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Equine veterinary journal2026; doi: 10.1002/evj.70181

Short-term clinical responses in horses and ponies treated with canagliflozin: A clinical field study.

Abstract: Treatment with the sodium-glucose co-transporter 2 (SGLT2) inhibitor canagliflozin in insulin dysregulated (ID) horses has shown promising results in randomised clinical trials. Larger field studies are needed to further evaluate treatment responses and potential adverse effects under real-world conditions. Objective: To assess the short-term effects of canagliflozin on postprandial glucose and insulin responses in client-owned horses and ponies with ID using a single-sample feed-challenge test (FCT), and to characterise treatment-associated changes in bodyweight, liver enzyme activities, and triglyceride concentrations. Methods: Multicentre pre-post intervention study. Methods: Seventy privately owned horses and ponies with ID, confirmed by an oral sugar test, were enrolled. Horses received oral canagliflozin (0.4-0.6 mg/kg bwt once daily) for 3 weeks. Bodyweight, clinical biochemical parameters, and glucose and insulin concentrations from an FCT based on each horse's forage were obtained before and after treatment. Data were analysed using linear mixed-effects models. Results: The least squares (LS) means insulin concentrations (± SEM) during the FCT decreased from 304.4 ± 25.4 to 171.2 ± 25.9 μIU/mL after 3 weeks of treatment with canagliflozin (p < 0.001). Thirteen percent (9/70) of horses did not exhibit a reduction in insulin concentrations after treatment. The geometric LS means (95% confidence interval) triglyceride concentration (0.4 [0.3-0.5] vs. 1.2 [0.9-1.5] mmol/L; p < 0.001) and glutamate dehydrogenase (GLDH) activity (91 [73-112] vs. 152 [123-188] μkat/L; p 5.6 mmol/L) were observed in 9% (6/70) of treated horses. Conclusions: Absence of a placebo-treated control group. Conclusions: The postprandial insulin concentrations decreased in most canagliflozin treated horses, however, a subset failed to respond or developed marked increases in triglycerides. These findings underscore the need for careful monitoring of insulin response and lipid parameters during SGLT2 inhibitor therapy in horses.
© 2026 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2026-05-10 PubMed ID: 42108673DOI: 10.1002/evj.70181Google 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.

Objective Overview

  • This study evaluated the short-term effects of canagliflozin, an SGLT2 inhibitor, on improving insulin regulation and metabolic parameters in insulin dysregulated horses and ponies under real-world clinical settings.
  • The research assessed changes in post-meal insulin and glucose levels, bodyweight, liver enzymes, and triglycerides over a 3-week treatment period.

Background and Rationale

  • Insulin dysregulation (ID) in horses and ponies is a significant health concern, often linked with laminitis and other metabolic disorders.
  • Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that reduces blood sugar by increasing glucose excretion through the urine.
  • Previous small randomized clinical trials indicated canagliflozin may lower insulin levels post-feeding in horses with ID, but larger, practical field studies are needed to assess effectiveness and safety.

Study Design and Methods

  • Multicentre pre-post intervention study involving 70 client-owned horses and ponies diagnosed with insulin dysregulation via an oral sugar test.
  • Participants received oral canagliflozin once daily (dosage 0.4-0.6 mg/kg bodyweight) for three weeks.
  • Pre- and post-treatment evaluations included:
    • Single-sample feed-challenge test (FCT) using each animal’s forage to measure postprandial (after meal) glucose and insulin concentrations.
    • Bodyweight measurements.
    • Clinical biochemical parameters including liver enzyme activities (especially glutamate dehydrogenase – GLDH) and blood triglyceride concentrations.
  • Data were statistically analyzed using linear mixed-effects models to assess changes attributable to treatment.

Key Results

  • Significant reduction in insulin levels during the FCT after three weeks of treatment:
    • Insulin concentrations decreased from an average of 304.4 ± 25.4 μIU/mL to 171.2 ± 25.9 μIU/mL (p < 0.001).
  • Approximately 13% of the horses (9 out of 70) did not show a reduction in insulin levels despite treatment.
  • Unexpected increases in blood triglyceride concentrations and liver enzyme (GLDH) activity were observed in some horses:
    • Triglycerides increased from an average of 0.4 (0.3-0.5) mmol/L to 1.2 (0.9-1.5) mmol/L (p < 0.001).
    • GLDH activity rose from 91 (73-112) to 152 (123-188) μkat/L (p < 0.001), indicating potential liver stress or damage.
  • These adverse metabolic changes, including marked hypertriglyceridemia (triglycerides > 5.6 mmol/L), were noted in about 9% (6/70) of treated horses.

Interpretation and Implications

  • The majority of treated horses showed improved insulin regulation with lower postprandial insulin concentrations, supporting canagliflozin’s potential as a therapeutic agent in insulin dysregulated equids.
  • However, a notable subset did not respond, highlighting variability in treatment efficacy among individuals.
  • The appearance of increased triglycerides and liver enzyme levels in some horses raises concerns about possible adverse effects of canagliflozin in this population.
  • These findings suggest a need for careful clinical monitoring of both insulin response and lipid/liver parameters when using SGLT2 inhibitors like canagliflozin in horses.
  • Not having a placebo control group is a limitation, meaning that some observed changes cannot be definitively attributed to the drug without further controlled trials.

Conclusions

  • Canagliflozin treatment effectively reduced postprandial insulin levels in most horses and ponies with insulin dysregulation in a real-world clinical setting.
  • There was individual variability in response with some non-responders and some animals experiencing elevated triglycerides and liver enzyme activity, which may indicate adverse metabolic effects.
  • Caution and thorough monitoring are necessary when utilizing SGLT2 inhibitors for managing insulin dysregulation in equine patients.
  • Further larger, placebo-controlled studies are warranted to fully establish safety and efficacy profiles of canagliflozin in this species.

Cite This Article

APA
Hällbom M, Lindåse ST, Wartel M, Bröjer J. (2026). Short-term clinical responses in horses and ponies treated with canagliflozin: A clinical field study. Equine Vet J. https://doi.org/10.1002/evj.70181

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Hällbom, Moa
  • Distriktsveterinärerna, The Swedish Board of Agricultural Science, Fjärdhundra, Sweden.
Lindåse, Sanna Truelsen
  • Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Wartel, Monika
  • Distriktsveterinärerna, The Swedish Board of Agricultural Science, Fjärdhundra, Sweden.
Bröjer, Johan
  • Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.

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