Understanding the physiology behind SGLT2 inhibitors

In this interview with dvm360, Ellen Behrend, VMD, PhD, MS, DACVIM, past faculty of Auburn University College of Veterinary Medicine and a current consultant at Veterinary Information Network, an online community and resource center for veterinarians, explains what a sodium-glucose cotransporter-2 (SGLT2) inhibitor is. Behrend, who specializes in small animal endocrinology, noted that this new class of oral medications have “revolutionized” the treatment of type 2 diabetes in humans and is now being used in veterinary medicine.

Currently, SGLT2 inhibitors are used in cats only as single agents for diabetes. In the video, Behrend goes into detail on how these medications work to decrease blood glucose concentrations in feline patients with diabetes.

Below is the interview transcript:

Ellen Behrend, VMD, PhD, MS, DACVIM: I'm Ellen Behrend. I am a board-certified small animal internist with a special interest in small animal endocrinology. I spent the majority of my career as a faculty member at Auburn University, and I now am a consultant for Veterinary Information Network.

[SGLT2 inhibitors] are drugs that have revolutionized the treatment of type 2 diabetes in people, and they're relatively new to veterinary medicine. We use them in cats only as single agents for diabetes.

SGLTs are a class of molecules that transport glucose across membranes. SGLT2 is mainly in the kidneys.

So, remember from physiology that glucose is freely filtered at the glomerulus and then the body in a normal dog, cat, human, typically reabsorbs pretty much all of the glucose, so there's no glucose in the urine. An SGLT2 inhibitor inhibits that. So, it stops the reabsorption of glucose from the renal tubules, meaning that the glucose is going to then be excreted through the urine instead, and by getting rid of all of that glucose in the urine, that's how SGLT2 inhibitors decrease blood glucose concentrations in diabetics.