A prescription medicine that makes the kidneys flush sugar into the urine, lowering blood sugar, weight, blood pressure and uric acid, and protecting the kidneys and heart in people with diabetes and kidney or heart disease. Genital fungal infections are common; dangerous acid buildup can occur at normal blood sugar. The longevity case rests almost entirely on mice. (Full Review)
| Marker | Target | Why |
|---|---|---|
| eGFR | Above 60 mL/min/1.73 m² | Governs both efficacy and eligibility |
| Serum creatinine | 0.6–1.1 mg/dL (women), 0.7–1.3 mg/dL (men) | Detects volume depletion and acute kidney injury |
| Urine albumin-to-creatinine ratio | Below 10 mg/g | Tracks the kidney benefit directly |
| Serum potassium | 4.0–4.5 mmol/L | Detects hyperkalaemia when combined with renin-angiotensin blockers |
| HbA1c | 4.8–5.4% | Confirms glucose effect and flags over-treatment |
| Serum uric acid | 3.5–5.5 mg/dL | Captures one of the more transferable benefits |
| LDL cholesterol | Below 70 mg/dL for those pursuing maximal risk reduction | Detects the expected upward drift |
| Haematocrit | 40–48% (men), 36–44% (women) | Detects excessive blood concentration |
| Beta-hydroxybutyrate | Below 0.6 mmol/L | Early warning for euglycaemic ketoacidosis |
| Serum magnesium and phosphate | Magnesium 2.0–2.6 mg/dL, phosphate 3.0–4.0 mg/dL | Both rise on this drug and relate to bone turnover |
| Bone mineral density | T-score above -1.0 | Detects the hip bone loss seen over two years |
| Body composition | No established target on this drug; track change from the individual's own baseline lean mass | Distinguishes fat loss from muscle loss |
Cadence: Baseline panel before starting; kidney function, electrolytes and standing blood pressure at 2 and 4 weeks; 3 months with lipids and haematocrit; every 6 months once stable. Bone density repeated at 2 years in anyone with reduced baseline bone density. Feet checked daily, and formally at each review.