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Cures4Cats 2023- Improvements in Treating Feline Diabetes

Jill told me, “I thought I was going to die” when she learned that her love, a cat named Luna, was diabetic.

She visited her veterinarian when she noticed that her cat was drinking a lot and losing weight. Since she had experienced these clinical signs before, she assumed she had a second cat with kidney disease. Dealing with cats with kidney disease isn’t easy, but she had done it in the past. However, 10- year-old Luna turned out to be diabetic.

For Jill, the diagnosis of diabetes was overwhelming to her. “I wasn’t going to be able give my cat a shot,” she said. For starters, Jill was a bit afraid of needles herself, so the notion just didn’t seem possible. Jill also was of the mindset that diabetes would lead to an early death sentence for her beloved Luna. She broke down into tears right there in the exam room.

A licensed veterinary technician was a superhero at that moment, and calmly explained that Dr. Deborah Greco, then at Colorado State University College of Veterinary Medicine, had discovered through research, that, given the right diet, appropriate insulin control, and weight management, cats with diabetes might go into remission. In fact, up to 50% of diabetic cats can eventually stop insulin therapy. Dr. Greco’s research was funded by the Winn Feline Foundation, now the EveryCat Health Foundation (1).

Additionally, Dr. Greco compared canned high-fiber/moderate-carbohydrate diets versus low-carbohydrate/low-fiber diets and showed that cats fed low-carbohydrate diets were almost twice as likely to be able to discontinue insulin injections. Feeding newly diagnosed diabetic cats a canned low-carbohydrate, high-protein diet, (such as Purina Veterinary Diets® DM Dietetic Management® for example, or similar diabetic diets), will result in the highest remission rates. For cats that refuse to eat canned food, Purina DM dry (or other low-carbohydrate kibbles) is another alternative. Combining kibbled diets with acarbose (a drug to reduce carbohydrate digestion and absorption) may also be helpful, though diarrhea is a limiting side effect (7).

So, there is hope for cats with diabetes. But what about those needles? While oral therapies for feline diabetes have been attempted in the past (ie glipizide and metformin), they had a generally low success rate and significant adverse effects. However, a new class of drugs may be able to change that.

Senvelgo® (velagliflozin oral solution), is a new treatment for cats with diabetes, which has just been approved by the U.S. Food and Drug Administration (FDA). Senvelgo® is a once-daily liquid oral solution that cat owners can give with a small amount of food or give directly into the cat’s mouth, with no needles required. As soon as one week after beginning treatment, Senvelgo® oral solution has been shown to improve the clinical signs of diabetes that cats experience by reducing elevated blood glucose levels and minimizing the risk of clinical hypoglycemic events (4).

While another drug in this class has also been recently approved (bexaliflozin), Bexacat™ is a tablet and Senvelgo® is a liquid. Studies have suggested that oral liquids are preferred to tablets in cats (5,6). However, it is important to note that at this point there have been no comparisons as to which drug (if either) is more effective in controlling diabetes.

Feline diabetes is one of the most common endocrine disorders in cats (2). However, because of the needles needed to deliver insulin and misconceptions about the prognosis in cats with diabetes, studies show that up to 30 percent of diagnosed cats are left untreated (3). And sadly, up to one in three diabetic cats is euthanized within the first year of diagnosis. The complexity required to treat diabetic cats is often a contributing factor. (3) The novel drug comes in liquid form, the formulation that cats and cat owners prefer, according to studies (5,6).

Senvelgo® will likely be available for pet parents in the United States by mid-Fall. Note that this product isn’t an option for all cats. Cats who have previously been treated with insulin or are considered “insulin dependent” should likely not receive drugs in this class. These drugs (called SGLT2 inhibitors) work by increasing the amount of sugar cats excrete in their urine, decreasing the blood sugar as a result. This has the benefit of decreasing many of the signs associated with high blood sugar, such as weight loss, damage to the pancreas, and neurologic signs, among others. Importantly, these drugs may increase the amount of urine cats produce and may increase the likelihood of urinary tract infections. A rare complication called “Euglycemic Diabetic Ketoacidosis”, which is serious and may be fatal, has also been described. These drugs are most suited for use in cats with early or mild signs of diabetes, not previously treated with insulin, who cannot be administered injections easily. Discuss these and all medications with your veterinarian.

~Steve Dale with Dr. Matt Kornya

1 EveryCat Health Foundation- Our Impact, Diabetes Mellitus and Diet https://everycat.org/our-impact/
2 Susan Gottlieb & Jacquie Rand (2018) Managing feline diabetes: current perspectives, Veterinary Medicine: Research and Reports, 9:, 33-42, DOI: 10.2147/VMRR.S125619
3 Niessen SJM et al., The Big Pet Diabetes Survey: Perceived Frequency and Triggers for Euthanasia. Vet Sci. 2017 May 14;4(2):27.
4 Data on File at Boehringer Ingelheim
5 Zimmering et al., Ease of Use of Semintra – Cat Owner Feedback Under European Field Conditions (‘Easy Programme’), Clinical/research abstracts accepted for presentation at ISFM Congress 2014. Journal of Feline Medicine and Surgery. 2014;16(9):764-769. doi:10.1177/1098612X14545295.
6 Taylor S, Caney S, Bessant C, Gunn-Moore D. Online survey of owners’ experiences of medicating their cats at home. J Feline Med Surg. 2022 Dec; 24(12):1283-1293. doi: 10.1177/1098612X221083752. PMID: 35343808.
7 Sweet success: Managing the difficult diabetic patient (Sponsored by Purina Veterinary Diets), DVM 360, November 2014. https://www.dvm360.com/view/sweet-success-managing-difficult-diabetic-patient-sponsored-purina-veterinary-diets.