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:

Owner satisfaction and prognosis for return to work after pancarpal arthrodesis in working dogs in the United Kingdom: a retrospective study (2011-2020).
50% (5/10) owners stated their dog could perform normal duties; 4/10 (40%) could perform most duties with some allowances. 80% (8/10) owners rated the level of post-operative lameness as unaffected with a normal gait. 90% (9/10) owners were either very satisfied or satisfied with the outcome of the procedure, and 90% owners stated the financial investment was worthwhile.

Prevalence of discospondylitis and association with congenital vertebral body malformations in English and French bulldogs.
The prevalence of discospondylitis was 3.4 (1.6-6.7) times higher in French bulldogs and 4.3 (1.7-9.8) times higher in English bulldogs, compared with the overall hospital cohort. One or more vertebral malformations were present in 12 French bulldogs (92.3%), 6 English bulldogs (75.0%), and 1 "other" breed dog (1.1%). Discospondylitis was diagnosed adjacent to congenital vertebral body malformations in 12 (80%) intervertebral discs in French bulldogs and 5 (50%) intervertebral discs in English bulldogs.

Association between highly pathogenic avian influenza outbreaks and weather conditions in Japan.
We found that higher average air temperatures two to three weeks prior, lower average wind speeds four weeks prior, and longer sunlight hours two and four weeks prior to outbreaks were significantly associated with increased risk of HPAI outbreaks in Japan. These results suggest that weather may influence environmental survival and transmission of the virus, as well as patterns of wild bird movement that could seed new outbreaks.

The Prevalence and Diagnosis of Feline Heartworm Infection
Visualization of supposed worm structures on echocardiography, in conjunction with a positive antigen test result, is as close to a definitive antemortem confirmation of adult heartworm infection as can be achieved.

The relationship between radiographic disc calcification score and FGF4L2 genotype in dachshunds.
Most dachshunds with 1 FGF4L2 copy have radiographic disc calcification scores that are associated with substantially lower risk of symptomatic disc disease. Radiographic disc calcification scores are similar in dachshunds with 0 and 1 FGF4L2 copies. Given the high allele frequency of FGF4L2, breeding to produce progeny with 1 FGF4L2 copy is expected to be a more achievable short-term goal for dachshund spinal health breeding programs than breeding for 0 copies. It is recommended that both K-n and FGF4L2 genotype status be considered when choosing dachshund breeding stock.