The Problem
As many as 30% of diabetic cats are euthanized during the first year after diagnosis. Difficult diabetic control, concerns for the cat’s welfare and potential impact on the pet owner’s lifestyle are the reasons most frequently cited.
Insulin has been the foundational treatment for feline diabetes for more than 50 years. However, the complexities of insulin therapy can lead to complications.
In addition, cats require twice-daily insulin injections to adequately control their diabetes, and the owner’s lifestyle, daily schedule and other obligations may make a commitment to lifelong care for their cat difficult to impossible.
Insulin is still a necessary treatment for insulin-dependent feline diabetes, but cats with insulin-resistant diabetes obviously need an effective, practical non-insulin alternative therapy.
The Solution
Feline diabetes has several pathophysiologic and clinical parallels with human type 2 diabetes. These include the central roles insulin resistance and beta cell glucose toxicity play in hyperglycemia development and clinical diabetes onset. Several classes of anti-diabetic drugs are useful for treating human type 2 diabetes mellitus. Each drug class has a specific pharmacologic action that impacts some aspect of diabetes pathology, such as direct stimulation of endogenous insulin secretion, improved insulin sensitivity, decreased carbohydrate absorption and enhanced renal glucose excretion. However, experience with many anti-diabetic drugs used for feline diabetes is limited and results were generally discouraging.
The first sodium–glucose cotransporter (SGLT) 2 inhibitors were introduced as a human type 2 diabetes mellitus treatment around 2013. Modern formulations of these drugs selectively target and specifically inhibit SGLT2, which is a transporter protein in the renal proximal tubules responsible for transporting 90% of the glucose reabsorbed from urine passing through the tubules. The remaining 10% of glucose is transported by SGLT1 proteins located further along the proximal tubules. The combined SGLT1 and SGLT2 actions result in no glucose being present in normal urine.
The Innovation
In diabetic people, SGLT2 inhibitors rapidly and safely lower blood glucose by promoting glucose loss in the urine. Studies have also demonstrated that these drugs improve glycemic milestones, such as glucose time-in-range, glycemic variability and blood HbA1c. The SGLT2 protein is found almost exclusively in the kidney and approved SGLT2 inhibitor drugs selectively target SGLT2 over SGLT1, so they have an excellent safety profile.
Extensive clinical data demonstrating SGLT2 inhibitor efficacy and safety in humans combined with the known similarities between human and feline diabetes suggested that the drug could offer a useful alternative to insulin for treating feline diabetes.
SENVELGO (velagliflozin oral solution), a veterinary SGLT2 inhibitor, was approved in 2023 for use in cats with newly diagnosed diabetes who have not received insulin. In a large study of 252 diabetic cats treated solely with SENVELGO oral solution, clinical signs and biochemical markers showed substantial improvement over the six-month study period. Findings included:
- Clinical signs, such as polyuria, polydipsia and polyphagia, were improved in 70% to 90% of cats at six months.
- Glycemic assessments were improved in 80% to 90% of cats at the six-month point.
- Serum fructosamine was improved in 80% of cats at the six-month point.
- Clinical hypoglycemia was not observed during the study.
In a European field trial, SENVELGO oral solution was compared with insulin treatment. Veterinarians classified the diabetes of 81% of cats treated with SENVELGO® (velaglfiflozin oral solution) and 64% in the insulin group as controlled, demonstrating that SENVELGO oral solution is at least as effective, if not more so, than insulin.
SENVELGO oral solution is approved for cats who meet the following criteria:
- The cat is newly diagnosed with diabetes and is considered otherwise healthy.
- The cat has never been treated with an insulin therapy.
- The cat has no clinically significant concurrent disorders.
Similar to diabetic cats treated with insulin, cats must be closely monitored and follow-up care is necessary to assess treatment response. For diabetic cats treated with SENVELGO oral solution, ketone monitoring is prioritized over glycemic monitoring (although it is still necessary) to help prevent euglycemic diabetic ketoacidosis, which develops in insulin-deficient patients with normal or near-normal glucose levels that are due to SGLT2 inhibitor mediated renal glucose excretion. As a sole treatment for feline diabetes, an SGLT2 inhibitor is effective only when endogenous insulin production is sufficient to prevent ketoacidosis, and SENVELGO oral solution is not indicated for insulin-dependent diabetic cats.
SENVELGO oral solution provides veterinarians with an effective alternative to insulin to treat newly diagnosed diabetic cats. The medication is administered orally once per day, so cat owners don’t have to worry about twice-daily injections. For cat owners whose lifestyle prevents them from administering twice-daily injections or who have a needle phobia, the availability of an oral daily drug may be a deciding factor for treatment rather than euthanasia.
IMPORTANT SAFETY INFORMATION: SENVELGO® (velagliflozin oral solution) is indicated to improve glycemic control in otherwise healthy cats with diabetes mellitus not previously treated with insulin. Before using this product, it is important to read the entire product insert, including the boxed warning.
Cats treated with SENVELGO may be at an increased risk of diabetic ketoacidosis or euglycemic diabetic ketoacidosis, both of which may result in death. Development of these conditions should be treated promptly, including insulin administration and discontinuation of SENVELGO.
Do not use SENVELGO in cats with diabetes mellitus who have previously been treated with insulin, who are receiving insulin, or in cats with insulin-dependent diabetes mellitus. The use of SENVELGO in cats with insulin-dependent diabetes mellitus, or the withdrawal of insulin and initiation of SENVELGO, is associated with an increased risk of diabetic ketoacidosis or euglycemic diabetic ketoacidosis and death.
Sudden onset of hyporexia/anorexia, lethargy, dehydration, or weight loss in cats receiving SENVELGO should prompt immediate discontinuation of SENVELGO and assessment for diabetic ketoacidosis, regardless of blood glucose level. SENVELGO should not be initiated in cats with ketonuria, ketonemia, pancreatitis, anorexia, dehydration, or lethargy at the time of diagnosis of diabetes mellitus, as it may indicate the presence of other concurrent disease and increase the risk of diabetic ketoacidosis.
Keep SENVELGO in a secure location out of reach of children, dogs, cats, and other animals to avoid accidental ingestion or overdose. For more information, please refer to the enclosed package insert or visit SENVELGOClinic.com.
SENVELGO® is a registered trademark of Boehringer Ingelheim Vetmedica GmbH, used under license. PROZINC® is a registered trademark of Boehringer Ingelheim Animal Health USA Inc. ©2024 Boehringer Ingelheim Animal Health USA Inc., Duluth, GA. All rights reserved. US-PET-0608-2024