Diabetes mellitus in cats.

Feline diabetes is a multifactorial disease with genetic and environmental factors, including diet, excess body weight, and physical inactivity, involved in its pathogenesis. Although type 2 diabetes is most common in cats, most cats are insulin-dependent at the time of diagnosis. If good glycemic control can be achieved early after diagnosis, a substantial proportion of diabetic cats go into clinical remission. Diabetic remission may be facilitated by using a low-carbohydrate-high-protein diet combined with a long-acting insulin, such as glargine, administered twice daily. Rather than just controlling clinical signs, these new treatment modalities make curing feline diabetes a realistic goal for practitioners.     

Heart failure is common in diabetic cats: findings from a retrospective case-controlled study in first-opinion practice

OBJECTIVES: To study the prognosis and cause of death in cats with diabetes mellitus. METHODS: Twenty consecutive cases of feline diabetes mellitus diagnosed in first-opinion practice were followed. Three control cats, without diabetes, were matched to each case of diabetes; these were also followed. RESULTS: One Somali cat with diabetes could not be matched, so complete data analysis considered only 19 diabetics and 57 matched controls. Death occurred in 14 of 20 diabetics and 23 of 57 controls although one control cat was eventually lost to follow-up. Heart disease and heart failure led to death in six diabetic cats. One of these was the non-matched Somali; nevertheless, the death rate from heart disease in the diabetics was five of 19 compared with two of 57 in controls. The relative risk of heart failure in diabetic cats was 10.4 times that of the controls; this difference in rates was statistically significant. Survival amongst diabetics was significantly worse than for controls. For the control cats median survival was 718 days after the index visit, whereas for the diabetic cases median survival was 385 days after diagnosis. CLINICAL SIGNIFICANCE: Heart disease and failure are common in diabetic cats. This observation deserves further attention.     

Diagnostic significance of serum glycated albumin in diabetic dogs

Measurements of serum fructosamine, glycated hemoglobin, and glycated albumin (GA) are increasingly used to complement serum glucose concentration for better management of diabetes mellitus. Fructosamine tests are currently not performed in veterinary medicine in Japan. As such, the measurement of GA may serve as a replacement test. Therefore, in the current study, serum GA and fructosamine were evaluated for a positive correlation in dogs, and, depending on the correlation, a reference range of GA percentage would also be determined from healthy control dogs. The degree of glycemic control in diabetic dogs was determined by fructosamine concentration. A positive correlation between GA and fructosamine was observed with both normal and diabetic animals. In addition, the reference interval of serum GA percentage in control dogs was determined to be 11.4-11.9% (95% confidence interval). Interestingly, no significant difference in serum GA percentages was observed between samples from diabetic dogs with excellent glycemic control and control dogs. However, good, fair, and poor glycemic control diabetic dogs resulted in a significant increase in serum GA percentages in comparison with control dogs. These results suggest that serum GA may be a useful diagnostic indicator, substituting for fructosamine, to monitor glycemic control in diabetic dogs.     

A retrospective-cohort study on the development of cataracts in dogs with diabetes mellitus: 200 cases

The objective of the study was to determine the incidence and estimated median time to cataract formation in dogs with diabetes mellitus. The animals studied were 200 dogs with diabetes mellitus which were referred to a university teaching hospital between 1985 and 1995. Medical records from dogs with a diagnosis of diabetes mellitus were reviewed and, where necessary, further follow-up information was gathered from the referring veterinarian. Incidence rate and median time to diabetic cataract formation was calculated using survival-analysis techniques in a retrospective cohort study design. Among the 200 dogs in the study population, 23 had cataracts at the time of diabetes diagnosis that were presumed to be related to other disease processes. Of the remaining 177 dogs, 132 had documented cataract development with features suggestive as being secondary to diabetes. Twenty-three dogs did not have obvious cataracts at the time of their last examination while 22 dogs did not have cataracts at the time they were lost to follow-up. These 55 cases contributed to the statistical models as noncases of cataracts until the last date for which an examination was available. Half of the population had developed cataracts by the 170th day postdiagnosis of diabetes mellitus, while 75% and 80% of the population developed cataracts by 370 days and 470 days, respectively. The results of this study suggest that the majority of dogs with diabetes will develop cataracts within 5–6 months from the time of diagnosis of the disease, and that approximately 80% of dogs will develop cataracts within 16 months of diagnosis.     

