Canagliflozin - Another Top Longevity Drug

Nice find. It’s association, but still, the numbers are impressive. Are SGLT2i very good or is metformin very mediocre?

“Results

- Among 74,975 matched patients in each cohort, SGLT2i use was associated with a lower incidence of overall dementia: 2.7% vs. 6.9%: adjusted hazard ratio (aHR) 0.80 [95% CI 0.76;0.84]. Reductions were observed in vascular dementia (0.8% vs. 2.0%; aHR 0.87), Alzheimer’s dementia (1.1% vs. 3.2%; aHR, 0.76), and all-cause mortality (6.8% vs. 15.4%; aHR, 0.92). Benefits were pronounced in older adults, particularly those aged ≥80 years.”

“Benefits were pronounced in older adults, particularly those aged ≥80 years.”

Well, you expect that since dementia (and ACM) increase with age, if there are benefits, they would be more pronounced in older adults.

What would be of interest is how long does one have to be on SGLT2i to start seeing benefits and are these a steady amount per year, or are the benefits cumulative with time beyond that steady level.

Obviously, we are talking about high risk individuals with significant morbidities. How does this map out for people on these agents who don’t have these morbidities, that’s the question for those who take them for longevity/healthspan purposes.

They make a point that of course these are associations, but the RCTs are inconsistent. One wonders about the numbers of people in these RCTs, if adequately powered.

“[…] this association remains unconfirmed due to inconsistent findings across studies, particularly randomized trials.”

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Impact of sodium-glucose cotransporter-2 inhibitors on aging biomarkers and plasma ceramide levels in type 2 diabetes: beyond glycemic control

Results: SGLT2i-treated patients showed significantly lower CerC16:0, CerC22:0, and CerC24:1 levels (p < 0.01) and decreased 5MC and H2AX (p < 0.05) compared to non-SGLT2i patients. IGF-1 was significantly elevated in the SGLT2i group (p < 0.01), suggesting a possible protective effect on metabolic health. PCA distinguished control from diabetic groups but revealed overlap between SGLT2i and non-SGLT2i groups.

Conclusion: Beyond glucose control, SGLT2i may improve plasma Cer and aging markers in diabetic patients, supporting their broader therapeutic potential in aging and age-related diseases. Further large-scale studies are warranted to confirm these effects and underlying mechanisms.

Open access paper:

https://www.mdpi.com/1648-9144/61/2/209

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Effects of empagliflozin and dapagliflozin, SGLT2 inhibitors, on miRNA expressions in diabetes-related cardiovascular damage in rats 2025

Empagliflozin and dapagliflozin affect miRNA expressions on diabetic rat heart.
Empagliflozin and dapagliflozin may have different cardioprotective mechanisms.
Dapagliflozin shows protective effect on thoracic aortas.

Association between sodium-glucose cotransporter 2 inhibitors and cancer: a systematic review and meta-analysis of randomized active-controlled trials 2025

SGLT2 inhibitors showed neutral cancer risk in T2DM patients but may reduce gastrointestinal cancer versus metformin, guiding tailored therapy based on patient risk profiles.

Impact of sodium-glucose cotransporter-2 inhibitors on aging biomarkers and plasma ceramide levels in type 2 diabetes: beyond glycemic control 2025

SGLT2i-treated patients showed significantly lower CerC16:0, CerC22:0, and CerC24:1 levels (p < 0.01) and decreased 5MC and H2AX (p < 0.05) compared to non-SGLT2i patients. IGF-1 was significantly elevated in the SGLT2i group (p < 0.01), suggesting a possible protective effect on metabolic health. PCA distinguished control from diabetic groups but revealed overlap between SGLT2i and non-SGLT2i groups.
Beyond glucose control, SGLT2i may improve plasma Cer and aging markers in diabetic patients, supporting their broader therapeutic potential in aging and age-related diseases. Further large-scale studies are warranted to confirm these effects and underlying mechanisms.

