SGLT2 inhibitors

In people, the strong results are in disease. Empagliflozin lowered cardiovascular death by 38% and death from any cause by 32% in patients with type 2 diabetes and heart disease [1], slowed kidney disease in people with or without diabetes [2], and cut heart failure hospitalizations in heart failure with preserved ejection fraction [3]. Across outcome trials, the class lowered death and heart and kidney events but raised the risk of genital infections and diabetic ketoacidosis [4].

The longevity case rests on animals. Canagliflozin extended median survival by 14% in male mice, with no gain in females [5].

No trial has tested an SGLT2 inhibitor in healthy people without diabetes, heart or kidney disease, so whether it slows aging or extends life in them is unknown.

• SGLT2 inhibitors are prescription drugs approved for type 2 diabetes, heart failure and chronic kidney disease. Use for longevity in healthy people is off-label and untested.
• Genital yeast infections are common, and urinary tract infections are more likely.
• They can cause ketoacidosis, sometimes with normal blood sugar, especially with low-carbohydrate diets, fasting, heavy exercise, illness or surgery. Doctors usually pause them before surgery.
• They increase urination and can cause dehydration or low blood pressure, so people on diuretics or with low blood pressure need care.
• They are not for type 1 diabetes outside specialist care, or for pregnancy.