Hyperinsulinaemia, characterised by abnormally high insulin levels in the bloodstream, is a primary contributor to most cases of laminitis. The exact mechanism by which elevated insulin levels lead to laminitis is still not fully understood.
Managing insulin dysregulation can be challenging, with diet and exercise (unless laminitis is already present) being the primary strategies. Unfortunately, these methods may not always yield satisfactory results.
Currently, there are no approved medications specifically designed to address this issue.
However, sodium-glucose cotransporter 2 inhibitors (SGLT2i), a class of drugs commonly employed in the treatment of type 2 diabetes in humans, show promise in reducing insulin concentrations in horses by promoting the excretion of glucose through urine.
Studies have demonstrated that these drugs can limit the increase in insulin levels after meals and prevent diet-induced laminitis. One such drug in this class is ertugliflozin, which some veterinarians have been using off-label to manage laminitis associated with hyperinsulinaemia.
A study conducted by Tania Sundra from Avon Ridge Equine Veterinary Services, in Western Australia, along with Erin Kelty and David Rendle, reviewed the clinical records of 51 horses that received ertugliflozin for the treatment of hyperinsulinaemia. The findings of this study are published in Equine Veterinary Education.
According to the authors, horse owners were informed about potential side effects such as loss of appetite, colic, increased drinking and urination, lethargy, or changes in behaviour, and were instructed to report any unusual signs or events immediately.
All horses had already been placed on a restricted diet. The diet and management for each horse remained consistent during the treatment period, allowing for a comparison of pre- and post-treatment results. Similarly, the timing of testing in relation to feeding was kept consistent for each horse.
After 30 days of treatment with ertugliflozin, the authors report a significant reduction in insulin levels, with the median dropping from >300 μu/ml to 43 μu/ml. This reduction was accompanied by a significant improvement in lameness, as indicated by Modified Obel lameness scores, which decreased from a median of 10/12 to 1/12.
During the treatment, there was an increase in serum triglyceride concentrations (from 0.6 mmol/L before treatment to 1.4 mmol/L after treatment). However, none of the horses developed clinical signs of hyperlipaemia.
Owners reported that 10 horses experienced increased drinking and urination while undergoing treatment with ertugliflozin, but no other adverse effects were noticed.
The authors suggest that ertugliflozin could potentially reduce insulin levels in horses and ponies affected by equine metabolic syndrome. Moreover, they propose that its use might speed up the recovery from laminitis that is linked to hyperinsulinaemia.
For more details, see:
Preliminary observations on the use of ertugliflozin in the management of hyperinsulinaemia and laminitis in 51 horses: A case series.
Tania Sundra, Erin Kelty, David Rendle
Equine Veterinary Education (2023) Vol 35, Pp 311-320
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