Monitoring techniques for diabetes mellitus in the dog and the cat

One of the keys to achieving glycemic control in animals with diabetes mellitus is the appropriate selection and interpretation of analytic monitoring tests. Diabetic animals are subject to many of the same problems described in human diabetics. Diabetics are more susceptible to infection, and wound healing is often impaired. Decreased insulin promotes lipolysis and moderate hyperlipidemia, which can lead to falsely lowered fructosamine levels, impaired renal circulation, and atherosclerosis. Hyperglycemic, hypoinsulinemic animals continue to lose weight despite an increased appetite and an increased intake because they are not able to use glucose. Many unregulated diabetic animals will present with vomiting and diarrhea that can exacerbate electrolyte abnormalities seen with the osmotic diuresis present in an uncontrolled state. Canine diabetics are prone to cataract formation secondary to sorbitol accumulation in the lens. Cats, on the other hand, can present with diabetic distal neuropathy, which may be reversible with appropriate treatment. With all of these potential complications, it is important to monitor these animals regularly; this is the only way that glycemic control can be properly maintained over time. This article reviews the monitoring parameters available to the modern practitioner and outlines the benefits of each test, as well as caveats, in their interpretation.     

Comparison of serum fructosamine and blood glycosylated hemoglobin concentrations for assessment of glycemic control in cats with diabetes mellitus.

OBJECTIVE: To correlate serum fructosamine concentrations with established measures of glycemic control and to compare serum fructosamine and blood glycosylated hemoglobin (GHb) concentrations as a means for assessing glycemic control in diabetic cats. DESIGN: Longitudinal cohort study. ANIMALS: 26 healthy cats, 5 cats with stress-induced hyperglycemia, 15 untreated diabetic cats, and 36 treated diabetic cats. PROCEDURE: Control of glycemia was classified and monitored and serum fructosamine and blood GHb concentrations were measured for 12 poorly controlled diabetic cats before and after improving glycemic control, 8 well-controlled treated diabetic cats before and after glycemic control deteriorated, and 5 cats with diabetes mellitus before and after onset of stress-induced hyperglycemia. RESULTS: Mean serum fructosamine and blood GHb concentrations were significantly higher in untreated diabetic cats, compared with healthy cats, and in 24 poorly controlled diabetic cats, compared with 12 well-controlled diabetic cats. Mean serum fructosamine and blood GHb concentrations decreased significantly in 12 poorly controlled diabetic cats after improving glycemic control and increased significantly in 8 well-controlled diabetic cats after glycemic control deteriorated. A significant stress-induced increase in mean blood glucose concentration was evident 12 hours after insulin administration, but not in 5 docile diabetic cats that became fractious. CLINICAL IMPLICATIONS: Serum fructosamine and blood GHb concentrations are clinically useful tools for monitoring control of glycemia in cats with diabetes mellitus.     

Fructosamine

Fructosamines are glycated serum proteins that, depending on their life span, reflect glycemic control over the previous 2 to 3 weeks. The nitroblue tetrazolium reduction method adapted to autoanalysis appeared to be a practical means to assay fructosamine quickly, economically, and accurately. The upper limit of the reference range is 374 μmol/L in dogs (95% percentile) and 340 μmol/L in cats (95% percentile). Newly diagnosed diabetic dogs and cats that had not undergone previous insulin therapy had significantly higher fructosamine concentrations than nondiabetic animals. In diabetic dogs that were receiving insulin therapy, the fructosamine test reflected the glycemic state far more accurately than did individual blood glucose measurements. Animals with satisfactory metabolic control revealed fructosamine concentrations within the reference range, whereas fructosamine concentrations above 400 μmol/L indicated insufficient metabolic control. On the basis of fructosamine concentrations, cats with a transitory hyperglycemia and cats with diabetes mellitus were differentiated. The fructosamine test is a valuable parameter for the diagnosis and metabolic control of diabetes mellitus in dogs and cats.     

