in patients with type 2 diabetes. Larger randomized controlled studies are warranted to validate these real-world findings.