Diabetic cats used to mean repeat trips to the clinic for blood glucose curves. The American Animal Hospital Association's first feline-only diabetes guidelines, released in 2026, say that's no longer the standard: routine in-hospital glucose curves are out, and a combination of oral medication and at-home monitoring is in.
The 2026 AAHA Diabetes Management Guidelines for Cats split feline diabetes care into its own document for the first time, reflecting how differently cats respond to treatment compared with dogs. The biggest driver of that shift is a class of oral drugs called SGLT2 inhibitors, sodium-glucose cotransporter 2 inhibitors, which the FDA approved for cats starting with Bexacat in 2022 and Senvelgo in 2023.
Why In-Hospital Glucose Curves Are Losing Favor
The guidelines now discourage routine in-hospital blood glucose curves for diabetic cats. Hospitalization itself can trigger stress hyperglycemia, elevated blood sugar caused by anxiety rather than the disease, which muddies exactly the readings a curve is meant to produce. Instead, AAHA recommends monitoring diabetic cats through clinical signs, continuous glucose monitors, and glucose data gathered at home, where a cat is calmer and the numbers are more likely to reflect reality.
That shift lines up with what Ellen Behrend, VMD, MS, PhD, DACVIM, a small-animal endocrinology specialist and consultant at the Veterinary Information Network, told dvm360 at the 2026 AVMA Convention. Behrend said the biggest barrier to SGLT2 adoption isn't the science, it's fear of a rare complication.
How Common Is the Risk Practitioners Fear Most
Diabetic ketoacidosis, or DKA, is the complication most often cited against SGLT2 inhibitors. Behrend told dvm360 that recent papers put the rate at roughly 5% to 7% of feline diabetic patients on the drugs, and that the licensing studies for Senvelgo in both the US and UK relied on urine ketone monitoring rather than blood draws. She also pointed out a counterintuitive upside: because SGLT2 inhibitors need far less monitoring than insulin, most cats end up cheaper to manage overall, even though the drug itself costs more per dose.
Not every diabetic cat is a candidate. Behrend's rule of thumb is a cat that's eating, drinking, and urinating normally, at a healthy or slightly heavy body weight, with adequate kidney function, since SGLT2 inhibitors work by pushing excess glucose out through the urine. Cats that are already sick, losing weight, or showing GI symptoms need to be seen and checked for DKA immediately rather than started on the drug.
For practices juggling aging pets with other chronic conditions, the pattern is familiar: more of the ongoing monitoring work is shifting out of the exam room and into wherever the cat already feels safe.
That's also where Fear-Free certified Caregivers from Homelove fit: a vet-directed at-home visit to weigh a diabetic cat, collect a urine sample, or relay how it's eating and behaving day to day gives the supervising veterinarian the same clinical picture AAHA's guidelines now say matters most, without the stress hyperglycemia that comes from a carrier and a waiting room.