SGLT2 inhibitor treatment in diabetic cats with complex cases

Abstract

Case series summaryThis retrospective case series describes seven diabetic cats treated with velagliflozin that were considered non-ideal candidates for this therapy. These more complicated diabetic feline cases were referred to the Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium. The sole inclusion criterion for this case series was treatment with velagliflozin (Senvelgo; Boehringer Ingelheim) after diagnosis of diabetes mellitus. Data on signalment, medical history, clinical findings, diagnostics, treatment, response and outcomes were available for all cats. The initial consultation for all cats took place between March 2024 and May 2025.Relevance and novel informationCurrent literature on the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in feline patients remains limited, with most studies involving highly selected populations with strict exclusion criteria. This case series describes the use of velagliflozin in non-ideal candidates for SGLT2 inhibitor therapy, aiming to support clinicians managing such cases and to provide useful information for future prospective studies. In these non-ideal cases, the use of velagliflozin may be considered off label; its administration should comply with local ethical and legal regulations, with informed client consent obtained. Consultation with a veterinary specialist is recommended when clinical experience is limited. This case series includes diabetic cats with suspected and/or confirmed comorbidities that complicate diabetes management, such as hypersomatotropism and chronic kidney disease. In addition, it reports on the concurrent use of other treatments, including cabergoline and insulin. The potential interaction and possible synergistic effects of these combined therapies represent an area of interest for future research. To ensure optimal glycaemic control and enable individualised dosing, four of the presented cases were closely monitored using continuous glucose monitoring (Freestyle Libre Sensor 2; Abbott Laboratories). Furthermore, the availability of measurements of ketone concentrations in urine and/or blood provided valuable insight into the metabolic changes associated with this new treatment. The role of ketone monitoring in predicting treatment response and identifying potential adverse effects represents another important area for future research.