SGLT2i continuously prevents cardiac hypertrophy by reducing ferroptosis via AMPK up-regulation 2025

Unexpectedly, mechanistic studies revealed that antagonism of AMPK aggravated oxidative stress and ferroptosis, reduced GPX4 (glutathione peroxidase 4) level, and partially abolished the anti-hypertrophic and anti-ferroptosis effects of SGLT2i in H9C2 cells. Taken together, the regulatory role between AMPK and ferroptosis was revealed for the first time in cardiac hypertrophy. SGLT2i counteracts ferroptosis by activating AMPK, providing a sustained protection against cardiac hypertrophy. This positions SGLT2i as a potential therapeutic agent for the treatment of cardiac hypertrophy. Besides, in addition to the downregulation of AMPK in hypertrophic heart tissue, its levels are also reduced in plasma, suggesting its potential to serve as a diagnostic marker for the early detection of ferroptosis and cardiac hypertrophy.

(poke @John_Hemming, on AMPK activation)

Neuroprotective roles of SGLT2 and DPP4 inhibitors: Modulating ketone metabolism and suppressing NLRP3 inflammasome in T2D induced Alzheimer’s disease 2025

SGLT2-i and DPP4-i enhance ketone metabolism in the brain.
SGLT2-i and DPP4-i suppress neuroinflammation and promote M2 microglial polarization.
SGLT2-i and DPP4-i inhibit NLRP3 inflammasome activation through distinct pathways.

SGLT2 Inhibitors and Cardiovascular Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Cohort Analysis 2025

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Dapagliflozin activates the RAP1B/NRF2/GPX4 signaling and promotes mitochondrial biogenesis to alleviate vascular endothelial ferroptosis 2025

The SGLT2 inhibitor canagliflozin attenuates mitochondrial oxidative stress and alterations of calcium handling induced by high glucose in human cardiac fibroblasts 2025

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Beautiful collection of papers, thank you Antoine!

I really hope we can dig into the disparate effects of SGLTi, because we all take different ones, and many papers that find effects lump them all together which severely limits the actionability of such findings.

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Have we seen this in other studies?

Have people seen their IGF-1 go up after starting?

(Not sure we want it to go up and do the extent flozins are CR mimetics I would have thought IGF-1 to go down if anything and not up)

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Fully agreed. I really wish I had measured my serum IGF-1 level before I started taking empagliflozin, but alas, I did not, as I was not aware that there was any impact of SGLTi on IGF-1 levels. I did however measure my level recently after 5 months of daily 12.5mg empagliflozin. It showed as 132 ng/mL, (reference interval 68-247). I wish I had a before and after reading, but regrettably, I don’t. FWIW, Dr. Fuhrman pegs optimal levels as between 80 and 150:

So whatever empaglifozin might or might not be doing to my IGF-1 levels, it doesn’t appear that at 12mg/day for five months takes me far out of the (presumably) reasonable range at age 66. YMMV.

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SGLTi in general seem very safe, even in people with chronic conditions. UTI incidence is slightly elevated in people with diabetes, but not seemingly in other conditions.

Update on the Efficacy and Safety of Sodium–Glucose Co-Transporter 2 Inhibitors in Patients with Chronic Diseases: A Systematic Review and Meta-Analysis

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A new open access paper:

Dapagliflozin ameliorates intestinal stem cell aging by regulating the MAPK signaling pathway in Drosophila

Introduction: Intestinal stem cells (ISCs) possess the ability to self-renew and differentiate, which is essential for maintaining intestinal tissue homeostasis. However, their functionality significantly declines with age, leading to diminished tissue regeneration and an increased risk of age-associated diseases.

Methods: This study investigates the effects of Dapagliflozin (DAPA), a novel insulin sensitizer and SGLT2 inhibitor, on aging ISCs using the Drosophila melanogaster model. Our findings demonstrate that DAPA can inhibit the MAPK signaling pathway, as confirmed by network pharmacology analysis and molecular docking experiments.

Results: DAPA ameliorates ISC aging, improves intestinal function (including enhanced fecal excretion, restored intestinal barrier integrity and acid-base balance), and enhances healthspan. These results highlight the potential of DAPA as an anti-aging therapeutic agent.

