ABSTRACT OF THE WEEK

Journal of veterinary internal medicine/ American College of Veterinary Internal Medicine
Volume 38 | Issue 4 (2024 Jul-Aug)

Efficacy and safety of once daily oral administration of sodium-glucose cotransporter-2 inhibitor velagliflozin compared with twice daily insulin injection in diabetic cats.

J Vet Intern Med. 2024 Jul-Aug;38(4):2099 - 2119.

Stijn J M Niessen¹, Hans S Kooistra², Yaiza Forcada³, Charlotte R Bjørnvad⁴, Balazs Albrecht⁵, Franziska Roessner⁶, Esther Herberich⁷, Carla Kroh⁸

¹ Veterinary Specialist Consultations & VIN Europe, Hilversum, The Netherlands.; ² Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.; ³ Veterinary Specialist Consultations & VIN Europe, Hilversum, The Netherlands.; ⁴ Bjørnvad Consultancy, Vedbæk, Denmark.; ⁵ Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany.; ⁶ Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany.; ⁷ Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany.; ⁸ Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany.

Abstract

BACKGROUND:Options for treatment of diabetes mellitus in cats are limited to insulin injections and monitoring for hypoglycemia.

HYPOTHESIS:Once daily sodium-glucose cotransporter-2 inhibitor velagliflozin PO is noninferior to insulin injections.

ANIMALS:Client-owned diabetic cats (127 safety; 116 efficacy assessment).

METHODS:Prospective, randomized (1 mg/kg velagliflozin), positive controlled (titrated Caninsulin), open label, noninferiority field trial, comparing number of cats with treatment success in ≥1 clinical variable and ≥1 glycemic variable (margin Δ: 15%) on Day 45; secondary endpoints included glycemic and clinical assessments during 91 days.

RESULTS:On Day 45, 29/54 (54%) velagliflozin-treated cats and 26/62 (42%) Caninsulin-treated cats showed treatment success, demonstrating noninferiority (difference -11.8%; upper 1-sided 97.5% confidence interval, -∞ to 6.3%). By Day 91, quality of life (QoL), polyuria, and polydipsia had improved in 81%, 54% and 61% (velagliflozin); on blood glucose (BG) curves, mean BG was <252 mg/dL in 42/54 (78%; velagliflozin) and 37/62 (60%; Caninsulin); minimum BG was <162 mg/dL in 41/54 (76%; velagliflozin) and 41/62 (66%; Caninsulin); serum fructosamine was <450 μmol/L in 41/54 (76%; velagliflozin) and 38/62 (61%; Caninsulin). Velagliflozin's most frequent adverse events were loose feces/diarrhea (n = 23/61, 38%), positive urine culture (n = 19/61, 31%), and nonclinical hypoglycemia (BG <63 mg/dL; n = 8/61, 13%); Caninsulin's: clinical and nonclinical hypoglycemia (n = 35/66, 53%), positive urine culture (n = 18/66, 27%), and loose feces/diarrhea (n = 10/66, 15%). Diabetic ketoacidosis occurred in 4/61 (7%; velagliflozin) and 0/66 (Caninsulin).

CONCLUSIONS AND CLINICAL IMPORTANCE:Once daily oral administration of velagliflozin was noninferior to insulin injections, showed good QoL and glycemia without clinical hypoglycemia.

Keywords

antidiabetic; beta‐cell; compliance; feline diabetes mellitus; glucosuria; glucotoxicity; glycemic control; prospective clinical trial; sodium‐glucose cotransporter‐2 (SGLT2) inhibitor;

Article Tools:

Medline

Email to me

Grants:

Boehringer Ingelheim Animal Health

Archives Highlights:

Litter box size and litter type preference and their associated behavioral changes in cats.
Our findings indicated that cats preferred litter boxes measuring ≥50 cm as well as clumping clay litter. Moreover, a comfortable litter environment combining these two elements promoted normal urination behavior while improving house-soiling (both urination and defecation).

Cryptorchidism in dogs and cats presented for elective gonadectomy: A descriptive cohort study of 306 animals treated between 2018 and 2023.
5,476 dogs and 11,559 cats were presented to the same facility for elective surgical castration, suggesting a cryptorchid incidence of 3.21 % for dogs and 1.12 % for cats. Cryptorchid testes were more commonly observed in the inguinal area than in the abdomen, and were more frequently located unilaterally on the right side in both dogs and cats.

Prevalence of Encephalitozoon hellem among companion and exhibition birds in Japan.
Although microsporidia can rarely cause severe systemic infections, including hepatitis, nephritis, and enteritis in young birds, most infected birds are subclinical and thought to recover spontaneously after a period of temporary spore shedding if they do not have immunosuppression. Microsporidia can cause self-limiting infection in immunocompetent humans and life-threatening chronic diarrhea in immunocompromised individuals.

The Most Common Environmental Risk Factors for Equine Asthma-A Narrative Review.
The symptoms of equine asthma are typical of respiratory inflammations, and they include coughing, nasal discharge, and breathing difficulty even at rest in horses with severe asthma. BALF and tracheal wash analyses are the most popular methods of diagnosing equine asthma. Inadequate housing conditions undoubtedly increase the risk of asthma.

Performing an Avian Physical Examination in Practice
As with mammalian physical examinations, it is important to develop a consistent order for the avian examination to thoroughly evaluate each body system. Some components of the physical examination differ between avian species. For example, cloacal palpation is performed in chickens, but not in parrots.