Use of the SGLT2 inhibitor canagliflozin for control of refractory equine hyperinsulinemia and laminitis
Authors: E. Kellon, K. Gustafson
Journal: Open Veterinary Journal
Summary
# Editorial Summary: Canagliflozin for Refractory Equine Hyperinsulinemia Horses with insulin dysregulation secondary to pituitary pars intermedia dysfunction and/or equine metabolic syndrome face substantial laminitis risk, yet dietary restriction of non-structural carbohydrates remains the cornerstone of management—a limitation for cases proving resistant to nutritional intervention, metformin supplementation, and hormonal therapy. Kellon and Gustafson evaluated the SGLT2 inhibitor canagliflozin in ten horses with refractory hyperinsulinemia and a history of laminitis, administering the medication once daily whilst maintaining concurrent dietary control, exercise and PPID treatment where indicated; baseline renal function was confirmed via serum creatinine and urea nitrogen, with fortnightly urinalysis performed to monitor for glucosuria and screen for adverse effects. All ten horses demonstrated substantial reductions in serum insulin to normal or near-normal concentrations, with complete resolution of laminitis pain and regression of abnormal adipose deposits in all cases, achieving 100% owner satisfaction. Whilst these results are encouraging for practitioners managing metabolically intractable cases, the authors acknowledge that canagliflozin should be reserved for truly refractory presentations and emphasise that foundational management—dietary management, movement, and PPID treatment—must remain in place; rigorous controlled trials investigating pharmacokinetics, safety and efficacy in the equine population are essential before broader adoption can be recommended.
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Practical Takeaways
- •Canagliflozin (an SGLT2 inhibitor) may be considered for horses with documented hyperinsulinemia and laminitis that fail to respond to diet control, metformin, levothyroxine, and pergolide
- •This medication requires monitoring of renal function (serum creatinine, blood urea nitrogen) before use and regular urinalysis every 2 weeks to detect glucosuria and screen for complications
- •Canagliflozin should be reserved for refractory cases and must be combined with core therapies: strict dietary control of sugars/starch, exercise when possible, and appropriate PPID treatment if indicated
Key Findings
- •All 10 horses with refractory hyperinsulinemia showed substantial decreases in serum insulin to normal or near-normal levels following canagliflozin treatment
- •Laminitis pain resolved completely in all cases with regression of abnormal fat deposits
- •Nine of ten horses were hyperglycemic (>5.5 mmol/l) or had a history of hyperglycemia prior to treatment
- •Owner satisfaction with outcomes was 100% with once-daily oral canagliflozin administration