Discussion: This study provides new evidence for the application of DAPA as an anti-aging treatment.

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I have been taking a half dose of dapagliflozin (5mg) and had my serum uric acid come back at 2.1 (LabCorp reference range: 3.8-8.4 mg/dL) in spite of 180mg of bempedoic acid daily. Openevidence says this is not a concern if it’s due to an SGLT2i, and my eGFR-cys is 118, so my renal function is fine. Has anyone successfully raised uric acid that is too low? I rarely drink alcohol and don’t wish to start, but I am considering a pro-gout diet if necessary.

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Some people find that eating more fish, like sardines, can raise your uric acid. I was on 12.5mg/day of empagliflozin (just bumped it up to 25mg/day), and LabCorp measured me at 3, which was also flagged as “low”. I’m fine with 3. The 2.1 is a little aggressive. Perhaps sardines.

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I wish I could develop a tolerance for sardines but I have failed three times. This list suggests I can supplement brewer’s yeast or spirulina. Maybe royal jelly too. I’ll see how it goes and report back. https://www.jstage.jst.go.jp/article/bpb/37/5/37_b13-00967/_html

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Empagliflozin: sex-specific effects on mitochondrial function and cellular redox-balance in HFPEF and MASLD 2025

Conclusions: Empagliflozin has distinct sex-specific effects in a diet-induced model of HFpEF and MASLD. It enhances cardiac and hepatic mitochondrial function in males while yielding different outcomes in females. Males experience a stronger impact from empagliflozin on cardiac mitochondrial respiration, while stronger effects on hepatic mitochondrial respiration could be detected in females. These findings underscore the importance of incorporating sex-based analyses in HFpEF and MASLD research, as responses to empagliflozin may vary significantly between sexes, potentially influencing treatment strategies.

Impact of SGLT-2 inhibitors on metabolic and cardiovascular health: a comparative analysis of patients with and without diabetes 2025

Dapagliflozin offers significant improvements in glycemic control, weight loss, and cardiac function in diabetic patients, while non-diabetic individuals experience notable cardiovascular benefits and modest weight loss. Gender differences in response suggest that men benefit more from reductions in fasting glucose and BMI, while women show more significant improvements in postprandial glucose levels. These findings support the broader use of dapagliflozin for managing cardiometabolic health beyond diabetes.

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Nice. The empa study is in obesity induced rats. Would be interesting to see general effects in non morbid rats. Of course they’d have to select different criteria, as there would be no NAFLD etc. The dapa study in humans is great, can’t wait for more.

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05/03/2021 - 174ng/ml
11/25/2024 - 200ng/ml (~2 months of Empagliflozin 25mg/day)
01/02/2025 - 206ng/ml

Of course, many changes between 2021 and 2024, but I’m not aware of any other changes I’ve made that scream impact on IGF-1. If anything, 3 years of aging should have reduced it slightly. I’m 32 for reference.

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SGLT2 inhibitors as a novel senotherapeutic approach 2025

King’s College London + Imperial College + Queen Mary University

Cellular senescence is the permanent cessation of cell proliferation and growth. Senescent cells accumulating in tissues and organs with aging contribute to many chronic diseases, mainly through the secretion of a pro-inflammatory senescence-associated secretory phenotype (SASP). Senotherapeutic (senolytic or senomorphic) strategies targeting senescent cells or/and their SASP are being developed to prolong healthy lifespan and treat age-related pathologies. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of anti-diabetic drugs that promote the renal excretion of glucose, resulting in lower blood glucose levels. Beyond their glucose-lowering effects, SGLT2 inhibitors have demonstrated protective effects against cardiovascular and renal events. Moreover, SGLT2 inhibitors have recently been associated with the inhibition of cell senescence, making them a promising therapeutic approach for targeting senescence and aging. This review examines the latest research on the senotherapeutic potential of SGLT2 inhibitors.

In conclusion, the present findings indicate the clinical potential of SGLT2 inhibition in preventing or delaying age-related diseases through a plethora of mechanisms. Thus, further studies are required to elucidate the efficacy and safety of SGLT2 inhibitors as a senotherapeutic for age-related pathologies.

