Effect of henagliflozin on aging biomarkers in patients with type 2 diabetes: A multicenter, randomized, double-blind, placebo-controlled study

Sodium-glucose cotransporter-2 inhibitors have been proposed as caloric restriction mimetics with potential anti-aging effects. However, clinical data on their influence on aging biomarkers are limited. In this multicenter, randomized, double-blind, placebo-controlled trial, 150 participants with type 2 diabetes are randomized (1:1) to receive oral henagliflozin (10 mg/day) or placebo for 26 weeks. Compared with placebo, henagliflozin significantly increases telomere length (primary endpoint), insulin-like growth factor-binding protein-3 levels, and β-hydroxybutyrate levels and improves glucose metabolism. Immune analysis reveals that henagliflozin significantly increases granzyme B expression in cytotoxic T lymphocytes (CTLs) and tends to increase perforin expression in CTLs and perforin and granzyme B expression in total T lymphocytes. Metabolomic analysis shows that henagliflozin induces changes in various metabolites, including increased thiamine levels and enhanced thiamine metabolism. These findings suggest that henagliflozin may exert anti-aging effects through multiple pathways. This study is registered at Chinese Clinical Trial Registry (ChiCTR2300068127).