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The fight against aging is an eternal pursuit of humankind. The aging rate of patients with type 2 diabetes mellitus (T2DM) is higher than that of healthy individuals. Reducing the aging rate of patients with T2DM and extending their life expectancy are challenges that endocrinologists are eager to overcome. Many studies have shown that antidiabetic medications have potent anti-aging potential. Telomeres are repetitive DNA sequences located at the ends of chromosomes, and telomere shortening is a hallmark of aging. This review summarizes clinical trials that have explored the association between antidiabetic medications and telomere length (TL) in patients with T2DM and explore the mystery of delaying aging in patients with T2DM from the perspective of telomeres. Various antidiabetic medications may have different effects on TL in patients with T2DM. Metformin and sitagliptin may protect telomeres in patients with T2DM, while exogenous insulin may promote telomere shortening in patients with T2DM. The effect of acarbose and glyburide on TL in patients with T2DM is still uncertain due to the absence of evidence from longitudinal studies.

Summary and Perspectives

This review summarizes clinical trials on the effect of antidiabetic medications on TL and the related mechanisms that may be involved. The effects of different antidiabetic medications on TL in patients with T2DM varied. Interventional studies28,30have shown that sitagliptin and metformin may prolong the TL of patients with T2DM, which is accompanied by a significant decrease in their blood glucose or HbA1c, suggesting that the telomere extension of these patients may be related to the good control of blood glucose by antidiabetic medications. Interestingly, a longitudinal study37 has shown that insulin may accelerate telomere shortening in patients with T2DM. The effect of acarbose and glyburide on TL in patients with T2DM remains uncertain due to the lack of longitudinal research evidence. However, observational studies33,34,36 suggest that the use of acarbose may be associated with telomere shortening and glyburide may protect TL in patients with T2DM. Further research is needed to investigate the relevant mechanism of the effect of antidiabetic medications on TL in patients with T2DM. When recommending treatment for patients with T2DM, especially for patients with different subtypes of T2DM, endocrinologists can re-examine the antidiabetic regimen from the perspective of telomeres and determine the most appropriate antidiabetic medications to achieve the dual goals of effective hypoglycemia and delayed aging.

Sodium-Glucose Transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have been confirmed to provide cardiovascular and renal benefits in patients with T2DM in large clinical trials and even reduce all-cause mortality in patients with T2DM.74 Mitiglinide improves postprandial metabolic disturbances and reduces excessive oxidative stress and inflammatory responses.75 All of these are potential anti-aging drugs or may have certain anti-aging effects; however, to date, no clinical trials have investigated the effect of these commonly used antidiabetic medications on TL. In the future, clinical trials are urgently needed to explore the effects of SGLT2i, GLP-1RA, glinides, and other antidiabetic medications on telomeres and to uncover more anti-aging drugs suitable for patients with T2DM.

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#2

suggest that the use of acarbose may be associated with telomere shortening

This is worrying.

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#3

But only if you are Severe Insulin-Resistant Diabetic.

However, in the other 3 subgroups, there was no significant difference in leukocyte TL observed between patients who used acarbose and those who did not use acarbose within each subgroup.

In fact it looks like it helped the ones with Mild Age Related Diabetes.

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#4

No real worries here. First it’s for people with T2DM and then:

The effect of acarbose and glyburide on TL in patients with T2DM is still uncertain due to the absence of evidence from longitudinal studies

The first study does not compare similar populations:

the acarbose group had lower HbA1c (HbA1c: 8.64 ± 2.38% vs 10.57 ± 2.86%, p=0.000), higher age (age: 54.2 ± 12.5 years vs 49.10 ± 13.25 years, p=0.011)

The second study have mixed result:

However, in the other 3 subgroups, there was no significant difference in leukocyte TL observed between patients who used acarbose and those who did not use acarbose within each subgroup

And finally:

However, the mechanism by which acarbose use is associated with shorter leukocyte TL in patients with T2DM is unclear. Both intestinal flora and oxidative stress hypotheses suggest that acarbose may have anti-aging effects.

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