References
Sodium-glucose co-transporter 2 inhibitor treatment in diabetic cats
Abstract
Sodium-glucose co-transporter 2 inhibitors are oral anti-hyperglycaemic agents that represent a new treatment strategy in feline diabetes mellitus and remove the need for daily injections, dose adjustments and glucose curves. Velagliflozin (Senvelgo; Boehringer Ingelheim) is currently the only licensed sodium-glucose co-transporter 2 inhibitor for use in cats in the UK. It induces glucosuria and thereby lowers blood glucose concentrations, reverses glucotoxicity and improves clinical signs. The most common side effect is loose stools, but these are often self-limiting and short-lived. The most concerning complication of treatment is euglycaemic diabetic ketoacidosis, which is best avoided by appropriate patient selection and effective treatment monitoring.
Traditionally, exogenous insulin treatment represented the mainstay in the management of diabetic cats to address hyperglycaemia and prevent ketosis (Sparkes et al, 2015). Previous trials with oral anti-hyperglycaemics like biguanides (metformin) (Nelson et al, 2004) or sulfonylureas (Nelson et al, 1993) as standalone treatments in diabetic cats yielded mostly unfavourable results and none were licensed for use in this species. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are now revolutionising feline diabetology. Their use in humans with type 2 diabetes has shown efficacy in improving glycaemic control, beta-cell function and insulin sensitivity without increasing the risk of hypoglycaemia (Xu et al, 2022).
Cats with diabetes mellitus typically experience a condition that is comparable to type 2 diabetes in humans, and is characterised by relative insulin deficiency and insulin resistance (Gostelow and Hazuchova, 2023). Chronic high glucose concentrations lead to glucose toxicity with resulting pancreatic beta-cell desensitisation and dysfunction. Reducing hyperglycaemia by increasing renal glucose excretion may lead to improved insulin secretions without the need for insulin treatment.
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