Bexagliflozin controls hyperinsulinemia in horses with naturally occurring insulin dysregulation: a placebo-controlled crossover trial.

Bexagliflozin 0.06 mg/kg daily effectively reduces hyperinsulinemia in horses.

This randomized, placebo-controlled crossover trial evaluated bexagliflozin, a sodium-glucose cotransporter 2 inhibitor, for managing insulin dysregulation in 10 Arabian horses with hyperinsulinemia. Horses received either bexagliflozin at 0.03 mg/kg daily (BEXA03), 0.06 mg/kg daily (BEXA06), or placebo for 10-day periods separated by 4-day washouts. Oral sugar tests assessed insulin dynamics via resting insulin levels, peak insulin concentration (Cmax), and area under the curve (AUC). The higher dose (BEXA06) significantly reduced all insulin parameters: resting insulin decreased from 53.9 to 17.6 μIU/mL, Cmax from 90.9 to 48.4 μIU/mL, and AUC from 9,146.3 to 4,084.0 μIU/mL·min compared to placebo. The lower dose (BEXA03) showed no significant effect. Mild hypertriglyceridemia occurred in 5 horses receiving BEXA06, but mean triglyceride concentrations were not statistically elevated. These findings demonstrate bexagliflozin's effectiveness at 0.06 mg/kg for short-term insulin control in equine insulin dysregulation with acceptable safety profile regarding lipid metabolism.

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