Use of the SGLT2 inhibitor canagliflozin for control of refractory equine hyperinsulinemia and laminitis

Ten laminitic horses with hyperinsulinemia refractory to diet control, metformin, levothyroxine and pergolide (if diagnosed with PPID) were treated with the sodium-glucose cotransporter-2 inhibitor canagliflozin (Invokana®). Nine horses were hyperglycemic (>5.5 mmol/L) or had a history of hyperglycemia. Prior to instituting therapy, renal function was assessed by determining serum creatinine and blood urea nitrogen concentrations. Canagliflozin was administered orally once a day, with food. Dipstick urinalysis was performed every 2 wk to confirm glucosuria and screen for proteinuria. Owners were also instructed regarding clinical signs consistent with urinary tract infection. All horses responded with a substantial decrease in serum insulin concentrations to normal or near normal values. Laminitis pain resolved in all cases, with regression of fat deposits. Owner satisfaction with outcomes was 100%.