Serum Fructosamine Concentration as an Index of Glycemia in Cats With Diabetes Mellitus and Stress Hyperglycemia

The purpose of this study was to evaluate fructosamine concentrations in clinically healthy cats, sick cats with stress hyperglycemia, and untreated diabetic cats to determine the usefulness of this test in diagnosing diabetes mellitus in cats, and in differentiating the disease from stress-induced hyperglycemia. In addition, we evaluated if the degree of glycemic control in cats treated for diabetes influenced their serum fructosamine concentrations. In the 14 sick cats with stress hyperglycemia, the median serum fructosamine concentration (269 μmol/L) was not significantly different from the median value in the 26 clinically normal cats (252 μmol/L). Two of the 14 cats with stress hyperglycemia (14.3%) had serum fructosamine concentrations above the upper limit of the reference range (175 to 400 μmol/U; on the basis of these results, the test specificity was calculated as 0.86. In 30 cats with untreated diabetes mellitus, the median serum fructosamine concentration was 624 μmol/L, markedly higher than the value in either the normal cats or the cats with stress hyperglycemia. All but 2 of the 30 untreated diabetic cats (6.7%) had serum fructosamine concentration above the upper limit of the reference range; on the basis of these results, the sensitivity of serum fructosamine concentration as a diagnostic test for diabetes mellitus was 0.93. When 30 diabetic cats receiving treatment were divided into 3 groups according to their response to treatment (ie, poor, fair, and good), the 16 cats that had a good response to treatment had significantly lower serum concentrations of both glucose and fructosamine compared with cats that had either a fair or poor response to treatment. A significant correlation (r_s= .70, n = 100, P < .001) was found between serum concentrations of glucose and fructosamine. Results of this study indicate that quantification of serum fructosamine concentration is a meaningful test for the diagnosis of diabetes, for differentiating diabetes from stress hyperglycemia; and for monitoring the metabolic control in treated diabetic cats.     

Funduscopic findings following cataract extraction by means of phacoemulsification in diabetic dogs: 52 cases (1993-2003)

OBJECTIVE: To determine prevalence of retinal hemorrhages and microaneurysms in dogs with diabetes mellitus following cataract extraction by means of phacoemulsification and identify potential risk factors. DESIGN: Retrospective study. PROCEDURE: Medical records of dogs undergoing phacoemulsification between 1993 and 2003 were reviewed, and information was recorded on signalment, history, physical examination findings, ophthalmic examination findings, results of laboratory testing, electroretinographic findings, and surgical findings. Glycemic control was classified as poor, intermediate, or good on the basis of baseline blood glucose concentration, perioperative body weight loss, daily insulin dosage, and presence of glucosuria and ketonuria. Data from diabetic and nondiabetic dogs were analyzed to determine prevalence and risk factors for development of retinal hemorrhages or microaneurysms following phacoemulsification. RESULTS: 11 of the 52 (21%) dogs with diabetes mellitus developed ophthalmoscopic signs of retinal hemorrhages or microaneurysms, compared with 1 of the 174 (0.6%) nondiabetic dogs. Median time from onset of diabetes mellitus to diagnosis of retinopathy was 1.4 years (range, 0.5 to 3.2 years). No risk factors for development of retinopathy were identified. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that retinal hemorrhages and microaneurysms may be more common and develop earlier in diabetic dogs than previously reported. This may affect treatment, as diabetic dogs survive longer with improved glycemic control.     

Diabetes mellitus in the cat: a review

About 80% of diabetic cats suffer from type 2 diabetes which is characterized by reduced insulin secretion from beta-cells and by insulin resistance. As in humans cats experienced a change in life habits and eating conditions over the last years leading to a tremendous increase in the prevalence of obesity. In both species obesity is one of the major risk factors for the development of type 2 diabetes. Treatment should be initiated immediately after diagnosis. In Zurich, therapy consists of application of an intermediate-acting insulin and dietary management. In the latter the use of diets with reduced carbohydrate content seems to be of utmost importance. We recently found that the percentage of cats with a transient course of diabetes increases from previous 25% to 50-70% when a diet with strongly reduced carbohydrate content is fed.     

Lifestyle risk factors for progesterone-related diabetes mellitus in elkhounds - a case-control study

Objectives : This study aims to investigate lifestyle risk factors for the development of progesterone‐related diabetes mellitus in female elkhounds. Methods : Owners of 48 diabetic elkhounds and 58 healthy elkhounds were interviewed by phone concerning lifetime diet and exercise routines. A logistic model was developed to assess the impact of diet and exercise on diabetes diagnosis. The agreement between lifetime owner‐perceived body condition score (BCS) and veterinary‐perceived BCS at inclusion was estimated in healthy control dogs using the Kappa statistic. Results : The model showed that diabetic dogs had increased odds for having been overweight (before diagnosis) compared with controls (OR=2·8, 95% confidence interval 1·1–7·5, P=0·034). Although feeding other food than commercial dog feed was associated with diabetes case status, the effect was not significant after BCS was entered into the model. The overall agreement between lifetime owner‐ and veterinary‐perceived BCS at inclusion in the study was 75% and had a Kappa statistic of 0·16 (P=0·12). Clinical Significance : This study indicates that a high owner‐perceived lifetime BCS is associated with progesterone‐related diabetes in elkhounds.     

