The research behind SGL2 inhibitors - miracle cure or disaster waiting to happen

There are no licenced veterinary drugs available for treating insulin dysregulation (ID) and preventing hyperinsulinaemia-associated laminitis in horses. Thus, the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for the control of equine hyperinsulinaemia with the goal of improving recovery from associated active laminitis or preventing future laminitis has recently been advocated. There are a small number of published studies reporting the use of the SGLT2i canagliflozin, ertugliflozin, dapagliflozin and velagliflozin to aid the management of equine ID. However, the doses used are largely extrapolated from human studies with limited consideration of species-specific variations. In addition, there is limited evaluation of the fundamental differences between ID in horses and humans, particularly the fact that most horses with ID remain hyperinsulinaemic but normoglycaemic such that increased urinary loss of glucose may not explain all of the beneficial effects of these drugs. Further study of the potential deleterious effects of treatment-associated hypertriglyceridaemia is required.

• Understanding of the mechanism of action of sodium glucose cotransporter-2 inhibitors (SGLT2i) and how their use might be beneficial in the management of equine insulin dysregulation.
• Understanding of the current evidence to support the use of SGLT2i to aid control of equine hyperinsulinaemia.
• Understanding of the potential side effects associated with SGLT2i use in horses and of the importance of monitoring.