AAHA releases 2026 diabetes management guidelines for cats
Bottom line
The American Animal Hospital Association has released its 2026 Diabetes Management Guidelines for Cats, a feline-specific update that separates cat recommendations from prior combined dog-and-cat guidance and reflects how much feline diabetes care has changed in the SGLT2 inhibitor era. Published April 27, 2026, and appearing in the Journal of the American Animal Hospital Association on May 1, the guidelines walk clinicians through diagnosis, treatment, monitoring, diabetic ketoacidosis, remission, and client education. A central shift is that the document positions SGLT2 inhibitors as an important first-line option for many newly diagnosed, otherwise healthy cats, while also emphasizing that not every cat is an appropriate candidate and that insulin remains essential in sicker or more complex cases. (aaha.org)
Why it matters: For veterinary teams, this is more than a routine guideline refresh. It formalizes a species-specific approach to feline diabetes, adds practical algorithms for starting and monitoring SGLT2 therapy, and puts beta-hydroxybutyrate monitoring at the center of safety screening because of the risk of diabetic ketoacidosis, including euglycemic DKA. The guidance also updates how clinicians think about diet transitions, continuous glucose monitoring, and remission, giving primary care teams a more structured framework for discussing options with pet parents who may prefer oral therapy over insulin injections. (aaha.org)
What to watch: Expect the next phase to be about adoption in general practice, especially how clinics implement patient-selection protocols for SGLT2 inhibitors and ketone monitoring workflows. (dvm360.com)
Key facts
- Organization
- American Animal Hospital Association
- Guideline
- 2026 Diabetes Management Guidelines for Cats
- Species focus
- Cats
- Publication date
- April 27, 2026
- Journal publication date
- May 1, 2026
- Main treatment shift
- SGLT2 inhibitors are positioned as an important first-line option for many newly diagnosed, otherwise healthy cats
- Safety monitoring
- Blood beta-hydroxybutyrate monitoring is central because of diabetic ketoacidosis risk, including euglycemic DKA
- Other treatment
- Insulin remains essential for sicker or more complex cases
- Remission
- AAHA supports an average U.S. remission rate of about 30% for insulin-treated cats
The American Animal Hospital Association’s new 2026 Diabetes Management Guidelines for Cats mark a notable turning point in feline endocrinology: cats now have their own dedicated diabetes guideline, and the recommendations explicitly reflect the arrival of FDA-approved SGLT2 inhibitors as a mainstream treatment option. AAHA published the guidelines on April 27, 2026, describing them as a milestone update for feline care, with the full practice guideline published in JAAHA on May 1, 2026. (aaha.org)
That species split is part of the story. The prior AAHA diabetes guidance from 2018 covered both dogs and cats, but the 2026 document argues that feline diabetes management now differs enough from canine care to warrant a separate roadmap. AAHA says the new guideline retains clinically relevant material from the 2018 version while incorporating new evidence and expert opinion on diagnosis, treatment, monitoring, diabetic ketoacidosis, remission, and client communication. (ebvminpractice.org)
The biggest clinical change is the prominence of SGLT2 inhibitors in newly diagnosed feline patients. AAHA’s guideline hub says the document provides step-by-step guidance on SGLT2 inhibitor treatment and monitoring, while dvm360’s coverage summarizes the update as recommending these drugs as first-line therapy for many cats with diabetes. The guidance discusses both bexagliflozin and velagliflozin, but it pairs that expanded use with clear guardrails: package inserts warn against starting these drugs in cats with certain ketone findings, and the guideline emphasizes that endogenous insulin is still necessary to prevent ketosis. (aaha.org)
AAHA also gets highly operational. The guideline highlights diagnosis, evaluation of newly diagnosed cats, insulin protocols, dietary management, troubleshooting, and diabetic ketoacidosis, including euglycemic DKA. In the SGLT2 section, the task force recommends continuing the cat’s usual diet for the first two weeks of treatment before slowly introducing a low-carbohydrate diet if the patient is doing well. It also identifies blood beta-hydroxybutyrate measurement as an essential part of SGLT2 monitoring. Elsewhere, the document expands on glucose monitoring, including continuous glucose monitoring, and notes that remission remains possible in many cats, with the task force supporting an average U.S. remission rate of about 30% for insulin-treated cats. (aaha.org)
Industry and expert commentary around the release has focused on exactly that balance between innovation and caution. AAHA quoted co-chair Renee Rucinsky as saying the feline-only format should make the guidance easier for practitioners to use and that the updated information on SGLT2 inhibitors is especially valuable. In a recent dvm360 interview, internist Ellen Behrend said appropriate candidates are essentially “happy diabetic” cats that are eating, drinking, and otherwise stable, while cats that are unwell, not eating, vomiting, having diarrhea, or underweight should receive insulin instead. That framing mirrors the guideline’s broader message that oral therapy may expand access and adherence, but only with careful case selection. (aaha.org)
Why it matters: For veterinary professionals, the practical significance is twofold. First, the guideline gives general practitioners a more current framework for discussing treatment choice with pet parents, especially those who may struggle with insulin administration and could benefit from an oral option. Second, it raises the bar for safety systems in practice: clinics using SGLT2 inhibitors need reliable screening, ketone monitoring, recheck protocols, and staff education around DKA and euglycemic DKA risk. In other words, the new flexibility in treatment comes with a greater need for disciplined workflow and case triage. (aaha.org)
There’s also a business and care-delivery angle. AAHA says the guideline includes charts and algorithms for starting SGLT2 treatment, insulin dosing, hypoglycemia troubleshooting, and management of unregulated patients, which could help standardize care across primary practice teams. Because the document also covers at-home monitoring and client education, it may support more consistent communication with pet parents about expectations, follow-up, and the possibility, but not certainty, of remission. (aaha.org)
What to watch: The next key question is how quickly feline practices and mixed general practices operationalize these recommendations, particularly around candidate screening for SGLT2 drugs, BHB monitoring, and when clinicians decide to pivot from oral therapy to insulin after the first month if hyperglycemia and clinical signs persist. (aaha.org)