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Home / Equine Research Bank / Open Vet J / Hypertriglyceridemia in equines with refractory hyperinsulin...
Open veterinary journal2023; 13(3); 365-375; doi: 10.5455/OVJ.2023.v13.i3.14

Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors.

Abstract: Sodium-Glucose CoTransporter-2 (SGLT2) inhibitors, the -flozin group of drugs, which block glucose reuptake in the renal proximal tubule, are being increasingly used off-label to treat horses with refractory hyperinsulinemia. After 2 years of use by animals in our group, a horse on canagliflozin was incidentally noted to be hyperlipemic. We have been following a cohort of equines (n = 20) treated with SGLT2 inhibitors due to refractory hyperinsulinemia. The animals are owned by members of the Equine Cushing's and Insulin Resistance Group and treated by their attending veterinarians. The index case was a 23 years old gelding with a 2 years history of recurring laminitis that began canagliflozin therapy to control hyperinsulinemia which was no longer responsive to metformin. Between 6 and 10 weeks post start of therapy, significant weight loss was noticed. Two days later he was hospitalized with colic symptoms and hyperlipemia but was bright, alert, and eating well throughout. Canagliflozin was discontinued and triglycerides returned to normal reference values within 10 days. A subsequent study of 19 other horses on SGLT2 inhibitors revealed varying degrees of hypertriglyceridemia, all asymptomatic. While this class of drugs holds great promise for cases of refractory hyperinsulinemia and laminitis that do not respond to diet or metformin therapy, hypertriglyceridemia is a potential side effect. In our experience, animals remained asymptomatic and eating well. Further study of hypertriglyceridemia in horses on SGLT2 inhibitors and the possible mitigating effect of diet is indicated. To our knowledge, this is the first report of hypertriglyceridemia with canagliflozin treatment in equines.
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Publication Date: 2023-03-20 PubMed ID: 37026076PubMed Central: PMC10072834DOI: 10.5455/OVJ.2023.v13.i3.14Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research is about the observed side effect of hypertriglyceridemia in horses treated with SGLT2 inhibitors for hyperinsulinemia that didn’t respond to metformin therapy. The study recommends further research about this side effect and possible dietary mitigation.

Introduction and Methodology

  • The Sodium-Glucose CoTransporter-2 (SGLT2) inhibitors, a class of drugs used primarily for diabetes treatment in humans, are being used in horses who have not positively responded to common treatments for hyperinsulinemia.
  • The authors noticed that a horse being treated with canagliflozin, an SGLT2 inhibitor drug, exhibited hyperlipemia after two years of therapy. Hyperlipemia is the excessive concentration of fats in the blood.
  • The horse was part of a larger cohort of 20 horses being treated with SGLT2 inhibitors for the same condition under the supervision of veterinarians affiliated with the Equine Cushing’s and Insulin Resistance Group.
  • All animals in the study suffered from recurrent laminitis – a painful and debilitating condition of the hoof – as a result of their hyperinsulinemia.

Observations and Results

  • Six to ten weeks post-initiation of therapy with canagliflozin, it was observed that one of the horses in the cohort began showing significant weight loss.
  • The horse was subsequently diagnosed with colic symptoms and hyperlipemia, although its overall behavior and appetite remained normal.
  • After discontinuing canagliflozin, the horse’s blood triglyceride levels returned to normal within 10 days.
  • Upon examination of the remaining 19 horses in the cohort, it was found that they were also suffering from varying degrees of hypertriglyceridemia, an increase in fatty acid concentration in the blood. However, none of these horses exhibited symptoms.

Conclusion and Further Recommendations

  • The report suggests that while SGLT2 inhibitors show potential in treating cases of hyperinsulinemia that are resistant to other treatment options, there is a noticeable risk of hypertriglyceridemia.
  • Despite the resultant hypertriglyceridemia, the study observed that the animals remained asymptomatic and willing to eat.
  • Further study on this side effect and potential ways to mitigate the risk, such as dietary interventions, are recommended.
  • To the authors’ knowledge, this is the first reported instance of hypertriglyceridemia arising as a result of canagliflozin treatment in horses.

Cite This Article

APA
Kellon EM, Gustafson KM. (2023). Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors. Open Vet J, 13(3), 365-375. https://doi.org/10.5455/OVJ.2023.v13.i3.14

Publication

Open veterinary journal
ISSN: 2218-6050
NlmUniqueID: 101653182
Country: Libya
Language: English
Volume: 13
Issue: 3
Pages: 365-375

Researcher Affiliations

Kellon, Eleanor M
  • Equine Cushing's and Insulin Resistance Group, Inc, 2307 Rural Road, Tempe, AZ 85282, USA.
Gustafson, Kathleen M
  • Equine Cushing's and Insulin Resistance Group, Inc, 2307 Rural Road, Tempe, AZ 85282, USA.

MeSH Terms

  • Horses
  • Animals
  • Male
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use
  • Canagliflozin / adverse effects
  • Hypoglycemic Agents / adverse effects
  • Diabetes Mellitus, Type 2 / chemically induced
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / veterinary
  • Glucosides / adverse effects
  • Metformin / therapeutic use
  • Glucose / therapeutic use
  • Hyperlipidemias / chemically induced
  • Hyperlipidemias / drug therapy
  • Hyperlipidemias / veterinary
  • Hypertriglyceridemia / complications
  • Hypertriglyceridemia / drug therapy
  • Hypertriglyceridemia / veterinary
  • Hyperinsulinism / drug therapy
  • Hyperinsulinism / veterinary
  • Horse Diseases / drug therapy

Conflict of Interest Statement

The authors declare no conflict of interest.

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