SGLT2 inhibitors

SGLT2 inhibitors (gliflozins, e.g. empagliflozin, dapagliflozin) block renal sodium-glucose cotransporter 2, causing urinary glucose excretion. They are approved for type 2 diabetes, heart failure (preserved and reduced ejection fraction), and chronic kidney disease, with robust cardiovascular and renal mortality benefits. Proposed mechanisms include a hypothesized ketone-mediated cardiac fuel shift, mild caloric loss, and reduced glomerular hyperfiltration, though the dominant pathway remains debated. Canagliflozin extended lifespan in male mice. Off-label longevity use in non-indicated adults remains investigational.