Longitudinal Improvement in Waist-to-Height Ratio During SGLT-2 Inhibitor Therapy Within a Structured Multidisciplinary Care Model: A Prospective Real-World Cohort Study

Background/Objectives: The waist-to-height ratio (WHtR) is a sensitive marker of central obesity. This study examined the longitudinal trajectory of WHtR in patients with type 2 diabetes (T2DM) initiating sodium–glucose cotransporter-2 (SGLT-2) inhibitor therapy within a structured, physician-supported multidisciplinary care model. Methods: This prospective observational cohort study included 140 adults with T2DM initiating SGLT-2 inhibitor therapy, followed at a diabetes outpatient clinic by a physician, diabetes nurse, and dietitian. Anthropometric and bioimpedance measurements, physical activity, and dietary adherence were assessed at baseline, month 3, and month 6. Longitudinal changes were analyzed by repeated-measures ANOVA with Bonferroni-corrected post hoc tests, and linear mixed-effects models assessed factors associated with WHtR over time. Results: Mean age was 54.08 ± 11.40 years, and 49.3% of participants were female. WHtR decreased from 0.665 ± 0.101 at baseline to 0.635 ± 0.096 at month 3 and 0.629 ± 0.096 at month 6 (p < 0.001). Body weight (87.68 ± 18.68 to 84.18 ± 17.01 kg), BMI, and waist, hip, and neck circumferences all decreased significantly (p < 0.001), while physical activity and Mediterranean diet adherence increased (p < 0.001). In the mixed-effects model, WHtR remained significantly lower at month 3 (β = −0.029) and month 6 (β = −0.035) than at baseline (both p < 0.001) after multivariable adjustment. Female sex was associated with a higher WHtR level (β = 0.095, p < 0.001), whereas the reduction in WHtR did not differ by sex (p = 0.167). Conclusions: Initiating SGLT-2 inhibitor therapy within a structured multidisciplinary diabetes care model was associated with a significant reduction in central adiposity over six months, most notably reflected by WHtR. These findings support WHtR as a simple tool for monitoring treatment response in patients with T2DM; as mean WHtR remained above 0.5, it may also help identify patients requiring further intervention.