Short-term effects of canagliflozin on glucose and insulin responses in insulin dysregulated horses: A randomized, placebo-controlled, double-blind, study.
Authors: Lindåse Sanna, Nostell Katarina, Forslund Anders, Bergsten Peter, Bröjer Johan
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Canagliflozin for Insulin Dysregulation in Horses Insulin dysregulation poses a significant laminitis risk in horses, yet current management options remain limited; this 2023 study evaluated whether canagliflozin, a sodium-glucose cotransporter-2 inhibitor, could reduce the dangerous postprandial insulin spikes that characterise this condition. Sixteen privately-owned insulin dysregulated horses received either 0.6 mg/kg canagliflozin or placebo once daily for three weeks in a randomised, double-blind, placebo-controlled design, with oral sugar tolerance tests performed at baseline and after treatment to measure insulin and glucose responses. Canagliflozin produced marked reductions in insulin concentrations: peak insulin dropped to 83.2 μIU/mL compared with 215.2 μIU/mL in the placebo group, whilst the total insulin area-under-the-curve decreased by more than 66%—a substantial improvement given that postprandial hyperinsulinemia directly precipitates laminitis risk in susceptible horses. Body weight declined by 11.1 kg on average with canagliflozin treatment, though triglyceride concentrations increased modestly (0.99 mmol/L), warranting monitoring in future longer-term studies. For practitioners managing insulin dysregulated horses, these short-term results suggest canagliflozin merits consideration as an adjunctive pharmacological tool alongside dietary management, though additional research into safety, optimal dosing, and sustained efficacy beyond three weeks remains essential before widespread clinical adoption.
Read the full abstract on PubMed
Practical Takeaways
- •Canagliflozin shows significant promise for reducing postprandial hyperinsulinemia in ID horses, a key mechanism for laminitis prevention
- •Short-term weight loss observed with canagliflozin may be beneficial for metabolically affected horses, though long-term effects require evaluation
- •Triglyceride elevation warrants monitoring during treatment and further investigation regarding clinical significance
Key Findings
- •Canagliflozin treatment reduced maximal insulin concentration by 61% compared to placebo (83.2 vs 215.2 μIU/mL) after 3 weeks
- •Insulin response (AUC0-180) was >66% lower in canagliflozin-treated horses compared to placebo
- •Canagliflozin treatment resulted in mean body weight decrease of 11.1 kg over 3 weeks
- •Triglyceride concentrations increased by 0.99 mmol/L with canagliflozin treatment