From needles to pills: transforming feline diabetes care
The FDA recently approved 2 oral SGLT2 inhibitors that are a suitable option for many newly diagnosed cats.
Feline diabetes mellitus (DM) is currently understood to have strong similarities to human type 2 diabetes. Veterinarians have traditionally relied upon insulin therapy to treat feline DM. However, responses to insulin vary, and cats may remain significantly hyperglycemic.
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The FDA recently approved 2 sodium-glucose cotransporter-2 (SGLT2) inhibitors, bexagliflozin and velagliflozin, for the treatment of uncomplicated feline DM. SGLT2 inhibitors decrease renal glucose reabsorption. This increases glucose excretion and, in patients with DM, may normalize blood glucose concentration. SGLT2 inhibitors are routinely used in the management of human type 2 diabetes and have been shown to mitigate hyperglycemia effectively and reduce the risks of cardiovascular and renal compromise.
The Journal of Veterinary Pharmacology and Therapeutics has published a study that shows SGLT2 inhibitors, such as bexagliflozin and velagliflozin, may offer a safe and effective oral treatment option for cats with uncomplicated DM.
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These oral hypoglycemic agents are a suitable option for many newly diagnosed cats, with rapid improvements in glycemic control and clinical signs. Suitable candidates must have some residual β-cell function, as some endogenous insulin production is required to prevent ketosis. Appropriate patient selection and monitoring are necessary, and practitioners should be aware of serious complications such as euglycemic diabetic ketoacidosis.
The SGLT2 inhibitors are seen as an exciting new addition to current treatment options for uncomplicated feline DM. For many owners, a once-daily oral medication is highly preferable to twice daily insulin injections, and this simplified approach is likely to improve outcomes for a substantial number of cats. SGLT2 inhibitors’ additional advantages include improvements in blood pressure, body weight, and fat distribution, along with a low propensity for clinical hypoglycemia.
This study recommends that prescribers consider SGLT2 inhibitors as an alternative to insulin therapy for cats with stable, uncomplicated DM. The authors advise ongoing monitoring for adverse effects such as dehydration, ketonuria, and changes in renal function. When used appropriately, SGLT2 inhibitors can offer improved convenience and potentially better quality of life for both feline patients and their owners.
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Nicole Naporowska is a 2025 PharmD candidate studying veterinary pharmacy at the University of Connecticut in Storrs.
Reference
Cook AK, Behrend E. SGLT2 inhibitor use in the management of feline diabetes mellitus. J Vet Pharmacol Ther. 2025;48 Suppl 1(Suppl 1):19-30. doi:10.1111/jvp.13466
