Abstract: Background- Characterization of early responses to velagliflozin treatment will help guide future case management. Objective- Describe clinical outcomes during initial 2 wk of velagliflozin Animals- Clinically stable, client-owned, insulin-naïve and previously insulin-treated diabetic cats (n=35). Methods- Prospective observational study. Exclusion criteria: body condition score < 5/9, uncontrolled comorbidity, ketonuria, recent glucocorticoids. Owners recorded daily appetite, activity, fecal score & vomiting. Clinical exam on days 0-1 (V1), 2-4 (V2), 6-8 (V3), & 14 (V4) of treatment included blood glucose (BG), blood ketones (BHB), & Diabetic Clinical Score (DCS). Diet was unchanged, apart from V1: psyllium supplementation, V2: pre-/probiotic if fecal score>5/7, V3: diet transition if fecal score still>5/7. Results- Sixty percent (21/35) completed 2 wk of velagliflozin treatment. At V1, 3/35 (8%) owners elected to continue insulin, 5/35 (14%) cats had newly recognized comorbidity, 2/35 (6%) had ketosis (1 started insulin, 1 euthanized). From the 25 cats included, transient hypersalivation occurred in 2/25 (8%). Exclusions between V1 & V4: 1 owner requested change to insulin, 3/24 (13%) were unwell with BHB >6.0 mmol/L (1/3 had eDKA, 2/3 were outpatients). BG < 250 mg/dL was achieved in 22/24: 19/21 treated for 2 wk and 3 with BHB >6.0 mmol/L. Transient ketosis (BHB 2.4-5.4 mmol/L) with improved DCS occurred in 4/21 (19%). Fecal score >5/7 developed in 5/24 (21%) and continued at V4 in 3/21 (14%). Median weight loss was 100 g [-200-600] with 5/21 (24%) cats losing >2%/wk. Clinical Importance- Sixty percent of eligible cats were successfully initiated on velagliflozin; ketosis may be transient.
