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pain and inflammation associated with conditions such as osteoarthritis. One commonly used corticosteroid is triamcinolone acetonide (TA), which can provide significant relief from lameness and improve performance. However, growing evidence suggests that even when corticosteroids are administered directly into a joint, they can have effects throughout the body, including alterations in blood glucose and insulin concentrations.
This is important because elevated insulin concentrations (hyperinsulinaemia) are strongly associated with endocrinopathic laminitis, one of the most common and serious causes of laminitis in horses. Horses with Equine Metabolic Syndrome (EMS) or insulin dysregulation (ID) are considered particularly vulnerable, but any horse experiencing a substantial increase in insulin may be at risk.
Researchers have recently investigated whether ertugliflozin, a member of the sodium-glucose co-transporter 2 inhibitor (SGLT2i) drug class, could help reduce these post-corticosteroid insulin increases. In human medicine, SGLT2 inhibitors are commonly used to treat Type 2 diabetes by promoting the excretion of glucose through the urine, thereby reducing blood glucose and insulin levels. More recently, these drugs have attracted attention in equine medicine as a treatment for severe insulin dysregulation.
Two independent studies have now examined the effects of ertugliflozin administration around the time of IA corticosteroid treatment in horses.
The first study, conducted by Page and colleagues at the University of Kentucky, used eight metabolically normal geldings in a controlled crossover design. Horses either received no treatment or were given ertugliflozin for seven days before and seven days after receiving a clinically relevant dose of triamcinolone acetonide. Researchers measured resting glucose and insulin concentrations and performed oral sugar tests to assess the horses' insulin responses.
The results showed that horses receiving ertugliflozin had significantly lower blood glucose and insulin concentrations following corticosteroid administration. Resting glucose concentrations remained lower for up to 48 hours after injection, while resting insulin concentrations were lower for up to 72 hours. Insulin responses during oral sugar testing were also reduced. Importantly, no obvious adverse effects were observed during the study.
A second study by Darch and colleagues produced similar findings. Using a randomised, blinded, placebo-controlled crossover design, eight Standardbred geldings received either ertugliflozin or a placebo before and after IA triamcinolone administration. The researchers monitored blood insulin, glucose and triglyceride concentrations over the treatment period.
Again, ertugliflozin substantially reduced the insulin response following corticosteroid injection. The peak insulin concentration (Cmax) was approximately 40 μIU/mL in the placebo group but only 17 μIU/mL in horses receiving ertugliflozin. Statistical analysis indicated a greater than 99% probability that the peak insulin concentration was lower when horses received ertugliflozin.
Together, these studies provide encouraging evidence that ertugliflozin can attenuate the increases in blood glucose and insulin that occur following IA corticosteroid administration. This finding is particularly relevant because corticosteroid-associated hyperinsulinaemia may contribute to laminitis risk.
However, both studies were conducted in horses that did not have insulin dysregulation. Consequently, the most important question remains unanswered: can ertugliflozin reduce post-corticosteroid insulin elevations in horses already suffering from EMS or ID, where the risk of laminitis is greatest?
Further research is now needed to determine whether this treatment strategy can safely protect high-risk horses. If successful, ertugliflozin could become an important tool that allows veterinarians to continue using corticosteroid joint injections while reducing the metabolic complications that may accompany them.
For more details,see:
1) Allen E Page, Jenna L McPeek, Ella McGreevy, Sophia Carattini, Emma N Adam.
Treatment with ertugliflozin mitigates the hyperinsulinemic response to intra-articular triamcinolone acetonide.
Equine Vet J. 2026.
https://doi.org/10.1002/evj.70150
2) Cara Darch, Timothy H. Hyndman, David Byrne, David Ian Rendle, Barny Fraser,
Ertugliflozin decreases the insulin spike in non-insulin dysregulated standardbred horses following intra-articular triamcinolone administration,
Domestic Animal Endocrinology, (2026) Vol 96,107016,
