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Background This retrospective real-world study evaluated saroglitazar 4 mg in Indian adults with type 2 diabetes mellitus (T2DM) and dyslipidemia. Methods Six hundred patients receiving saroglitazar 4 mg at Dr Aravind's Diabetes Centre, Bengaluru, were assessed at baseline, four months, and six months. Glycemic, lipid, hepatic, FibroScan, renal, and anthropometric parameters were analyzed using paired t-tests. Results Significant improvements were observed across all outcomes (p<0.0001). Fasting blood sugar (FBS) decreased by 101.81 mg/dL, postprandial blood sugar (PPBS) by 111.58 mg/dL, and HbA1c from 8.90% to 7.61%. Triglycerides reduced by 163.34 mg/dL, high-density lipoprotein cholesterol (HDL-C) increased by 9.25 mg/dL, and total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) decreased. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), controlled attenuation parameter (CAP) score, liver stiffness measurement (LSM), serum creatinine, estimated glomerular filtration rate (eGFR), and body weight also improved. Conclusion Saroglitazar 4 mg significantly improved glycemic, lipid, hepatic, renal, and weight-related outcomes over six months in patients with T2DM and dyslipidemia.