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Most of the sglt2i are in slow release tabs that shouldn’t be split. Is dapa different?

A doctor told me to split them. This is a list of inactive ingredients on the first search result hit. None of them indicate enteric coating or slow release. Two indicate the opposite.

Microcrystalline cellulose: A filler and binder, often used in immediate-release and controlled-release formulations but not specific to either.

Anhydrous lactose: A filler or diluent, typically in immediate-release tablets.

Crospovidone: A disintegrant that promotes rapid tablet breakdown for immediate release.

Silicon dioxide: A glidant or anti-caking agent, not related to release properties.

Magnesium stearate: A lubricant to aid tablet manufacturing, not specific to release type.

Grok confirms:
Dapagliflozin, sold under brand names like Farxiga (US) and Forxiga (EU), is a sodium-glucose cotransporter 2 (SGLT2) inhibitor primarily used for type 2 diabetes, heart failure, and chronic kidney disease. Based on available information, dapagliflozin is typically formulated as an immediate-release tablet, not as an enteric-coated or slow-release (sustained-release) formulation.Key Points:Formulation: Dapagliflozin tablets are film-coated, but the coating is not described as enteric or designed for delayed or controlled release. The film coating is primarily for stability, ease of swallowing, or aesthetic purposes, not for modifying release kinetics. Pharmacokinetic data indicate that dapagliflozin reaches maximum plasma concentration (Cmax) within 1-2 hours after oral administration in a fasting state, consistent with immediate-release formulations.No Enteric Coating: There is no evidence from standard references, including the drug’s package insert or pharmacological profiles, suggesting that dapagliflozin requires or commonly uses an enteric coating. Enteric coatings are typically used for drugs that are acid-labile, irritate the stomach, or target intestinal release (e.g., proton pump inhibitors or aspirin). Dapagliflozin does not have these characteristics, as it is stable in gastric pH and absorbed primarily in the small intestine after rapid dissolution.No Slow-Release Formulation: Dapagliflozin is not marketed as a slow-release or extended-release product. Its mechanism of action relies on inhibiting SGLT2 in the kidneys to promote glucose excretion, which does not necessitate prolonged release. The drug’s half-life (approximately 12.9 hours) supports once-daily dosing without the need for modified-release technology.Clinical Use: The immediate-release nature of dapagliflozin aligns with its therapeutic goal of achieving rapid and consistent glucose-lowering effects. Modified-release formulations are more common for drugs requiring reduced dosing frequency or minimized peak-trough fluctuations, which is not a primary concern for dapagliflozin.Supporting Evidence:The FDA-approved prescribing information for Farxiga describes dapagliflozin as a film-coated tablet available in 5 mg and 10 mg strengths, with no mention of enteric or controlled-release properties.Pharmacokinetic studies show that dapagliflozin’s absorption is rapid, with urinary glucose excretion effects observed soon after administration, further supporting an immediate-release profile.Unlike medications such as enteric-coated aspirin or extended-release metformin (e.g., Glucophage XR), dapagliflozin’s formulation does not include polymers like hydroxypropyl methylcellulose (HPMC) or methacrylic acid copolymers (e.g., Eudragit) commonly used for enteric or slow-release coatings.Conclusion:Dapagliflozin does not have to be and is not usually enteric-coated or slow-release. It is formulated as an immediate-release, film-coated tablet for rapid absorption and onset of action. If you have a specific brand or formulation in mind, please provide additional details, and I can investigate further. Always consult your healthcare provider for guidance on your specific medication.

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I don’t believe that is accurate, I think most of them can be split. The companies like to promote this idea so you won’t save money and will buy the lower dose/ higher price tablets, but I think they likely work just as well split. See this thread: Which pills can be split and in what dose and which cannot be split

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I have split dapa and monitored with a cgm. I did not see any issue.

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and I have split empagliflozin and monitored with CGM and all works as expected (greatly reduced blood glucose spikes).

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