Update (June 26, 2026): Bexagliflozin (Bexacat) Safety and Effectiveness in Newly Diagnosed Diabetic Cats — Hadd et al. 2023

Bottom line.

• A 2023 prospective clinical trial (Hadd et al., JVIM) in 84 client-owned cats newly diagnosed with diabetes mellitus showed bexagliflozin (Bexacat) decreased hyperglycemia and clinical signs of DM when administered as once-daily oral tablets; the drug was FDA-approved in January 2023.^1,2
• Serious adverse events occurred in approximately 10% of cats and included DKA, pancreatitis, hepatic lipidosis, weight loss, urinary tract infections, dehydration, anemia, and hypercalcemia; gastrointestinal adverse events (vomiting, diarrhea, anorexia, lethargy) were typically mild and self-limiting.¹
• The 2026 AAHA Diabetes Management Guidelines for Cats state that bexagliflozin should not be initiated if blood BHB is >3.6 mmol/L, or if BHB is >2.4 mmol/L and the cat has a history of acidosis or renal compromise; detecting ketonuria during treatment should prompt discontinuation and transition to insulin.³
• This is a clinician-facing evidence summary. It is not a dosing protocol; confirm regimen, monitoring and contraindications against current product labeling and a veterinary formulary.

Drug facts

• Class: Sodium-glucose cotransporter 2 (SGLT2) inhibitor.¹
• Mechanism: Inhibits SGLT2 in the renal proximal convoluted tubule, blocking glucose reabsorption and promoting urinary glucose excretion, lowering blood glucose independently of endogenous insulin.³
• Formulation/route: Flavored 15 mg oral tablet; administered once daily.¹
• FDA approval: January 2023 (Bexacat, Elanco); indicated for use in cats newly diagnosed with diabetes mellitus not previously treated with insulin.²
• Key trial population: 84 client-owned cats newly diagnosed with diabetes mellitus.¹

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What the evidence shows

Trial design and population

The pivotal safety and effectiveness study (Hadd MJ, Bienhoff SE, Little SE, et al., JVIM 2023) was a prospective clinical trial in 84 client-owned cats newly diagnosed with diabetes mellitus.¹ Cats received bexagliflozin as once-daily oral flavored tablets. The study evaluated the effectiveness of bexagliflozin at decreasing hyperglycemia and observed clinical signs, and assessed the safety profile with particular attention to serious adverse events.

Effectiveness

Bexagliflozin decreased hyperglycemia and observed clinical signs of diabetes mellitus in the enrolled cats.¹ SGLT2 inhibitors lower blood glucose by blocking most reabsorption of glucose in the renal proximal convoluted tubules, mitigating clinical signs (polyuria, polydipsia, polyphagia) while reversing glucose toxicity and allowing for potential beta-cell recovery.³ Serum fructosamine concentrations were routinely within the reference range after 8 weeks of treatment in cats receiving SGLT2 inhibitor therapy in this and related studies.³

Serious adverse events (~10%)

Serious adverse events occurred in approximately 10% of cats in the trial and included: DKA, pancreatitis, hepatic lipidosis, weight loss, urinary tract infections, dehydration, anemia, and hypercalcemia.¹ The most serious complication attributable to bexagliflozin therapy was DKA, including euglycemic DKA (EDKA) in which acid-base and electrolyte derangements occur without overt hyperglycemia (blood glucose <250 mg/dL).³ The reported incidence of DKA/EDKA with SGLT2 inhibitor therapy is 5–7% across trials — the same as the DKA incidence with insulin-treated cats.³

Minor adverse events

Other common adverse effects — vomiting, diarrhea, anorexia, and lethargy — were typically mild and self-limiting.¹ Approximately 38–50% of cats on SGLT2 inhibitor therapy have changes in stool consistency in the first 2 weeks, likely from mild cross-inhibition of SGLT1 in the small intestine causing osmotic diarrhea; antibiotic therapy is not indicated for this effect.³

Modest increases in serum total calcium have been reported in a small number of cats on SGLT2 inhibitors, and the 2026 AAHA guidelines recommend monitoring ionized calcium in cats with a history of hypercalcemia.³

BHB monitoring and ketonuria contraindication

Per the bexagliflozin package insert (referenced in the 2026 AAHA guidelines), bexagliflozin should not be initiated if blood BHB is >3.6 mmol/L, or if BHB is >2.4 mmol/L and the cat has a history of acidosis or renal compromise.³ Detecting ketonuria on the screening urinalysis or during treatment should prompt discontinuation and transition to insulin. The 2026 AAHA guidelines recommend blood BHB monitoring (using a validated handheld ketone meter) as essential in the monitoring of cats receiving SGLT2 inhibitors, particularly during the first 2 weeks of therapy when DKA risk is highest.³

Comparison with velagliflozin (SENSATION study)

Both bexagliflozin and velagliflozin are SGLT2 inhibitors with the same mechanism and indication. The larger SENSATION study (Behrend et al. 2024, JAVMA) enrolled 252 cats and confirmed the glucose-lowering effectiveness of velagliflozin over 180 days, with EDKA incidence of 5–7%.⁴ The 2026 AAHA guidelines treat both drugs as clinically equivalent for patient selection and monitoring purposes, and the monitoring schedule in Table 6.1 applies to both agents.³

How this fits clinical practice

Bexagliflozin (Bexacat) was the first SGLT2 inhibitor approved for veterinary feline use (January 2023), followed by velagliflozin (Senvelgo) in August 2023. Both are guideline-endorsed options for appropriate candidates. The Hadd et al. 2023 trial established the registration data supporting bexagliflozin approval. The principal clinical considerations are: (1) rigorous patient selection to exclude metabolically unstable cats, (2) mandatory pre-treatment BHB measurement, (3) close monitoring for EDKA in the first 2 weeks, and (4) a clear clinical plan for transitioning to insulin if the cat does not respond or develops ketosis. Do not infer specific doses from this summary; consult current product labeling and the 2026 AAHA guidelines.

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References

1. Hadd MJ, Bienhoff SE, Little SE, et al. 2023. Safety and effectiveness of the sodium-glucose cotransporter inhibitor bexagliflozin in cats newly diagnosed with diabetes mellitus. J Vet Intern Med 37(3):915–24. https://onlinelibrary.wiley.com/doi/10.1111/jvim.16730
2. Veterinary Medicine at Illinois. 2023. FDA Approves SENVELGO (velagliflozin) for Feline Diabetes. https://vetmed.illinois.edu/2023/11/02/pharmacists-corner-fda-approves-new-liquid-oral-feline-diabetes-medication/
3. American Animal Hospital Association. 2026. 2026 AAHA Diabetes Management Guidelines for Cats — Section 6: SGLT2 Inhibitor Treatment and Monitoring. https://www.aaha.org/resources/2026-aaha-diabetes-management-guidelines-for-cats/section-6-sglt2-inhibitor-treatment-and-monitoring/
4. Behrend EN, Ward CR, Chukwu V, et al. 2024. Velagliflozin, a once-daily, liquid, oral SGLT2 inhibitor, is effective as a stand-alone therapy for feline diabetes mellitus: the SENSATION study. J Am Vet Med Assoc 262(10):1343–53. https://avmajournals.avma.org/view/journals/javma/262/10/javma.24.03.0174.xml

Changelog

• 2026-06-26: First published.