INTRODUCTION: Individuals with both obesity and type 2 diabetes mellitus (T2DM) are at heightened risk for developing cardiovascular and kidney-related complications. Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, has shown promising effects on heart health and renal function. This study aims to evaluate the influence of empagliflozin on these outcomes among Chinese patients suffering from obesity and T2DM. METHODS: This study included 500 adults with obesity and T2DM who were treated with empagliflozin for at least 6 months. Demographic information, clinical data, and treatment records were collected. Primary outcomes included changes in cardiovascular parameters and renal function measured at 1 week and 1, 3, and 6 months after treatment initiation. Secondary outcomes included heart failure hospitalization, mortality, and safety events. RESULTS: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed significant reductions after 6 months of empagliflozin therapy (p <
0.002). Renal function improved significantly, with a rise in estimated glomerular filtration rate (eGFR) and a decline in serum creatinine levels (p <
0.01). Glycated hemoglobin (HbA1c) levels initially increased after 1 week but continued to decrease thereafter (p <
0.002). Albuminuria modestly reduced over time, with significant decreases from baseline to 3 months (p <
0.01). Body weight was also significantly reduced after 6 months (p <
0.002). Major adverse cardiovascular events (MACE) occurred in 8.4% of patients, and 1.0% progressed to end-stage renal disease. Multivariate analysis identified higher HbA1c levels and lower DBP as significant predictors of MACE, while reduced eGFR and elevated albuminuria were significant predictors of chronic kidney disease (p <
0.05). CONCLUSION: Empagliflozin significantly improved cardiovascular and renal outcomes in Chinese populations with obesity and T2DM, with sustained benefits observed over 6 months. Elevated HbA1c, lower DBP, increased albuminuria, and reduced eGFR were associated with higher risks of adverse events during treatment period, highlighting the necessity of careful monitoring in high-risk patients.