What Every Vet Should Know About the 2026 AAHA Feline Diabetes Guidelines

What's New in the 2026 AAHA Diabetes Management Guidelines for Cats

Feline diabetes has quietly undergone one of the bigger practice-changing shifts in small animal medicine over the last few years, and the newly published 2026 AAHA Diabetes Management Guidelines for Cats formalizes that shift into a comprehensive, 15-section roadmap. Released in April 2026 and developed by a dedicated feline task force, the guidelines make clear that cats are no longer just "small dogs with diabetes" they get their own species-specific playbook, and it looks meaningfully different from anything published before the SGLT2 inhibitor era.

The Headline Shift: An Oral Option Alongside Insulin

For decades, insulin injections were essentially the only real answer for a newly diagnosed diabetic cat. That's changed with the arrival of two FDA-approved SGLT2 inhibitors — bexagliflozin (Bexacat) and velagliflozin (Senvelgo) — both dosed once daily by mouth. These drugs work by blocking glucose reabsorption in the kidney rather than by supplying exogenous insulin, which means owners can skip injections entirely for a meaningful subset of newly diagnosed, previously insulin-naive cats who are eating well and hemodynamically stable.

The guidelines are careful to frame this as an option, not a universal replacement for insulin. Patient selection matters enormously: cats with vomiting, poor appetite, significant chronic kidney disease, hepatopathy, or hypercalcemia are poor candidates, and every candidate should be screened for early ketosis before starting therapy. The task force is explicit that older oral hypoglycemics familiar from human type 2 diabetes — glipizide, metformin — remain unreliable in cats and aren't recommended.

Ketone Monitoring Becomes Central, Not Optional

Perhaps the most operationally significant change for general practice: blood beta-hydroxybutyrate (BHB) monitoring is now considered an essential part of managing any cat on an SGLT2 inhibitor, not a nice-to-have. Because these drugs work independently of insulin, a cat can develop diabetic ketoacidosis without ever becoming hyperglycemic — a phenomenon the guidelines call euglycemic DKA, or EDKA. It shows up almost exclusively in the first two weeks of treatment, and the reported incidence (5–7%) tracks right alongside the DKA rate seen with insulin therapy, so it isn't a rare edge case.

The guidelines lay out a structured monitoring schedule — checks at days 2–3, 7, 14, and 30, then quarterly — built around ketone measurement (a handheld BHB meter is the preferred tool) rather than glucose alone. Practices that haven't stocked ketone meters as routine diabetic-cat equipment may want to reconsider that now.

Diagnosis: One Snapshot Is No Longer Enough

On the diagnostic side, the guidelines tighten the bar for confirming diabetes. A diagnosis now calls for evidence of sustained hyperglycemia — elevated fructosamine or hemoglobin A1c, or documented hyperglycemia/glucosuria on more than one occasion, ideally captured in a non-stressed or home environment rather than relying on a single stressed in-clinic blood draw. In-hospital glucose curves, long a diagnostic and monitoring staple, are explicitly not recommended for cats anymore, given how dramatically stress hyperglycemia can skew a single hospital visit.

Remission Gets Its Own Section and Its Own Realistic Numbers

Diabetic remission is largely a feline phenomenon (it's rare in dogs), and the guidelines devote a full section to it. The task force settled on roughly 30% as a reasonable average U.S. remission rate, with most remissions occurring within the first six months of treatment. Reversible drivers of insulin resistance — obesity, recent steroid use, unaddressed dental disease — meaningfully raise the odds, which is a useful talking point for client conversations about weight management and diet.

A practical warning built into this section: cats that go into unrecognized remission while still on insulin are at real risk of dangerous hypoglycemia, since nobody adjusted the dose. The guidelines lean on watching for a falling insulin requirement, disappearing glucosuria, or a normalizing fructosamine as the tip-off that a dose reduction — or a full stop — may be overdue.

If you trained before 2023, feline diabetes management as taught in your curriculum may already be a step behind what's now considered standard of care. For students heading into clinical rotations or new grads building their first diabetic-cat treatment plans, the practical takeaways are: get comfortable discussing SGLT2 inhibitors as a legitimate first-line option for the right newly diagnosed cat, treat ketone monitoring as non-negotiable for any cat on one of these drugs, and stop relying on single in-hospital glucose readings to make a diabetes diagnosis. The full guidelines, along with a downloadable 3-2-1 quick-reference sheet and treatment algorithms, are freely available on AAHA's site — worth bookmarking before your next endocrinology rotation or SGLT2-treated patient walks through the door.

Source: 2026 AAHA Diabetes Management Guidelines for Cats, American Animal Hospital Association, published April 26, 2026.