BACKGROUND

The gut microbiota plays a critical role in metabolic health and type 2 diabetes mellitus (T2DM). Alterations in microbial composition may influence glycemic control and systemic inflammation.

MATERIALS AND METHODS

In this single-center, randomized study, 60 adults with T2DM receiving metformin were evaluated biologically and received either empagliflozin or sitagliptin. Demographic, metabolic, and lifestyle data were collected. Gut microbiota profiling was conducted at two timepoints to assess changes in bacterial and fungal taxa. Blood glucose, HbA1c, and inflammation markers were analyzed longitudinally.

RESULTS

Both treatment groups showed significant improvements in glycemic control. Median fasting glucose decreased from 132 to 123 mg/dL ( = 0.046) in the sitagliptin group and from 131 to 114 mg/dL ( = 0.025) in the empagliflozin group. Median HbA1c levels declined significantly in both groups, with a greater reduction in the empagliflozin group ( = 0.001 vs. = 0.049). The microbiota analysis revealed an increase in beneficial bacteria (e.g., spp. and spp.) and a decrease in pro-inflammatory taxa and spp.). Notably, empagliflozin was associated with a more pronounced microbiota rebalancing and a significant decline in fungal overgrowth (e.g., spp.; = 0.034).

CONCLUSIONS

Treatment with sitagliptin and empagliflozin led to improved glycemic outcomes and partial restoration of gut microbial balance in T2DM patients. Empagliflozin showed superior efficacy in modulating both glycemia and dysbiosis.