Exploring the FDA-approved SGLT2 inhibitors for cats

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, talks about the 2 FDA-approved sodium-glucose cotransporter-2 (SGLT2) inhibitors available for treating type 2 diabetes in cats, in this interview with dvm360. Behrend also outlines which patients are ideal candidates for this new class of oral medications and discusses off-label use.

Below is a partial transcript:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): There are 2 SGLT2 inhibitors that are now FDA-licensed in the United States for treatment of diabetes in cats as a sole agent. Those are Bexacat [bexagliflozin] and Senvelgo [velagliflozin].

I, at this point, look at them very similarly. Until someone does a study that compares one to the other, head on, we're not going to know if there's any real differences between them. So right now, I think about them interchangeably.

The basic difference to me is that Bexacat is a pill. It is given 1 pill per cat for any cat that is greater than 3.3 kilograms in weight, or whatever that is—7 pounds-ish.

Senvelgo is a liquid that is based on weight for the dose at one milligram per kilogram. So to me, it really comes down to what the owner prefers at this point, whether they would rather give their cat a pill or whether they would try and give their cat a liquid.

I think that SGLT2 inhibitors should be considered in any newly diagnosed diabetic cat. They are one of the first line treatments in type 2 diabetics in people. And remember that we think the majority of cats are type 2 diabetics.

Basically, in order to be a candidate for either one—an SGLT2 inhibitor—there's a few guidelines. One is the cat has to be happy or healthy, meaning that it is eating fine, drinking fine, urinating well, no vomiting, no diarrhea. It's a happy cat, with the exception that it's a diabetic.

Number 2, according to the FDA, these drugs should not be used in a cat that has ever gotten insulin before. I do use the SGLT2 inhibitors off-label and cats that have had insulin before, but that is off-label.

We also want to make sure that the cat doesn't have any ketones in its urine or an elevated beta hydroxybutyrate blood level. And by elevated, that typically means—depends who you ask—greater than 2.4 millimoles per liter, for sure. Once it gets above 1 millimole per liter, you're getting into a gray zone [of] whether or not you should start the drug...