Effects of Hypoglycemic and Hypolipidemic Drugs on Intestinal Microbiocenosis in Cardiometabolic Disorders

Introduction. Intestinal microbiocenosis plays a key role in maintaining the body’s homeostasis, but its composition can be disrupted by various factors, including medications. Currently, the effect of antibiotics on intestinal microbiocenosis is well studied, data on the effects of non-antibiotic, hypoglycemic and lipid-lowering drugs remain fragmentary. The aim of the study – to conduct a retrospective review of modern studies on the effect of non-antibiotic hypoglycemic and hypolipidemic pharmacological agents on the qualitative and quantitative composition of intestinal microbiocenosis in patients with cardiometabolic disorders. Materials and methods. A search was performed for scientific publications in the accessible scientific electronic databases PubMed, Researchgate, Scopus and Web of Science for the period from 2010 to 2025 for keywords related to the microbiome, drugs and dysbiosis. The review includes only human studies to ensure the clinical relevance of the results. Results. It has been established that non-antibiotic drugs, including hypoglycemic agents (metformin, SGLT2 inhibitors – dapagliflozin, empagliflozin; DPP-4 inhibitors – linagliptin, vildagliptin) and lipid-lowering agents (statins – atorvastatin, rosuvastatin; fenofibrate, ezetimibe), cause specific and reproducible changes in the taxonomic profile of the intestinal microbiota in patients with metabolic disorders. The most significant effects include: an increase in Akkermansia muciniphila when taking metformin and fenofibrate; the growth of Faecalibacterium prausnitzii and Bifidobacterium longum under the action of SGLT2 and DPP-4 inhibitors; a decrease in the α-diversity of the microbiota when using statins; and minimal but statistically significant changes when taking ezetimibe. Discussion and conclusion. The data obtained indicate that modern hypoglycemic and hypolipidemic drugs have microbiome-modulating potential. Some of these changes (e.g. the growth of A. muciniphila and F. prausnitzii) may partially explain the therapeutic effects of the drugs, including improving tissue sensitivity to insulin, reduced inflammation, and endothelial protection. At the same time, statins are associated with moderate dysbiosis, which requires consideration during long-term therapy. The results highlight the need to integrate microbiome profiling into a personalized approach to the treatment of patients with type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Further prospective studies are required to assess the clinical significance of the identified microbiotic shifts and develop strategies for their correction.