Bexagliflozin (Bexacat) 15 mg PO q24h is FDA-approved as a sole oral therapy for uncomplicated feline diabetes mellitus (DM), achieving treatment success in 84% of newly diagnosed cats over a 6-month period. FDA DailyMed An…+1

The mechanism is insulin-independent. Bexagliflozin competitively inhibits sodium-glucose cotransporter 2 (SGLT2) in the renal proximal tubule, reducing glucose reabsorption and increasing urinary glucose excretion. The higher the blood glucose concentration, the greater the filtered glucose load and the more glucose excreted. Journal of Vete…+1

Pharmacokinetics in cats are relevant to dosing timing. Systemic exposure is 82% higher for peak plasma concentration (C_max) and 54% higher for area under the curve (AUC) in the fasted versus fed state, so administration timing relative to meals affects exposure. Median time to peak plasma concentration is approximately 0.5 hours (range 0.5–2 hours) and mean half-life is approximately 5 hours. There is no drug accumulation with daily dosing in healthy cats, though some diabetic cats showed persistent blood levels after discontinuation, possibly related to decreased liver function in those individuals. FDA DailyMed An…

Glycemic efficacy is rapid and durable. A measurable decrease in blood glucose is detectable after the first dose, with durable reductions in mean blood glucose and fructosamine sustained across the 6-month study period. Serum beta-hydroxybutyrate decreased for the study population as a whole. Journal of Vete… In cats with poorly regulated DM already receiving insulin, adding bexagliflozin produced a significant reduction in insulin dose requirement in all treated cats. Canadian Journa…

Clinical sign improvement is robust for polyuria and polydipsia but less consistent for polyphagia. Polyphagia is the sign least likely to improve, because the caloric wasting induced by SGLT2 inhibition drives compensatory hyperphagia. Neurological signs, musculature, and coat quality improved throughout the study period, and owner quality-of-life scores improved by study end. Journal of Vete…

Hypoglycemia risk is minimal. No symptomatic hypoglycemic episodes were observed in the 6-month field study. Nonclinical data confirm bexagliflozin does not produce hypoglycemia in healthy cats at doses up to 9 tablets per day for 182 days. Journal of Vete…

Patient selection is the critical safety variable. Bexagliflozin requires residual β-cell function — some endogenous insulin production is necessary to prevent ketosis. The ideal candidate is an otherwise healthy, newly diagnosed diabetic cat with good appetite and no relevant comorbidities. Key pre-treatment considerations include absence of ketosis, adequate renal function, exocrine pancreatic status, and screening for concurrent endocrinopathies. Journal of Vete…+1

Euglycemic diabetic ketoacidosis (DKA) is the most serious complication. Because SGLT2 inhibition lowers blood glucose independently of insulin, DKA can develop without overt hyperglycemia — a presentation unfamiliar to most veterinarians. Decreased insulin (or increased glucagon) increases lipolysis and hepatic ketogenesis; SGLT2 inhibitors may also influence glucagon secretion. Urine dipstick screening may underdetect euglycemic DKA compared to serum or blood beta-hydroxybutyrate measurement. Prompt discontinuation of bexagliflozin and initiation of insulin resolved DKA in all cats in which treatment was permitted. Journal of Vete…+1

Cats with hypersomatotropism represent a special population. Two cats with elevated IGF-1 concentrations consistent with acromegaly were enrolled in the bexagliflozin field study; both met glycemic and clinical sign criteria for treatment success at 6 months, though they were excluded from the formal effectiveness analysis because hypersomatotropism was a protocol exclusion criterion. The insulin-independent mechanism of SGLT2 inhibition is theoretically advantageous in insulin-resistant acromegalic cats. Journal of Vete…

Gastrointestinal adverse effects occur but are typically transient. Loose feces and diarrhea are recognized adverse effects, attributable to partial SGLT1 cross-reactivity in the gastrointestinal tract. For the majority of affected cats, stool changes were temporary and did not impair body condition. Journal of Vete…

Would you like a comparison of bexagliflozin versus velagliflozin for patient selection and dosing in newly diagnosed feline DM?