These drugs are prescription medications for type 2 diabetes that make the kidneys pass excess sugar into the urine. In heart failure, long-term kidney disease or high-risk type 2 diabetes, they reduce hospital stays for heart failure and slow kidney decline. The case for slowing aging rests on male mice and gene studies. Main risks: genital yeast infections and a rare, dangerous blood-acid buildup. For healthy adults, benefits remain unmeasured. (Full Review)
| Marker | Target | Why |
|---|---|---|
| eGFR and serum creatinine | Creatinine men 0.74–1.35 mg/dL, women 0.59–1.04 mg/dL; eGFR: no established target, track change from own baseline | Safety check: guides starting and continuing |
| HbA1c | 4.0–5.6% | Falls, mainly in diabetes |
| Blood beta-hydroxybutyrate | Below 0.4 mmol/L; compare with own baseline | Safety check: rising ketones signal possible ketoacidosis |
| Hematocrit | Men 41–50%, women 36–44% | Expected to rise |
| Serum uric acid | Men 3.4–7.0 mg/dL, women 2.4–6.0 mg/dL | Expected to fall |
| Urine albumin-to-creatinine ratio | Below 30 mg/g | Expected to fall |
| LDL-C | No established target; compare with own baseline | May rise slightly |
| Blood pressure (seated and standing) | No established target; compare with own baseline | Expected to fall; safety check for hypotension |
| Lean mass on DXA | No established target; compare with own baseline | Safety check: meaningful loss may prompt changes |
| ALT | 7–56 U/L | Expected to fall in fatty liver |
Cadence: Baseline before starting; eGFR at 2–4 weeks after starting, then every 6–12 months; HbA1c, lipids, hematocrit, uric acid, urine albumin-to-creatinine ratio and ALT at 3 months, then every 6–12 months; home blood pressure weekly during the first month; blood ketones whenever ill, fasting or before procedures; body composition annually