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Equine veterinary journal2026; doi: 10.1002/evj.70150

Treatment with ertugliflozin mitigates the hyperinsulinemic response to intra-articular triamcinolone acetonide.

Abstract: Intra-articular (IA) corticosteroids can cause hyperinsulinemia, which can subsequently increase the risk of laminitis, particularly in horses with insulin dysregulation (ID). Sodium glucose cotransporter 2 inhibitors (SGLT2i), a drug class that is being utilised more commonly in horses with insulin dysregulation, could potentially be used to control post-IA corticosteroid hyperinsulinemia. Objective: To determine whether treatment with the SGLT2i drug ertugliflozin decreases hyperinsulinemia following intra-articular corticosteroid administration in metabolically normal horses. Methods: Prospective, controlled, cross-over study design. Eight mixed-breed, metabolically normal geldings either received no treatment (CTL) or were treated with ertugliflozin (ERT) for 7 days before and 7 days after a total dose of 18 mg of IA triamcinolone acetonide (TA). Samples for resting glucose and insulin concentrations, as well as dynamic oral sugar testing (OST), were collected. Treatments were crossed over and the study repeated. Two-way, repeated measures analysis of variance was used to identify timepoint by treatment differences (p < 0.05). Results: Insulin was significantly lower 2 days after IA TA with ERT treatment at 60 min post-OST. Resting glucose concentrations were significantly lower with ERT treatment at 8 h, 12 h, 24 h, and 48 h while resting insulin concentrations were significantly lower with ERT treatment at 12 h, 24 h, 48 h, and 72 h post-IA injection. Conclusions: Non-insulin dysregulated horses and compounded ertugliflozin were utilised. Conclusions: Treatment with ertugliflozin decreases glucose and insulin changes following IA corticosteroid administration in metabolically normal horses. Further investigation of this treatment strategy in insulin dysregulated horses is warranted as it may reduce hyperinsulinemia and, therefore, the risk of laminitis with IA corticosteroid administration.
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Publication Date: 2026-02-01 PubMed ID: 41622114DOI: 10.1002/evj.70150Google 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.

Overview

  • This study investigated whether ertugliflozin, a sodium glucose cotransporter 2 inhibitor (SGLT2i), can reduce the increase in insulin levels caused by intra-articular corticosteroid injections in healthy horses.
  • The research found that ertugliflozin treatment significantly lowered insulin and glucose levels following corticosteroid administration, suggesting potential benefits in managing insulin spikes and reducing laminitis risk.

Background and Purpose

  • Intra-articular corticosteroids (specifically triamcinolone acetonide) are used to treat joint inflammation but can cause hyperinsulinemia (high insulin levels) as a side effect.
  • Hyperinsulinemia increases the risk of laminitis, a painful hoof condition, especially in horses with insulin dysregulation (ID), a metabolic disorder common in some horses.
  • SGLT2 inhibitors like ertugliflozin lower blood glucose by promoting glucose excretion through the urine and are increasingly considered for managing insulin dysregulation in horses.
  • The study’s objective was to test if ertugliflozin could blunt or mitigate the insulin spike caused by intra-articular corticosteroid injections in metabolically normal (non-ID) horses.

Methods

  • The study used a prospective, controlled, cross-over design involving eight metabolically normal geldings of mixed breeds.
  • Each horse experienced two treatment phases separated by a washout period:
    • No treatment (control, CTL) phase.
    • Ertugliflozin treatment (ERT) phase, where horses received the drug for 7 days before and 7 days after an intra-articular injection of triamcinolone acetonide (18 mg total dose).
  • Resting blood glucose and insulin levels were measured alongside dynamic testing using an oral sugar test (OST), which evaluates how the horse’s body handles sugar intake.
  • Samples were collected at multiple time points to assess changes over time after corticosteroid injection.
  • Statistical analysis: Two-way repeated measures ANOVA was used to analyze differences in insulin and glucose between treatments over time. A p-value of less than 0.05 indicated significant differences.

Key Results

  • Treated horses showed significantly lower insulin levels 2 days post-injection, especially at 60 minutes after the oral sugar test, suggesting ertugliflozin mitigated the hyperinsulinemic response.
  • Resting glucose concentrations were significantly decreased with ertugliflozin at multiple time points post-injection: 8, 12, 24, and 48 hours.
  • Resting insulin concentrations were also significantly lower with ertugliflozin at 12, 24, 48, and 72 hours post-injection.
  • These findings demonstrate ertugliflozin’s effectiveness in reducing both basal and stimulated insulin and glucose concentrations following corticosteroid treatment in metabolically normal horses.

Conclusions and Implications

  • This study is the first to show that ertugliflozin can attenuate the increases in insulin and glucose caused by intra-articular corticosteroids in healthy horses.
  • Though the study was conducted on non-insulin dysregulated horses, the promising results suggest potential therapeutic use for horses with insulin dysregulation to prevent harmful hyperinsulinemia and associated laminitis risk.
  • Since hyperinsulinemia predisposes horses to laminitis, especially when combined with corticosteroid use, ertugliflozin could be a valuable adjunct treatment.
  • Further research is recommended to evaluate the safety, efficacy, and dosing of ertugliflozin in insulin dysregulated horses and in clinical settings.

Cite This Article

APA
Page AE, McPeek JL, McGreevy E, Carattini S, Adam EN. (2026). Treatment with ertugliflozin mitigates the hyperinsulinemic response to intra-articular triamcinolone acetonide. Equine Vet J. https://doi.org/10.1002/evj.70150

Publication

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

Researcher Affiliations

Page, Allen E
  • Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA.
McPeek, Jenna L
  • Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA.
McGreevy, Ella
  • College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee, USA.
Carattini, Sophia
  • Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA.
Adam, Emma N
  • Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA.

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