The Role of Diet in the Prevention and Management of Feline Diabetes

Identifying the target population and preventive strategies to combat feline obesity

Feline obesity continues to be a priority health and welfare issue. Most research surrounding obesity currently focuses on obesity treatment. However, treatment for feline obesity is slow, often unsuccessful and not without consequences. Identifying high-risk populations for obesity onset is crucial for developing and implementing preventive strategies. This review identifies post-gonadectomy kittens aged 5-12 months as the primary target population for obesity prevention in domestic cats and highlights dietary and feeding management strategies to be implemented for obesity prevention.

Influence of high-protein and high-carbohydrate diets on serum lipid and fructosamine concentrations in healthy cats

OBJECTIVES

The aim of this study was to determine whether high-protein and high-carbohydrate diets exert differential effects on serum cholesterol, triglyceride and fructosamine concentrations in healthy cats.

METHODS

A randomised, crossover diet trial was performed in 35 healthy shelter cats. Following baseline health assessments, cats were randomised into groups receiving either a high-protein or high-carbohydrate diet for 4 weeks. The cats were then fed a washout diet for 4 weeks before being transitioned to whichever of the two studied diets they had not yet received. Fasting serum cholesterol, triglyceride and fructosamine concentrations were determined at the end of each 4-week diet period.

RESULTS

Cats on the high-carbohydrate diet had significantly lower serum cholesterol (P <0.001) concentrations compared with baseline measurements. Cats on the high-protein diet had significantly higher serum cholesterol (P <0.001) and triglyceride (P <0.001) concentrations, yet lower fructosamine (P <0.001) concentrations compared with baseline measurements. In contrast, overweight cats (body condition score [BCS] >5) had lower cholesterol (P = 0.007) and triglyceride (P = 0.032) concentrations on the high-protein diet than cats within other BCS groups.

CONCLUSIONS AND RELEVANCE

Diets higher in protein and lower in carbohydrates appear beneficial for short-term glucose control in healthy cats. A high-protein diet was associated with significantly elevated cholesterol and triglyceride concentrations in healthy cats, even though the increase was significantly less pronounced in cats with a BCS >5. This finding suggests that overweight cats process high-protein diets, cholesterol and triglycerides differently than leaner cats.

Identifying the composition of commercial Brazilian cat food with stable isotopes of carbon and nitrogen

Considering the increasing pet owner's concern about the food their pets are consuming, in this study we investigated the origin of the main ingredients in wet and dry foods produced in Brazil using stable isotope ratios of carbon and nitrogen. We concluded that chicken and pork seem to be the dominant ingredients in most of the samples, with larger proportions in wet cat food. Even in pet foods showing 'beef' as the main ingredient on the label, we found a low proportion of bovine products in both wet and dry cat foods. Comparing the contribution of plant-derived products (C₃ and C₄ plants) and animal-derived products (chicken-pork, bovine and fish), approximately 21 % of cat foods had more than 30 % of ingredients with plant origin in their composition. The high amount of plant-derived products in cat foods found here raises the question whether this should be mentioned on package labels.

Attitudes and Practices of Australian Veterinary Professionals and Students towards Early Age Desexing of Cats

Simple Summary

Globally, desexing is used to reduce/prevent overpopulation of cats. However, its effective use is hampered by widely held views that it should occur at around six months of age, whereas female cats can breed from four months of age. As a result, many cats may have an unplanned litter before they are desexed. In Australia, increasing numbers of municipalities are mandating desexing of cats by three months of age, before the traditional age of 4–6 months. Achieving this goal requires support from veterinary professionals, so we used online and face-to-face surveys to determine the preferred desexing ages for cats and rationale of 957 Australian veterinarians, veterinary nurses, veterinary science students, and veterinary nursing students. A complementary survey of 299 veterinary practice websites across Australia documented information provided about desexing cats. Vet nurses and nursing students were more conservative than vets or vet students, preferring to desex cats (especially females) after four months because of concerns about anaesthetic risk. Over half of surveyed websites provided no information about desexing cats or offered desexing without explaining why it was necessary or when to perform it. In Australia, the preferences and practices of some current/future veterinary professionals do not match changing cat legislation.