Beta cell and insulin antibodies in treated and untreated diabetic cats

Beta cell and insulin antibodies are involved in the pathogenesis of diabetes in human patients. Beta cell antibodies have also been found in about 50% of newly diagnosed diabetic dogs. This study's objective was to examine these antibodies' role in feline diabetes. The serum of 26 newly diagnosed untreated diabetic cats, 29 cats on insulin therapy, 30 cats with diseases other than diabetes, and 30 healthy cats was examined for beta cell and insulin antibodies. For beta cell antibody testing, purified beta cells from a radiation-induced transplantable rat insulinoma were used. Serum from cats in which anti-beta cell antibodies were induced by injecting a purified beta cell suspension subcutaneously was used as a positive control. Following incubation with test sera, fluorescein-labeled anti-cat immunoglobulins were used to visualize binding between the beta cells and cat gamma globulins. Each serum was tested on two different tumor preparations. For the detection of insulin antibodies, a charcoal separation method was used. It was found that none of the healthy cats, none of the newly diagnosed, untreated diabetic cats and none of the cats with diseases other than diabetes had antibodies against beta cells or against endogenous insulin. Four diabetic cats (14%) that had been treated with different insulin preparations had insulin antibodies.It is concluded that immune-mediated processes are not causing diabetes in the cat. Further studies are needed to evaluate if antibodies directed against exogenous insulin alter the response of diabetic cats to insulin.     

Insulin therapy for dogs and cats.

Management of diabetic dogs and cats requires a tremendous cooperative effort between the practitioner and the client. Consistency in the handling, availability, and formulations of the different insulins will improve client compliance. In addition to insulin therapy, successful management of the diabetic animal includes the client's perceptions of the animal's health, maintenance of the animal's body weight, consistency in water consumption, and monitoring serial blood glucose concentrations. Serial blood glucose determinations improve the practitioner's ability to identify and address problems associated with insulin therapy, and thereby delay or minimize the complications of long-term diabetes.     

Tuberculosis in goats: assessment of current in vivo cell-mediated and antibody-based diagnostic assays

Tuberculosis in goats, mainly caused by Mycobacterium bovis and M. caprae, is a zoonotic disease with implications for public health, as well as having an economic impact due to decreased goat production, increased mortality rates and costs of diagnosis. There is an increasing need for surveillance of tuberculosis-infected goat herds, particularly in countries that are not officially free of bovine tuberculosis, and goats sharing farms with cattle should be subjected to the official tuberculin test. In Spain, some regions have programmes for the control of tuberculosis in goats, applying the same diagnostic assays that are used for cattle. The objective of tuberculosis eradication in livestock requires adaptation of existing control strategies to include goats. As such, it is necessary to determine whether current diagnostic assays for tuberculosis in cattle will work as efficiently in the goat. This review provides an overview of current in vivo tools for diagnosis of caprine tuberculosis, including estimates of the sensitivity and specificity of tests performed in this species. The number of tested animals and co-infection with Mycobacterium avium subsp. paratuberculosis are also addressed, with the aim of demonstrating the limitations of current assays and the need for further research.     

Evaluation of detemir in diabetic cats managed with a protocol for intensive blood glucose control

The aim of this study was to report outcomes using detemir and a protocol aimed at intensive blood glucose control with home monitoring in diabetic cats, and to compare the results with a previous study using the same protocol with glargine. Eighteen cats diagnosed with diabetes and previously treated with other insulins were included in the study. Data was provided by owners who joined the online German Diabetes-Katzen Forum. The overall remission rate was 67%. For cats that began the protocol before or after 6 months of diagnosis, remission rates were 81% and 42%, respectively (P = 0.14). No significant differences were identified between the outcomes for the glargine and detemir studies, with the exception of three possibly interrelated factors: a slightly older median age of the detemir cohort at diabetes diagnosis, a higher rate of chronic renal disease in the detemir cohort and lower maximal dose for insulin detemir.     

