Objectives <p>This study aimed to compare the effects of telmisartan with those of other angiotensin II receptor blockers (ARBs) in improving cardiometabolic parameters in patients with metabolic disorders. The analysis builds on previous research by incorporating more recent trials, additional biomarkers, dose-based subgroup analysis, and subgroup analysis by type of metabolic disorder.</p> Methods <p>We conducted a meta-analysis of randomized controlled trials identified from PubMed, Google Scholar, and EBSCOHost from database inception through June 2025. A total of 20 randomized controlled trials involving adult patients with metabolic disorders were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE framework. Random-effects models were used to pool effect estimates, and heterogeneity was assessed using the I² statistic.</p> Results <p>Compared with other ARBs, telmisartan was associated with a significant improvement in the primary outcome, insulin resistance measured by HOMA-IR (SMD: -0.82, 95% CI: -1.30 to -0.35; <i>p</i> = 0.0007). In contrast, no statistically significant improvement was observed in HbA1c, the most clinically relevant marker of long-term glycemic control. Modest between-group differences favoring telmisartan were observed for secondary surrogate markers, including fasting plasma glucose, triglycerides, and total cholesterol, while adiponectin showed variable and inconsistent changes across studies. No adjustment for multiple comparisons was performed; therefore, statistically significant findings should be interpreted with caution.</p> Conclusion <p>Telmisartan was associated with modest improvements in selected surrogate metabolic markers compared with other ARBs; however, the lack of a significant effect on HbA1c substantially limits the clinical interpretation of these findings, particularly regarding long-term glycemic control.</p>