Compare
Side by side.
| SGLT2 inhibitors | Metformin | |
|---|---|---|
| Evidence | GRADE A | GRADE B |
| Category | metabolic | metabolic |
| Status | Rx | Rx |
| Typical cost | $30–$600 / mo | $5–$20 / mo |
| Mechanism | Block glucose re-absorption in the kidney, lowering blood sugar and producing mild calorie loss, diuresis and metabolic shifts toward fat burning. | Lowers glucose production by the liver and improves insulin sensitivity. It mildly affects mitochondrial energy signaling (AMPK), which may mimic some effects of caloric restriction. |
| Human evidence | EMPA-REG, EMPEROR and EMPA-KIDNEY trials showed reduced cardiovascular death, heart-failure hospitalization and kidney decline. Canagliflozin extended lifespan in male mice in the ITP. | Observational data suggest diabetics on metformin may have outcomes comparable to non-diabetics. The TAME trial is designed to test aging outcomes but has not reported. Some data suggest it can blunt exercise adaptations in older adults. |
| Side effects | Genital yeast infections · Dehydration · Rare euglycemic ketoacidosis | GI upset, diarrhea · Vitamin B12 deficiency with long use · Rare lactic acidosis (kidney impairment) |
Not medical advice — talk to a licensed clinician. Content is educational, reflects published literature, and is not a recommendation to start, stop or change any treatment.