Velagliflozin, an SGLT2 Inhibitor, as Once-Daily, Oral Solution, Stand-Alone Therapy for Feline Diabetes Mellitus

Abstract: Background: A mainstay treatment for human diabetics, sodium-glucose cotransporter-2 (SGLT2) inhibitors hold promise for diabetic cats.

Hypothesis/Objectives: 1. Glycemic and clinical parameters will improve in > 70% of diabetic cats receiving once-daily velagliflozin. 2. < 15% of cats will develop ketoacidosis.

Animals: 252 client-owned diabetic cats; 214 (85%) naïve diabetics (ND) and 38 (15%) insulin-treated (IT).

Methods: Prospective trial evaluating once daily, oral velagliflozin. Physical examinations and blood collections performed days 0, 3, 7, 30, 60, 120, and 180. Data are median (range).

Results: At screening, blood glucose (BG) was 436 mg/dl (272 - 676). At days 30, 60, 120, and 180, single BG after receiving velagliflozin was 153 (62-480), 134 (64-414), 128 (55-461), and 125 (77-384), respectively. Fructosamine at screening was 538 µmol/l (375-794). On the same recheck days, fructosamine was 310 (204 - 609), 286 (175 - 531), 269 (189 - 575), and 263 (203 - 620). At day 180, 81% of cats had a BG and/or fructosamine within reference ranges; 88.6% (124/140) and 87.7% (121/138) showed improvement in polyuria and polydipsia, respectively. Eighteen cats (7.1%) developed ketoacidosis. Ketoacidosis was less common in ND (11/214; 5.1%) compared to IT cats (7/38; 18.4%). At ketoacidosis diagnosis, 14 cats (77.8%) had euglycemic ketoacidosis, i.e. BG < 250 mg/dL. Most ketoacidotic events (13/18; 72.2%) occurred within the first 7 days of treatment. No clinical hypoglycemia occurred.

Conclusions and clinical importance: Velagliflozin is effective as a stand-alone oral solution therapy in feline diabetics with a low overall incidence of ketoacidosis.