Efficacy and Safety of Non-Insulin Antidiabetic Drugs in Cats : A Systematic Review
Romero-Vélez, Félix (Universitat Autònoma de Barcelona. Hospital Clínic Veterinari)
Rejas, Juan (Universidad de León. Departamento de Medicina, Cirugía y Anatomía Veterinaria)
Ruiz de Gopegui, Rafael (Universitat Autònoma de Barcelona. Departament de Medicina i Cirurgia Animals)

Date:	2025
Abstract:	Feline diabetes mellitus is a common disease typically requiring daily insulin injections, which can be challenging for cats and their owners. This has prompted interest in non-insulin antidiabetic drugs (NIADs). We conducted the first comprehensive systematic review to gather and critically evaluate all scientific evidence on the use of these NIADs in cats. Our review of 20 studies found that older oral drugs like glipizide have limited efficacy and may even be harmful to the pancreas. In contrast, a new class of once-daily oral drugs, the SGLT2 inhibitors (bexagliflozin and velagliflozin), are highly effective, often working as well as insulin. However, their main risk is not low blood sugar (hypoglycemia) but a different serious side effect called euglycemic diabetic ketoacidosis (eDKA), which requires careful monitoring. This review shows that veterinarians and cat owners now have a viable oral alternative to insulin, but the choice of treatment involves a new risk-benefit discussion centered on owner education and vigilance for signs of eDKA. Background: While insulin is the standard of care for feline diabetes mellitus (FDM), non-insulin antidiabetic drugs (NIADs) are emerging as alternatives. This systematic review aims to synthesize and critically appraise the current evidence for the efficacy and safety of NIADs in cats. Methods: A systematic review was conducted following PRISMA guidelines. Major databases were searched for studies evaluating NIADs in diabetic cats or at-risk/experimental models. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Results: Twenty studies were included. In diabetic cats (10 studies), traditional agents (glipizide, metformin, acarbose) showed limited efficacy based on evidence with a high risk of bias. Newer SGLT2 inhibitors (bexagliflozin, velagliflozin) demonstrated high treatment success rates and non-inferiority to insulin but were associated with a significant risk of euglycemic diabetic ketoacidosis (eDKA). In at-risk/experimental models (10 studies), thiazolidinediones consistently improved insulin sensitivity, while glipizide was shown to accelerate islet amyloidosis. Conclusions: The evidence supports a paradigm shift towards SGLT2 inhibitors as a viable oral monotherapy for select cases of FDM. This alters the clinical risk-benefit discussion from preventing hypoglycemia to mitigating eDKA. Significant evidence gaps remain, particularly the lack of high-quality RCTs and data in cats with common comorbidities.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Feline diabetes mellitus ; SGLT2 inhibitors ; Velagliflozin ; Bexagliflozin ; Glipizide ; Exenatide ; Evidence-based medicine
Published in:	Animals, Vol. 15 (august 2025) , ISSN 2076-2615

DOI: 10.3390/ani15172561
PMID: 40941356

21 p, 884.2 KB

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