It is a challenge for both veterinarians and horse owners alike to manage insulin dysfunction, especially in obese horses suffering from equine metabolic syndrome (EMS) and/or on high non-structural carbohydrate (NSC) diets.
Velagliflozin is a drug that is able to increase renal output of glucose and reduce renal glucose reabsorption to result in lowered blood glucose and insulin concentrations. Sodium-glucose co-transport proteins are responsible for most all of glucose reabsorption. This drug is used as an anti-diabetic for humans.
An Australian study examined the effects of using this medication on ponies screened for having insulin dysregulation [Meier, A.; Reiche, D.; de Laat, M.; Pollitt, C.; Walsh, D.; Sillence, M. The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies. PLoS ONE 13(9): e0203655 https://doi.org/10.1371/journal.pone.0203655].
Of the 49 ponies selected for the trial based on high blood insulin concentrations, 12 were treated with velagliflozin (0.3 mg/kg orally) and 37 served as controls. The ponies were fed a challenge diet with 12 grams NSC/kg body weight per day for 18 days. Treated ponies were given the medication with food daily for 21 days prior to and throughout the 18 days of the challenge diet. The results are as follows:
- Treated ponies had 22% lower maximum glucose than controls;
- Treated ponies had 45% lower maximum insulin concentrations than controls – 149 μIU/ml vs. 272 μIU/ml;
- Laminitis developed in 38% (14 of 37) of the controls and in none of the treated ponies.
- Laminitis was also prevented in ponies diagnosed with clinical pars pituitary intermedia dysfunction (PPID)—four of the treated ponies with confirmed PPID did not develop laminitis whereas all five of the control ponies with PPID did. None of the PPID ponies received pergolide treatment.
- Treated ponies had no problems with hypoglycemia or other adverse effects.
The authors concluded that, “Velagliflozin shows promise as a safe and effective compound for treating insulin dysregulation and preventing laminitis by reducing the hyperinsulinemic response to dietary NSC.” Further studies are needed to evaluate long-term effects of this medication in horses.
