Top tips: Managing diabetics with SGLT2-inhibitors – do’s and don’ts

Two years after the official introduction of the SGLT2-inhibitor velagliflozin (Senvelgo) on the UK and European market and more than 10 years after the initial clinical trials with SGLT2 inhibitors plenty of new lessons have been learned that go beyond the official guidelines that were designed to introduce this category of drugs for the first time into the veterinary landscape. As is often the case (and should be the case), at the moment of introduction, safety was the primary focus in setting up guidelines for usage. Clinicians had only been used to using insulin to treat feline diabetes mellitus and were now confronted with an entirely new modality of treatment without insulin. These guidelines have served their purpose well, resulting in minimal side effects in the many thousands of cats with diabetes mellitus treated thus far.
Nonetheless, lessons have been learned, and this lecture will focus on those lessons, which therefore go beyond the initial guidelines provided with the introduction of this drug category. Some of the lessons described during this lecture therefore also go beyond the official label that is associated with market authorisation obtained earlier. It is important though that we learn from the experiences thus far and follow the science to ensure we make full use of the SGLT2i when they can be used and avoid them when they should not be used.
In short, this lecture will deal with all the issues surrounding SGLT2is that the drug companies will not tell you. Example issues (more will be discussed during the lecture) are detailed below.

• Realise that SGLT2i hold promise for more than one type of diabetes mellitus
• Realise that ketonuria or hyperketonaemia in the happy cat has little predictive value for DKA and thus does not mean we need to stop SGLT2i
• Realise what SGLT2i can mean for dogs with diabetes mellitus
• Realise what can make DKA under SGLT2i different from regular DKA
• Realise that SGLT2i probably should be teh preferred option over insulin in the clinically happy diabetic cat if we seek to normalise pet-owner bond