Lipid Profile Changes Associated with Different Antidiabetic Treatment Strategies in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Real-World Retrospective Cohort Study
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Background: Dyslipidemia is a major modifiable cardiovascular risk factor in patients with type 2 diabetes mellitus (T2DM). Evidence comparing lipid profile changes associated with SGLT2 inhibitors and metformin in routine clinical practice remains limited. Objective: To compare lipid profile changes among SGLT2 inhibitor monotherapy, SGLT2 inhibitor combined with metformin, and metformin monotherapy in patients with T2DM using real-world clinical data. Methods: A retrospective cohort study was conducted using medical records from two regional referral hospitals in East Kalimantan, Indonesia, between January 2020 and December 2025. A total of 254 patients were included through total sampling: SGLT2 inhibitor monotherapy (n=119), combination therapy (n=11), and metformin monotherapy (n=124). Changes in LDL-C, HDL-C, and triglycerides were analyzed using Wilcoxon signed-rank and Kruskal–Wallis tests. Spearman correlation and multiple linear regression assessed factors associated with lipid changes. Results: Median LDL-C decreased from 146 to 103 mg/dL, triglycerides from 167.5 to 135 mg/dL, and HDL-C increased from 42 to 50 mg/dL (all p<0.001). Improvements occurred in 81.1%, 92.9%, and 93.7% of patients, respectively. No significant between-group differences were observed for LDL-C (p=0.930), HDL-C (p=0.057), or triglycerides (p=0.103). Age was independently associated with HDL-C changes, while systolic blood pressure changes were independently associated with triglyceride changes. Conclusion: Lipid improvements were observed during follow-up, without significant differences among treatment strategies. Given the observational design and unequal group sizes, findings should not be interpreted as evidence of causal effects or therapeutic equivalence.
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