Longitudinal changes in glycaemic, renal, and lipid parameters among Malaysian patients on SGLT2 inhibitors: A real-world retrospective study

Objectives: Sodium-glucose cotransporter-2 inhibitors offer proven cardiometabolic and renal benefits, yet real-world evidence from Southeast Asian populations remains limited. This study evaluated 12-month outcomes in a Malaysian outpatient cohort initiated on sodium-glucose cotransporter-2 inhibitors. Methods: This real-world retrospective cohort study was conducted using routinely collected electronic health record data from a tertiary public hospital in Malaysia and was registered with the National Medical Research Register (NMRR). Adult outpatients with new prescriptions for empagliflozin or dapagliflozin between January 2019 and December 2023 were identified through systematic screening of hospital electronic medical records. Patients with available clinical or laboratory follow-up data at approximately 3 months were included and followed for up to 12 months. The primary outcomes were longitudinal changes in glycaemic, renal, lipid, and haemodynamic parameters. Secondary outcomes included changes in urine protein categories, heart failure hospitalisation, all-cause mortality, and treatment-related adverse events. Longitudinal changes were primarily assessed using paired comparisons, with exploratory adjusted analyses performed for selected clinical outcomes to account for key baseline confounders. Results: A total of 116 patients (mean age 56.1 ± 13.4 years; 76.7% male) were included. The majority had type 2 diabetes mellitus (94.8%), hypertension (81.0%), and dyslipidaemia (52.6%). Empagliflozin was prescribed in 97.4% of cases. Significant reductions were observed in body weight at all follow-up timepoints (e.g., 3 months: −2.8 kg, P < 0.001) and glycated haemoglobin (12 months: −0.54%, P = 0.002), with a consistent increase in high-density lipoprotein cholesterol (12 months: +0.08 mM, P = 0.027). During follow-up, 15 patients (12.9%) were hospitalised for heart failure and 5 patients (4.3%) died. Conclusion: Sodium–glucose cotransporter-2 inhibitors were well tolerated and associated with sustained metabolic benefits in a high-risk Malaysian outpatient population. Changes in renal indices were consistent with recognised haemodynamic effects observed after SGLT2 inhibitor initiation in routine clinical practice and did not raise major safety concerns in this real-world cohort. These findings support the integration of SGLT2 inhibitors into routine care, particularly in settings with a high cardiometabolic burden.