Once-daily oral drugs that make the kidneys shed excess sugar. Proven to protect the heart and kidneys and lower death risk, even without diabetes. Benefits are strongest in people with existing heart or kidney disease; the aging-slowing promise is unproven. Generally well tolerated, but yeast infections and dangerous blood-acid buildup are real risks. (Full Review)
| Marker | Target | Why |
|---|---|---|
| eGFR | >90 mL/min/1.73 m² ideal; stable values acceptable | Detects kidney response and injury |
| Serum creatinine | 0.6–1.1 mg/dL (women), 0.7–1.3 mg/dL (men) | Tracks kidney function alongside eGFR |
| HbA1c | <5.4% functional; <5.7% conventional non-diabetic | Assesses glucose response |
| Fasting glucose | 70–85 mg/dL functional; <100 mg/dL conventional | Monitors glycemic effect and hypoglycemia risk |
| Beta-hydroxybutyrate | <0.6 mmol/L at rest | Screens for ketoacidosis risk during illness or fasting |
| Electrolytes (sodium, potassium, magnesium) | Mid-normal range | Detects shifts from the diuretic effect |
| Blood pressure (standing and seated) | ~110–125 / 70–80 mmHg | Detects excessive lowering and orthostatic drops |
| Uric acid | 3.5–5.5 mg/dL | Tracks a secondary metabolic benefit |
Cadence: Baseline before starting, then at 2–4 weeks and 3 months, and every 6–12 months thereafter if stable; more frequent in older adults or those with reduced kidney function