Can implementing spectrum-of-care approaches in management of canine diabetes mellitus improve dog and owner outcomes?

Canine diabetes mellitus (DM) is a treatable disease, yet euthanasia rates are high. Anticipated costs, impact on owner lifestyle, and financial constraints contribute to early euthanasia. Insulin, diet, monitoring, and veterinary care make up the bulk of expenses, and substituting affordable choices in one or more of these areas can significantly affect overall costs without compromising care.

Freestyle Libre-Derived Metrics in Assessing Glycemic Control in Diabetic Dogs.

Background: The FreeStyle Libre provides several metrics that are currently recommended for assessing glycemic status and guiding therapy in human medicine.

Hypothesis/objective: To evaluate the use of various FreeStyle Libre derived metrics for monitoring glycemic control (GC) in diabetic dogs.

Animals: Eighty-five client-owned dogs with diabetes mellitus (DM).

Effect of Fenofibrate on Markers of Gut Barrier Function in Dogs With Naturally Occurring Diabetes Mellitus.

Background: Fenofibrate improves gut barrier function and reduces serum lipids in purpose-bred dogs with induced diabetes mellitus (DM), but its effects in dogs with naturally occurring DM are unknown.

Objectives: Determine the effects of fenofibrate on markers of systemic and pancreatic inflammation, markers of gut barrier function, lipoprotein profiles, and glycemic control in dogs with naturally occurring DM.

Animals: Sixteen client-owned dogs with naturally occurring, uncomplicated DM.

Assessment of Exenatide Extended-Release for Maintenance of Diabetic Remission in Cats.

Background: Insulin-treated diabetic cats frequently achieve transient remission. The glucagon-like peptide-1 receptor agonist, exenatide extended-release (exenatide-ER), preserves β cell function in people with type 2 diabetes mellitus (DM).

Objectives: Investigate the effect of exenatide-ER on the duration of diabetic remission in cats.

Accuracy of the Freestyle Libre 3 Continuous Glucose Monitoring System in Hypo- and Euglycemic Cats.

Background: The FreeStyle Libre 3 (FSL3) has several improvements compared to previous FreeStyle Libre systems, but its accuracy has not yet been determined in cats. In diabetic people, FSL3 offers increased accuracy, and its smaller size could be advantageous for use in veterinary patients.

Objectives: Assess the accuracy of FSL3 in cats with experimentally induced hypoglycemia.

Counterregulatory responses of healthy cats to insulin-induced hypoglycemia.

In health, insulin-induced hypoglycemia (IIH) activates counterregulatory hormone responses and parasympathetic (PS) and sympathoadrenal systems, which leads to increased glucagon secretion. In diabetes mellitus, these responses are impaired, resulting in greater severity and delayed recovery from hypoglycemia. These counterregulatory responses in health and disease have been documented in humans, rodents, and dogs, but not yet in cats.

Insulin degludec 100 U/mL for treatment of spontaneous diabetes mellitus in dogs.

Background: The advantages of insulin degludec 100 U/mL (IDeg100) in the treatment of diabetes mellitus (DM) include consistent release, predictable glucose-lowering effect, and minimal day-to-day variability.

Hypothesis/objectives: To describe the use of IDeg100 in dogs with DM, level of diabetic control and adverse effects.

Animals: Thirty-three client-owned dogs with DM.

Transmucosal glucagon rapidly increases blood glucose concentration in healthy cats.

Objectives: To evaluate the effect of transmucosal glucagon powder (Baqsimi; Amphastar Pharmaceuticals) on blood glucose (BG) concentrations in healthy cats and describe adverse reactions to its administration.

Methods: A randomized, controlled, crossover study was conducted on six healthy cats with a 7-day washout period between treatments. Transmucosal glucagon powder was administered intranasally and rectally and compared with intranasal placebo.

A dose titration protocol for once-daily insulin glargine 300 U/mL for the treatment of diabetes mellitus in dogs.

Background: In purpose-bred dogs, insulin glargine 300 U/mL (IGla300) has long duration of action, peakless time-action profile, and low potency, making it suitable for use as a basal insulin.

Hypothesis: To evaluate IGla300 in client-owned diabetic dogs monitored using a flash glucose monitoring system (FGMS).

Animals: Ninety-five client-owned diabetic dogs, newly diagnosed or previously treated with other insulin formulations, with or without concurrent diseases.

Drug release profile of a novel exenatide long-term drug delivery system (OKV-119) administered to cats.

Beneficial weight-loss properties of glucagon-like peptide-1 receptor agonists (GLP-1RA) in obese people, with corresponding improvements in cardiometabolic risk factors, are well established. OKV-119 is an investigational drug delivery system that is being developed for the long-term delivery of the GLP-1RA exenatide to feline patients. The purpose of this study was to evaluate the drug release characteristics of subcutaneous OKV-119 implants configured to release exenatide for 84 days.

Magnet-assisted endoscopic removal of ferromagnetic metallic gastric foreign bodies in 4 dogs.

Objective: Describe presenting signs, diagnostic findings, and magnet-assisted endoscopic removal method of ferromagnetic gastric foreign bodies (FBs) in dogs.

Clinical Presentation: Four dogs presented with ingestion of sharp metallic FBs. The presence of gastric FBs was confirmed by abdominal radiography.

Isolation of feline islets of Langerhans by selective osmotic shock produces glucose responsive islets.

Introduction: Pancreatic islet isolation is essential for studying islet physiology, pathology, and transplantation, and feline islets could be an important model for human type II diabetes mellitus (T2D). Traditional isolation methods utilizing collagenases inflict damage and, in cats, may contribute to the difficulty in generating functional islets, as demonstrated by glucose-stimulated insulin secretion (GSIS). GLUT2 expression in β cells may allow for adaptation to hyperosmolar glucose solutions while exocrine tissue is selectively disrupted.

