Sodium–Glucose Cotransporter 2 (SGLT2) inhibitors are a new class of drugs in veterinary medicine that have been approved by the FDA to treat newly diagnosed diabetes mellitus in cats. However, because cats have unique physiologic and metabolic characteristics, patient selection for this therapy requires careful consideration. Here are 4 tips from Renee Rucinsky, DVM, DABVP (Feline), for determining which cats can benefit from this innovative treatment. Hear the full Vet2Vet conversation between Dr. Rucinsky and Cassi Fleming, MS, DVM, sponsored by Boehringer Ingelheim Animal Health, below.
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- The ideal candidate
SGLT2 inhibitors are appropriate for otherwise healthy diabetic cats, specifically those newly diagnosed who have not been previously treated with injectable insulin. These cats are typically overweight, eating well, and not clinically sick. - Check for comorbidities
Cats affected by comorbidities, such as chronic kidney disease, endocrinopathies, liver disease, or pancreatitis, typically are not good SGLT2 inhibitor candidates. Suggested diagnostics include a complete blood count, biochemistry panel with electrolytes, urinalysis (including urine ketones), and a total T4. Ideal candidates will have an absence of ketones in the urine and show no evidence of concurrent illness. - Assess pancreas health
SGLT2 inhibitors provide a platform for the cat’s own endogenous insulin, so a cat’s pancreatic β cells must be able to make at least some insulin. In a thin, geriatric, diabetic cat with inflammatory bowel disease or small cell lymphoma, inflammatory or neoplastic cells may infiltrate the pancreas and inhibit β cell function, making SGLT2 inhibitors less effective. - Monitor regularly for ketosis
Euglycemic diabetic ketoacidosis is a slight risk when using SGLT2 inhibitors, and regular ketosis monitoring is important. If screening for serum ketones is possible, then blood beta-hydroxybutyrate (BHB) should be considered at the time of initial screening. In healthy, non-diabetic cats, plasma blood beta-hydroxybutyrate (BHB) concentrations are usually less than 0.1 mmol/L. Most well-regulated, clinically healthy diabetic cats will have BHB levels under 2 mmol/L, but values higher than 2.4 mmol/L indicate substantial ketosis.
IMPORTANT SAFETY INFORMATION: Due to an increased risk of the development of diabetic ketoacidosis or euglycemic diabetic ketoacidosis, which may result in death, do not use SENVELGO® (velagliflozin oral solution) in cats with diabetes mellitus who have previously been treated with insulin, who are receiving insulin, or in cats with insulin-dependent diabetes mellitus. See package insert for full prescribing information or visit SENVELGOClinic.com.
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