The Diabetes Drug I Take Without Diabetes
The SGLT2 inhibitors carry hard outcome data in tens of thousands of people and a lifespan signal in mice. Why I take one without diabetes, and what it costs.
William H. Light, MD
10/25/20261 min read
Some drugs earn a place on a longevity list through a mouse study. This class earned it through outcome trials in people.
These drugs (the SGLT2 inhibitors, the “-gliflozins”) make the kidney let a little sugar go into the urine. That lowers blood glucose, but it was never the main event. In the large trials, people taking them were hospitalized less often for heart failure, their kidney disease progressed more slowly, and fewer of them died.
Two trials carry most of the weight. In EMPA-REG OUTCOME, seven thousand people with type 2 diabetes and heart disease took empagliflozin or placebo for about three years, and deaths from any cause fell from 8.3 percent to 5.7 percent. Treat thirty-eight people for three years and you prevent one death. In DAPA-CKD, forty-three hundred people with chronic kidney disease, a third of them without diabetes, took dapagliflozin or placebo. All-cause mortality fell from 6.8 to 4.7 percent, and the trial was stopped early because the benefit was clear.
The class has one more thing almost nothing else on a longevity list can claim. One member, canagliflozin, lengthened the lives of male mice in the National Institute on Aging’s Interventions Testing Program. That puts human outcomes and an animal lifespan signal in the same drug class.
I take one (bexagliflozin, 20 mg) without having diabetes. That is an extrapolation from the trials, and I want to be honest that it is one. I chose that member of the class on price: about fifty dollars a month through a pharmacy that publishes its markup, against five or six hundred for the better-known brands.
It is a prescription drug with real side effects, among them genital yeast infections, dehydration and, rarely, a dangerous form of ketoacidosis. It’s a conversation to have with your physician, not a supplement to order.
Adapted from Outlast: A Doctor’s Guide to Longevity, by William H. Light, M.D.