Pros of using SGLT2 inhibitors for cats with diabetes

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, talks about advantages of using sodium-glucose cotransporter 2 (SGLT2) inhibitors in cats with diabetes. She encourages veterinarians to consider this new class of drugs, as they can have high efficacy.

Below is a partial transcript, lightly edited for clarity:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): I think there's a few...advantages to using an SGLT2 inhibitor in cats. One is this is oral, and although I know a lot of veterinarians feel that it's way easier to give an injection to a cat than an oral medication, remember, owners don't feel that way.

In one study, I think it was about 40% of owners...were really scared about giving injections to their diabetic pet—wasn't necessarily a cat—so, having an oral medication for owners is a big advantage. If you read the package insert, it says that the medication should not be given with a meal for both of them. And really, what they mean is that the medication should not be given with a whole meal, because you want to make sure that the cat is going to eat everything and get the full dose of medication at one time. So, you can mix the pill, hide it in a small amount of food, or you can mix the liquid in with the small amount of food and give it to the cat that way if that's easier for the owner, or it can go directly into the mouth.

Another big advantage is that it's once a day, and it doesn't matter what time of day. You do have to be relatively consistent. You don't have to be as consistent as we are with insulin, like you know, they can pick a time and give the medication 2 hours or so on either side every day and it's their choice what time that medication is given. Also, it doesn't have to be paired with food. So whether or not you meal-feed a diabetic cat or let them eat free, choice is somewhat controversial.

I still recommend meal feedings, which I'm not going to get into. But whichever way you go, it doesn't matter. The cat can eat when it wants—it doesn't matter. It has to still be eating. It can meal feed. It can feed, you know, as it wants, graze throughout the day. It can eat multiple meals throughout the day. As long as the cat is eating, it can eat whenever it wants to eat.

And then the monitoring is such a big difference as well, because we don't have to do glucose curves unless it's an odd situation in a cat on an SGLT2 inhibitor alone.

An advantage of insulin is we feel comfortable with it. I mean, a lot of people don't like [managing patients with diabetes], and diabetes, honestly, as an endocrinologist, is my least favorite endocrine disease. I find them just as challenging as you do, probably, but we're comfortable with insulin at this point. So it's easier to go in your comfort zone, but I think it's worthwhile trying these drugs in cats, because they really can be quite remarkable with their efficacy.