Effects of metformin versus sulfonylureas on atherogenic indices and cardiometabolic risk in type 2 diabetes mellitus

Introduction Atherogenic dyslipidaemia is a common feature of type 2 diabetes mellitus (T2DM) and contributes substantially to increased cardiovascular risk. Antidiabetic therapies may exert differential effects on lipid metabolism and atherogenic markers. Methods This retrospective study included 80 patients with T2DM, equally divided into two groups ( n = 40 each) according to treatment regimen: metformin or sulfonylurea. Clinical and biochemical parameters including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and non-high-density lipoprotein (non-HDL) cholesterol were assessed at baseline and after 3 months of therapy. Correlation and regression analyses were performed to evaluate associations between glycaemic parameters and lipid profile. Results Metformin achieved significantly greater reductions in HbA1c, total cholesterol, and non-HDL cholesterol compared with sulfonylurea ( p < 0.05), while differences in FBG, TG, and HDL were not statistically significant ( p > 0.05). Regression analysis identified FBG and HbA1c as independent predictors of non-HDL cholesterol levels. Pearson correlation analysis demonstrated significant positive correlations between glycaemic parameters (FBG and HbA1c) and atherogenic lipids (TC, TG, and non-HDL), whereas HDL showed inverse correlations. A strong correlation between total cholesterol and non-HDL cholesterol was also observed. Clustering of cardiometabolic risk factors, including body mass index and blood pressure, was more pronounced in the sulfonylurea group. Conclusion Metformin appears to be more effective than sulfonylurea in improving both glycaemic control and atherogenic lipid profile. These findings suggest that metformin may confer additional cardiovascular benefits in patients with T2DM by reducing atherogenic risk.