AAHA’s 2026 feline diabetes guidelines elevate SGLT2 inhibitors
Bottom line
AAHA has released its 2026 Diabetes Management Guidelines for Cats, a feline-specific update that formalizes a major shift in how many newly diagnosed cats may be treated. For the first time, AAHA split canine and feline diabetes guidance into separate documents, reflecting how differently the disease behaves across species. The new recommendations elevate SGLT2 inhibitors, including bexagliflozin tablets and velagliflozin oral solution, as appropriate first-line options for many newly diagnosed, otherwise healthy cats that haven’t previously received insulin, while also moving away from in-hospital blood glucose curves and expanding guidance on continuous glucose monitoring, diabetic remission, and client communication. (aaha.org)
Why it matters: For veterinary teams, the update changes both case selection and workflow. The guidelines stress that SGLT2 inhibitors are only for carefully screened, metabolically stable cats, and that blood beta-hydroxybutyrate monitoring is essential because ketosis risk remains a central safety concern. They also reframe treatment success around clinical improvement, body weight, and overall patient status, rather than tight in-hospital glucose regulation alone. That could reshape how practices counsel pet parents, choose between oral therapy and insulin, and structure follow-up for newly diagnosed feline diabetics. (aaha.org)
What to watch: Expect close attention to how broadly primary care practices adopt SGLT2-first protocols, and whether real-world experience further refines candidate selection, ketone monitoring, and transitions to insulin. (aaha.org)
Key facts
- Organization
- American Animal Hospital Association (AAHA)
- Guideline
- 2026 Diabetes Management Guidelines for Cats
- Publication date
- April 26, 2026
- First feline-specific update
- AAHA split canine and feline diabetes guidance into separate documents for the first time
- First-line options
- SGLT2 inhibitors for many newly diagnosed, otherwise healthy cats that have not previously received insulin
- Named drugs
- Bexagliflozin tablets and velagliflozin oral solution
- Monitoring
- Blood beta-hydroxybutyrate screening before treatment, and ongoing monitoring for ketosis
- Not recommended
- In-hospital blood glucose curves are not recommended for cats
- Safety concern
- Ketosis, including diabetic ketoacidosis, remains a central risk with SGLT2 inhibitors
The American Animal Hospital Association published its 2026 Diabetes Management Guidelines for Cats on April 26, 2026, with a companion announcement on April 27, marking the first time AAHA has issued feline-specific diabetes guidance separate from canine recommendations. The headline change is clear: SGLT2 inhibitors now have a defined first-line role for many newly diagnosed feline diabetes cases, reflecting a treatment landscape that has changed quickly since oral agents for cats reached the market. (aaha.org)
That separation from canine guidance is more than editorial. AAHA says diabetes management in cats now requires a distinct approach, in part because of species-specific disease patterns and in part because the arrival of feline-labeled SGLT2 inhibitors has widened the gap between cat and dog protocols. The 2026 document retains relevant material from the 2018 AAHA diabetes guideline, but updates diagnosis, treatment, and monitoring around newer evidence, including continuous glucose monitors, remission pathways, and the risks and logistics tied to oral therapy. (aaha.org)
In practical terms, the guidelines say SGLT2 inhibitors are approved in the United States only for newly diagnosed diabetic cats that are otherwise healthy, eating, well hydrated, and not previously treated with insulin. AAHA specifically names bexagliflozin tablets and velagliflozin oral solution as once-daily oral options. At the same time, the task force emphasizes that not every cat is a candidate: cats with vomiting, hyporexia, cachexia, lethargy, major comorbidities, significant chronic kidney disease, hypercalcemia, or other signs of systemic compromise should generally be steered toward insulin instead. (aaha.org)
The most consequential operational detail may be monitoring. AAHA calls blood beta-hydroxybutyrate measurement an essential part of SGLT2 inhibitor monitoring and says every candidate should be screened for ketosis before treatment starts. The guideline cites package-insert thresholds for bexagliflozin and notes that both bexagliflozin and velagliflozin labeling warn against starting therapy when ketonuria is present; ketonuria during treatment should trigger discontinuation and transition to insulin. That emphasis aligns with FDA safety communications describing diabetic ketoacidosis, including euglycemic DKA, as an important risk with these drugs. (aaha.org)
AAHA also updates how feline diabetes should be followed once treatment begins. The guidelines say in-hospital blood glucose curves are not recommended for cats, and the related FAQ frames CGM data as trend information rather than a reason to overreact to isolated readings. The broader message is that clinicians should monitor the cat, not just the numbers, with clinical signs and body weight carrying substantial weight in treatment decisions. AAHA’s press release goes further, describing relief of clinical signs as a meaningful endpoint that replaces older, tighter glycemic targets as the central goal in many cases. (aaha.org)
AAHA’s own leadership and task force members are presenting the release as a milestone. Chief Medical Officer Jessica Vogelsang said the split into separate canine and feline documents recognizes the unique nature of the disease in each species, while co-chair Renee Rucinsky said the feline-specific format should make the recommendations easier for practitioners to use and called the updated SGLT2 guidance invaluable. Those comments match the tone of outside veterinary coverage, which has framed the document as the biggest feline diabetes update in years because it gives primary care teams a more concrete framework for choosing between insulin-first and oral-first care. (aaha.org)
Why it matters: For veterinary professionals, these guidelines could change the front end of feline diabetes care as much as the back end. Practices now need reliable screening pathways for newly diagnosed cats, clearer protocols for ketone testing, and team training on which patients are poor candidates for oral therapy. They may also need to reset pet parent expectations: oral treatment may reduce the burden of injections for some families, but it doesn’t reduce the need for careful case selection, follow-up, or fast recognition of ketosis risk. For clinics that have been cautious about SGLT2 inhibitors, AAHA’s endorsement may accelerate adoption, but likely only alongside tighter safety workflows. (aaha.org)
What to watch: The next phase will be real-world uptake, especially in general practice, where teams will test how well these recommendations translate into safer oral-first treatment, practical BHB monitoring, and timely conversion to insulin when cats fall outside the ideal profile. (aaha.org)