Managing nutrition in aging horses with metabolic disease

Aging horses with metabolic disease are becoming a more visible nutrition and management challenge, and a new article in The Horse argues that the answer isn’t simply “feed low sugar.” In “Aging Metabolic Horses—What Do They Need?”, published March 5, 2026, Stacey Oke, DVM, MSc, outlines how clinicians and nutrition experts are approaching older horses with insulin dysregulation, PPID, or both, especially when those endocrine issues overlap with arthritis, muscle loss, poor dentition, and shifting body condition. (thehorse.com)

That overlap is important because PPID and equine metabolic syndrome are both strongly tied to laminitis risk, but they don’t always present the same way. UC Davis describes equine metabolic syndrome as a disorder centered on insulin dysregulation, often with regional adiposity and difficulty losing weight, while also noting that thinner animals can be affected. In older horses, PPID can further worsen metabolic control, making dual diagnosis clinically relevant rather than incidental. AAEP proceedings on the older horse have similarly stressed that prevention should focus on early identification of horses at risk for endocrinopathic laminitis through body condition monitoring and testing for both insulin dysregulation and PPID. (ceh.vetmed.ucdavis.edu)

The Horse article’s core message is that diet remains the foundation of management, even when the horse is not overtly obese. It cites Erica Macon, MS, PAS, PhD, of Texas A&M, who says limiting nonstructural carbohydrates is crucial for controlling postprandial hyperinsulinemia in horses with insulin dysregulation. The article notes that low-NSC hay, reduced pasture access, and ration balancers remain standard tools, but it also flags an important nuance from veterinarian Tania Sundra: individual horses may have different insulin responses to the same diet. That variability matters in practice, because it pushes veterinarians and nutritionists toward closer follow-up rather than one-size-fits-all feeding advice. (thehorse.com)

The piece also reflects a broader shift in equine endocrine care toward layered management. The Horse reports that pergolide remains the recommended treatment for PPID, and it cites the Equine Endocrinology Group’s dosing guidance as a starting point. For more difficult insulin dysregulation cases, the article discusses SGLT2 inhibitors, while cautioning that these drugs should be considered in the context of individual risk factors and used within a comprehensive plan centered on nutrition, exercise, and overall metabolic health. That framing is consistent with other recent coverage in The Horse, which notes that medications such as metformin, levothyroxine, and SGLT2 inhibitors may be used in refractory or severe cases, but under direct veterinary supervision. (thehorse.com)

One reason this story is especially relevant for equine practice is that “senior metabolic horse” often becomes shorthand for multiple simultaneous problems. Dental disease is a good example. A related The Horse nutrition commentary on feeding horses with EOTRH notes that balanced pelleted rations may need to become the dietary mainstay, and that soaked hay, hay pellets, cubes, or complete feeds can help maintain nutrition when incisors or other teeth are compromised. The University of Minnesota’s veterinary team has also reported that horses often eat better and gain weight after painful EOTRH teeth are removed, underscoring how oral pain can masquerade as a simple nutrition problem. (thehorse.com)

Industry and expert commentary around equine endocrine disease has been moving in the same direction: more individualized, more multidisciplinary, and more realistic about what older horses can tolerate. AAEP educational programming in 2025 highlighted practical feeding strategies for endocrine and metabolic conditions, while broader equine nutrition commentary has emphasized that geriatric horses commonly bring dental disease, arthritis, sarcopenia, and endocrine disorders to the same exam. Inference: the field is treating nutrition less as a stand-alone recommendation and more as part of a coordinated medical management plan involving the veterinarian, nutritionist, and farrier. (learn.aaep.org)

Why it matters: For veterinary professionals, this is a useful synthesis of where senior-horse metabolic care is heading. The practical challenge isn’t just preventing weight gain in an easy keeper. It’s deciding how to restrict carbohydrates without worsening muscle loss, how to maintain forage intake in horses with poor teeth, how to support exercise when osteoarthritis limits movement, and when to add or adjust drugs as laminitis risk changes. That’s especially relevant because PPID appears commonly in horses 15 and older, and because endocrinopathic laminitis remains the most consequential complication across these cases. For pet parents, “he’s just getting old” may delay workups; for clinicians, the article reinforces the value of testing, monitoring, and revisiting the feeding plan as the horse ages. (thehorse.com)

What to watch: The next step is likely more refinement, not a wholesale change in direction: closer use of endocrine guidelines, more case-by-case ration formulation, and more discussion around when medications such as SGLT2 inhibitors belong in older horses already juggling PPID, laminitis history, dental compromise, or weight loss. (thehorse.com)