Beyond the glucose curve: Following cats on SGLT2 inhibitors

Kelly Cairns, DVM, MS, DACVIM (SAIM), explains how safety and patient selection shape the decision to start a cat with diabetes on an oral SGLT2 inhibitor, and which patients make strong candidates. She also shares why the monitoring plan looks different than it does with insulin, and what that distinction means for primary care teams.

Below is a partial transcript of the conversation.

dvm360: When you first see a newly diabetic cat, how do you decide between insulin or SGLT2 drugs?

Kelly Cairns, DVM, MS, DACVIM (SAIM): For me, the decision is really based upon safety and patient selection, not at all about whether an oral medication might be easier for that client to give that cat, so there [are] really clear lines in my mind.

We have 2 great drugs in Bexacat [bexagliflozin] and Senvelgo [velagliflozin oral solution]. There’s a liquid, there is a tablet. They are contraindicated in cats that have ever received insulin, who are receiving insulin now, or have insulin-dependent diabetes. We shouldn’t take a cat off insulin to just put them on an SGLT2 inhibitor.

I also do not use the oral drug if a cat is sick at the moment—clinically anorectic, dehydrated, lethargic, or ketotic. If the cat is vomiting, if the cat has comorbidities, we do need to do an assessment including checking for ketones, including beta-hydroxybutyrate. We also need to make sure that the kidney function and the liver function are OK, because both drugs have warnings or overt contraindications in the setting of those diseases, as well as other comorbidities. We want to use these drugs on label.