Management of canine diabetes.

The majority of diabetic dogs appear to have a form of type 1 diabetes analogous to the latent autoimmune diabetes of adults (LADA) in humans. Evidence of acute or chronic pancreatitis occurs in about 40% of diabetic dogs. Blindness caused by cataract formation eventually occurs in the majority of diabetic dogs and is not dependent on glycemic control. Insulin is the mainstay of therapy for diabetic dogs, and a conservative approach to insulin therapy is crucial. Most diabetic dogs require twice-daily dosing with lente or NPH insulin to adequately control their clinical signs. The diet fed should primarily be palatable and nutritionally balanced. Improved glycemic control may be achieved in some dogs if the diet contains increased insoluble fiber.     

Remission of Diabetes Mellitus in Cats with Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) has long been considered a key clinical feature of type‐1 diabetes mellitus (DM) in humans although. An increasing number of cases of ketoacidosis have been reported in people with type‐2 DM. Hypothesis/Objectives: Cats initially diagnosed with DKA can achieve remission from diabetes. Cats with DKA and diabetic remission are more likely to have been administered glucocorticoids before diagnosis. Animals: Twelve cats with DKA and 7 cats with uncomplicated DM. Methods: Retrospective case review. Medical records of cats presenting with DKA or DM were evaluated. Diabetic remission was defined as being clinically unremarkable for at least 1 month after insulin withdrawal. The cats were assigned to 1 of 3 groups: (1) cats with DKA and diabetic remission; (2) cats with DKA without diabetic remission; and (3) cats with DM and diabetic remission. Results: Seven cats with DKA had remission from diabetes. These cats had significantly higher concentrations of leukocytes and segmented neutrophils, and significantly lower concentrations of eosinophils in blood and had pancreatic disease more often than did cats with uncomplicated DM and diabetic remission. With regard to pretreatment, 3/7 cats in group 1, 1/5 cats in group 2, and 1/7 cats in group 3 had been treated with glucocorticoids. Conclusions and Clinical Importance: Remission of DM in cats presenting with DKA is possible. Cats with DKA and remission have more components of a stress leucogram, pancreatic disease, and seemed to be treated more often with glucocorticoids than cats with uncomplicated DM and diabetic remission.     

Diabetic retinopathy in a cat with megestrol acetate-induced diabetes

A case of diabetes mellitus in a cat is described, associated with prolonged administration of megestrol acetate for miliary dermatitis. The cat was presented with blindness due to diabetic retinopathy. Following the diagnosis, megestrol acetate was withdrawn. The diabetes proved to be transient and resolved after insulin therapy; however, severe visual impairment remained. The mechanism by which megestrol acetate induces diabetes is discussed.     

Oral medications for treating diabetes mellitus in dogs and cats

Five classes of oral hypoglycaemic drugs and two trace minerals used to treat diabetes mellitus in humans are reviewed and current knowledge on the use of these drugs in diabetic dogs and cats is presented. Oral sulphonylurea drugs stimulate insulin secretion and have been used successfully to treat diabetes in cats but not dogs. Preliminary studies evaluating the efficacy of the biguanide, metformin, in diabetic cats have not been promising. Pharmacokinetic studies have been performed in healthy cats, but clinical studies evaluating the efficacy of the insulin-sensitising drugs, thiazolidinediones, have not been reported. Treatment with the alpha-glucosidase inhibitor, acarbose, improved control of glycaemia in diabetic dogs; similar studies have not been reported in cats. Although chromium picolinate did not improve control of glycaemia in diabetic dogs, vanadium has improved control of the abnormality in diabetic cats.     

Dietary management of diabetes mellitus

Dietary therapy should be designed to enhance insulin therapy and improve glycaemic regulation of the diabetic dog and cat. Dietary therapy will not alleviate the necessity for insulin therapy in dogs and cats with insulin-dependent diabetes mellitus. Preliminary work suggests that dietary therapy may ultimately be the only therapy necessary to maintain glycaemic control in cats with suspected non-insulin-dependent diabetes mellitus. Currently, the feeding of a high fibre, high complex carbohydrate diet is recommended at a caloric intake designed to correct obesity and maintain ideal bodyweight. Several small meals should be fed during the period of insulin activity, to help minimise post prandial fluctuations in the blood glucose concentration.