Abstract

Surgical desexing of cats is typically carried out after six months of age (Mature Age Desexing, MAD); between 4–6 months (Traditional Age Desexing, TAD); or before four months (Early Age Desexing, EAD). We complemented existing surveys of veterinarians’ acceptance of EAD with online and face-to-face surveys, to ascertain the preferred desexing ages for cats and rationale of 957 Australian veterinarians, veterinary nurses, veterinary science students, and veterinary nursing students. A complementary survey of 299 veterinary practice websites across Australia documented any information provided about desexing cats. The most common reason for preferred desexing ages was reducing stray cat populations (30%); 78% of these respondents chose ages aligning with EAD. Vet nurses and nursing students were more conservative than vets or vet students, preferring to desex cats >4 months. Perceived anaesthetic risk was a major motivation, especially for nurses ≤5 years’ experience. Across 299 urban practices in Australian capital cities, 55% of surveyed websites provided no information about desexing cats or listed desexing without explaining why it was necessary, or when to perform it. Increasingly, Australian legislatures mandate desexing of cats by three months of age, so the practices of some current/future veterinary professionals do not match changing legislation.

Safety and efficacy assessment of a GLP-1 mimetic: insulin glargine combination for treatment of feline diabetes mellitus

A commonly used therapeutic strategy for type 2 diabetes mellitus (DM) in humans involves the use of synthetic incretin hormone-based therapies including exenatide, a glucagon-like pepetide-1 hormone agonist. Glucagon-like pepetide-1 agonists can be used alone or as an ancillary therapy with other agents, including insulin and oral antihyperglycemics. Little is known about the role of these therapies for DM in cats. Therefore, the primary objective of this study was to evaluate the safety and efficacy of short-acting exenatide combined with insulin, as compared to placebo and insulin for the treatment of DM in cats. Treatment with exenatide was well tolerated; only 2 cats developed side effects requiring dose reduction. Two cats (25%) went into diabetic remission while receiving exenatide and insulin, whereas remission was not reported during placebo treatment. The average change in the daily exogenous insulin dose was significant (β = -0.56 U/kg, 95% confidence interval, -0.96 to -0.15, P = 0.007), and the dose of insulin administered was lower during exenatide treatment. The average weight loss experienced on exenatide was significantly higher than on placebo (β = 0.65 kg, 95% confidence interval, 0.09-1.21, P = 0.02). There was no significant difference in any of the hormone concentrations evaluated for cats on exenatide vs placebo treatments. Overall, the treatment of diabetic cats with insulin and a fixed dose of exenatide was found to be safe. The weight loss and decreased exogenous insulin requirement experienced with exenatide treatment could be a significant benefit for overweight diabetic cats and warrants further evaluation.

Managing feline diabetes: current perspectives

Diabetes mellitus is a common endocrine disease in cats. While type 2 diabetes is the most common form seen in cats, other underlying causes may contribute to insulin resistance. Guidelines for diagnosis vary and often do not take into account prediabetic cats. The goals of treatment are to maximize the chance of remission, while minimizing the risks of hypoglycemia. This article presents a further overview of current treatment and monitoring recommendations for diabetic cats.

2018 AAHA Diabetes Management Guidelines for Dogs and Cats*

Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM. An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.

ISFM consensus guidelines on the practical management of diabetes mellitus in cats

PRACTICAL RELEVANCE

Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats.

CLINICAL CHALLENGES

Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently--unless hypoglycaemia is encountered.

EVIDENCE BASE

The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.

Pet obesity management: beyond nutrition

Excess weight has been associated with many clinical and subclinical conditions that put a pet's health at risk. Successful weight management programs extend beyond standard nutritional management and incorporate an understanding of human-animal interaction. Understanding the processes and dynamics of human-animal relationships can be a useful tool for practitioners in developing successful treatment plans for their clients. Obesity is a nutritional disorder requiring lifelong management; however, when veterinarians go beyond standard treatment to include an understanding of human-animal interaction, it is also one of the few conditions in veterinary medicine that is completely preventable and curable.