Horse owner experiences and observations with the use of SGLT2i for the management of equine metabolic syndrome and hyperinsulinaemia‐associated laminitis
Authors: T. Sundra, E. Kelty, Gabriele Rossi, Guy Lester, D. Rendle
Journal: Equine Veterinary Education
Summary
# Editorial Summary: SGLT2 Inhibitors for Equine Metabolic Syndrome – Owner Perspectives Sodium–glucose cotransporter 2 inhibitors (SGLT2i) represent an emerging pharmacological option for managing hyperinsulinaemia and laminitis in horses, yet little is known about real-world owner experiences during treatment. Sundra and colleagues conducted a cross-sectional online survey of 342 horse owners who had used SGLT2i therapy, predominantly ertugliflozin (79.8%), primarily for elevated insulin concentrations (84.2%) and active laminitis (59.7%). The majority of owners—85.3%—reported meaningful improvements in their horses' quality of life, with particularly encouraging results among those who had previously contemplated euthanasia: 80.5% noted pain reduction to mild or absent levels within 30 days, and 94.8% observed overall quality-of-life improvement. Satisfaction rates were high (86% reporting extreme or moderate satisfaction), though a third of owners encountered initial adverse effects, most commonly polyuria and polydipsia, alongside less frequent concerns about weight loss and behavioural changes. For practitioners, these findings validate clinical optimism about SGLT2i efficacy whilst emphasising the importance of owner counselling about transient side effects during induction and acknowledging that cost, long-term safety data, and medication availability remain genuine practical barriers to wider adoption.
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Practical Takeaways
- •SGLT2i treatment shows promising results for managing hyperinsulinaemic horses with laminitis, with strong owner satisfaction and reported pain relief even in cases previously considered for euthanasia
- •Educate owners about common early adverse effects (especially polyuria and polydipsia) as these appear manageable and often temporary; 33% experience some initial side effects but these do not typically lead to treatment discontinuation
- •Current limitations include high medication cost, availability issues, and lack of long-term efficacy data—discuss realistic timelines and set management expectations around diet, exercise and monitoring alongside pharmacological intervention
Key Findings
- •85.3% of owners reported improved quality of life after SGLT2i treatment, with 80.5% of horses previously considered for euthanasia showing mild or absent pain within 30 days
- •Ertugliflozin was the most commonly prescribed SGLT2i (79.8%), used primarily for elevated insulin concentrations (84.2%) and active laminitis (59.7%)
- •33.3% of owners reported initial adverse effects, most commonly excessive urination (20.5%), excessive drinking (11.1%), and excessive weight loss (9.9%)
- •86% of owners were satisfied or extremely satisfied with SGLT2i treatment, though concerns included cost, availability, and long-term efficacy