Spontaneous remission and relapse of diabetes mellitus in a male dog.

An 8-year-old male neutered Miniature Schnauzer was diagnosed with diabetes mellitus based on fasting hyperglycemia and glucosuria after a 2-week history of polydipsia and periuria, in line with the Agreeing Language in Veterinary Endocrinology consensus definition. Treatment of insulin and dietary management was initiated. The insulin dose was gradually reduced and eventually discontinued over the next year based on spot blood glucose concentrations that revealed euglycemia or hypoglycemia.

Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats.

Objective: To describe a laparoscopic technique and outcome for partial pancreatectomy in cats.

Study Design: Prospective cohort study.

Animals: Nine cats.

Anemia in canine chronic kidney disease is multifactorial and associated with decreased erythroid precursor cells, gastrointestinal bleeding, and systemic inflammation.

Objective: Compare erythropoiesis-related factors between different stages of canine chronic kidney disease (CKD).

Animals: 8 healthy adult dogs (controls), and 24 dogs with CKD, equally divided into 3 groups based on International Renal Interest Society-CKD Guidelines (stage 2, 3, and 4) were recruited between December 2012 and December 2014.

Methods: The following were assessed in all dogs and then compared between groups: bone marrow cytology, CBC, reticulocyte count, urinalysis, serum biochemistry, blood pressure, occult gastrointestinal bleeding, and serum concentrations of parathyroid hormone (PTH), erythropoietin, interleukin-1β, interleukin-3, tumor necrosis factor-α (TNFα), and interferon-γ.

Assessment of the FreeStyle Libre 2 interstitial glucose monitor in hypo- and euglycemic cats.

Background: Continuous glucose monitoring systems have been validated for eu- and hyperglycemic cats. The FreeStyle Libre 2 (FSL2) is sufficiently accurate in people during hypoglycemia to guide critical treatment decisions without confirmation of blood glucose concentration (BG).

Objectives: Assess FSL2 accuracy in cats with hypoglycemia.

Establishment of a feline glycated hemoglobin reference interval for a novel dried-blood-spot assay and the effects of anemia on assay results.

Background: Glycated hemoglobin A1c (HbA1c) reflects long-term (months) glycemic control and has been previously investigated as a monitoring and diagnostic tool in diabetic cats. However, a standardized, reliable, and globally available test and reference intervals (RIs) have not been established. A novel dried-blood-spot card system (A1Care, Baycom Diagnostics) allows for easy collection and evaluation of HbA1c levels in feline patients.

Case report: Androgen-secreting adrenocortical tumors in eight cats.

Urine marking, aggression, and other behavioral concerns are common reasons for cat owners to seek veterinary care. Empiric treatment for lower urinary tract disease or primary behavior disorders are commonly pursued, especially in those cases with normal routine laboratory evaluations. Herein, we report the clinicopathologic findings in eight sexually altered cats that were diagnosed with androgen-secreting adrenocortical tumors.

Both Feline Coronavirus Serotypes 1 and 2 Infected Domestic Cats Develop Cross-Reactive Antibodies to SARS-CoV-2 Receptor Binding Domain: Its Implication to Pan-CoV Vaccine Development.

The current study was initiated when our specific-pathogen-free laboratory toms developed unexpectedly high levels of cross-reactive antibodies to human SARS-CoV-2 (SCoV2) receptor binding domain (RBD) upon mating with feline coronavirus (FCoV)-positive queens. Multi-sequence alignment analyses of SCoV2 Wuhan RBD and four strains each from FCoV serotypes 1 and 2 (FCoV1 and FCoV2) demonstrated an amino acid sequence identity of 11.5% and a similarity of 31.

Insulin Therapy in Small Animals, Part 1: General Principles.

Understanding the pharmacology of insulin and how it relates to the pathophysiology of diabetes can lead to better clinical outcomes. No insulin formulation should be considered "best" by default. Insulin suspensions (NPH, NPH/regular mixes, lente, and PZI) as well as insulin glargine U100 and detemir are intermediate-acting formulations that are administered twice daily.

Insulin Therapy in Small Animals, Part 2: Cats.

No insulin formulation should be considered best by default for management of feline diabetes. Rather, the choice of insulin formulation should be tailored to the specific clinical situation. In most cats that have some residual beta cell function, administering only a basal insulin might lead to complete normalization of blood glucose concentrations.

Insulin Therapy in Small Animals, Part 3: Dogs.

Insulin therapy should ideally mimic a basal-bolus pattern. Lente, NPH, NPH/regular mixes, PZI, glargine U100, and detemir are intermediate-acting formulations that are administered twice daily in dogs. To minimize hypoglycemia, intermediate-acting insulin protocols are usually geared towards alleviating (but not eliminating) clinical signs.

Glucose Counterregulation: Clinical Consequences of Impaired Sympathetic Responses in Diabetic Dogs and Cats.

Insulin induced hypoglycemia (IIH) is common in veterinary patients and limits the clinician's ability to obtain adequate glycemic control with insulin therapy. Not all diabetic dogs and cats with IIH exhibit clinical signs and hypoglycemia might be missed by routine blood glucose curve monitoring. In diabetic patients, counterregulatory responses to hypoglycemia are impaired (lack of decrease in insulin levels, lack of increase in glucagon, and attenuation of the parasympathetic and sympathoadrenal autonomic nervous systems) and have been documented in people and in dogs but not yet in cats.

Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog.

Objective: To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog.

Case Summary: A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration.