Effects of the Sodium-Glucose Cotransporter-2 Inhibitor Velagliflozin on Insulin Concentrations in Horses With Insulin Dysregulation.
Authors: Thane Kristen, Voth Rebecca, Klee Rebecca, Warnken Tobias, Chukwu Victor, Frank Nicholas
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Insulin dysregulation in horses—characterised by excessive circulating insulin despite normal blood glucose—represents a significant welfare and lameness risk, yet pharmacological management options remain limited. Researchers at the University of Minnesota conducted a 40-week trial involving 37 privately-owned horses with confirmed insulin dysregulation (baseline fasting insulin >75 μIU/mL) to evaluate velagliflozin, a sodium-glucose cotransporter-2 inhibitor that works by promoting urinary glucose excretion, as a potential therapeutic intervention. During the initial 20-week double-blind phase, horses receiving velagliflozin 0.3 mg/kg daily showed substantially lower resting insulin concentrations (median 71 μIU/mL) compared with placebo controls (157 μIU/mL)—a reduction of approximately 155 μIU/mL—whilst horses given placebo that subsequently received velagliflozin in the open-label phase demonstrated comparable improvements, confirming the drug's efficacy. Body condition score also decreased more markedly in treated animals (approximately 1 point lower than baseline), and whilst all horses experienced transient elevations in serum triglycerides, no clinical adverse effects were documented. For equine practitioners managing metabolic disease, velagliflozin offers a novel pharmacological option to reduce hyperinsulinaemia and associated laminitis risk, though triglyceride monitoring during initial treatment and investigation of longer-term safety profiles would be prudent before widespread clinical adoption.
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Practical Takeaways
- •Velagliflozin at 0.3 mg/kg once daily is an effective pharmacological tool for managing hyperinsulinemia in horses with insulin dysregulation, with substantial reductions in resting insulin levels
- •Monitor triglyceride concentrations during treatment as transient elevations occur, though no clinical complications were observed in this study
- •Expect weight loss in treated horses (approximately 1 BCS point over 20 weeks), which may be beneficial for insulin dysregulation management but requires nutritional monitoring
Key Findings
- •Velagliflozin treatment reduced resting insulin concentration to 71 µIU/mL compared to 157 µIU/mL in placebo group (p<0.0001), with an average treatment effect of 155 µIU/mL reduction
- •Horses previously receiving placebo showed further insulin reduction to 50 µIU/mL when switched to velagliflozin in the open-label phase (p<0.0001)
- •All horses experienced transient increases in serum triglyceride concentration during velagliflozin treatment with no reported clinical abnormalities
- •Horses receiving velagliflozin showed greater body condition score reduction (median 1 point lower than baseline, p=0.02) compared to placebo group