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Linari G, Fleeman L, Gilor C, Giacomelli L, Fracassi F. Insulin glargine 300 U/ml for the treatment of feline diabetes mellitus. J Feline Med Surg 2022; 24:168-176. [PMID: 34009061 PMCID: PMC10812176 DOI: 10.1177/1098612x211013018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed to evaluate the efficacy and safety of insulin glargine 300 U/ml (IGla-U300) in cats with variable duration of diabetes mellitus (DM). METHODS Thirteen client-owned cats with DM completed a prospective clinical trial. Four cats were highly suspected of hypersomatotropism and excluded from the insulin efficacy evaluation. All cats were treated with IGla-U300 SC at a starting dosage of 0.5 U/kg q12h and fed with a low carbohydrate diet. Cats were monitored for 8 weeks with a once-weekly at-home 16 h blood glucose curve (BGC) and a questionnaire evaluating the presence of DM-related clinical signs. In-clinic evaluations, including serum fructosamine measurement, were scheduled within 3 days of the first, third, sixth and eighth BGC. Glycemic variability was assessed by calculating the SD of each BGC. RESULTS Excluding four cats suspected of hypersomatotropism, at the time of the eighth BGC, improved or absent polyuria, polydipsia, polyphagia, weight loss, lethargy and improved or normal general demeanor were reported in 8/9 (88%), 8/9 (88%), 7/9 (77%), 7/9 (77%), 7/9 (77%) and 8/9 (88%) cats, respectively. Two cats achieved remission after 29 and 53 days. Another two cats went into remission after the end of the study (days 82 and 96). All cats that achieved remission were newly diagnosed diabetics. Median (range) serum fructosamine concentration significantly decreased when comparing the time of enrollment (604 [457-683] µmol/l) with the eighth week of treatment (366 [220-738] µmol/l) (P = 0.02). In all 13 cats, biochemical hypoglycemia (blood glucose <60 mg/dl; <3.3 mmol/l) was detected in 13/104 (12.5%) BGCs, while clinical signs suggesting hypoglycemic episodes were not reported. Glycemic variability was significantly lower at the fifth BGC when comparing cats that achieved remission with cats that did not achieve remission (P = 0.02). CONCLUSIONS AND RELEVANCE IGla-U300 seems effective and safe for the treatment of feline diabetes, but more long- term and comparative clinical trials are needed.
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Affiliation(s)
- Guido Linari
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | | | - Chen Gilor
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Lucia Giacomelli
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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Crinò C, Iavazzo F, Ferri F, Coppola LM, Salesov E, Lutz TA, Reusch CE, Zini E. Diabetic remission in a cat treated with an implantable pump to deliver insulin. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:30-34. [PMID: 31892750 PMCID: PMC6909408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A diabetic cat was referred because of poor metabolic control and difficulties the owner experienced injecting insulin. A pump, telemetrically controlled with a smartphone, was implanted subcutaneously to deliver insulin. Before implantation, the pump reservoir was filled with a rapid-acting human recombinant insulin. The insulin was administered through continuous infusion or periodic boluses over 2 weeks while the cat was hospitalized and over another 2 weeks after discharge from the hospital. Adjustments of insulin dosage were performed based on blood glucose concentrations measured with a continuous blood monitoring system (CGMS). The cat achieved diabetic remission that is still lasting after 1 year. The treatment protocol adopted in this cat contributed to achieving remission. The owner's unwillingness to inject insulin into an uncooperative cat was circumvented with the implantable pump. Key clinical message: The implantable subcutaneous pump, telemetrically controlled by a smartphone, easily allowed the clinician to modify the type of administration and the amount of insulin delivered; the concurrent use of a CGMS allowed detection of sudden changes in blood glucose while limiting stress to the cat.
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Affiliation(s)
- Chiara Crinò
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Francesca Iavazzo
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Filippo Ferri
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Luigi M Coppola
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Elena Salesov
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Thomas A Lutz
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Claudia E Reusch
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Eric Zini
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
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Strage EM, Sundberg M, Holst BS, Andersson Franko M, Ramström M, Fall T, Lewitt M. Effect of insulin treatment on circulating insulin-like growth factor I and IGF-binding proteins in cats with diabetes mellitus. J Vet Intern Med 2018; 32:1579-1590. [PMID: 30112786 PMCID: PMC6189377 DOI: 10.1111/jvim.15243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 04/15/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Insulin-like growth factor-I (IGF-I) is used to screen for acromegaly in diabetic cats. In humans, most circulating IGF-I forms ternary complexes (TC) with IGF-binding protein (IGFBP-3) and an acid-labile subunit. Compared to humans, the amount of TC in cats is more variable. Insulin-like growth factor-I concentrations are reported to increase during insulin treatment, more rapidly in cats achieving remission. OBJECTIVES To investigate (i) factors associated with circulating IGF-I concentrations, including IGFBP-profiles (ii) effect of insulin treatment on IGF-I concentrations and (iii) IGF-I as prognostic marker of diabetes mellitus remission. ANIMALS Thirty-one privately owned diabetic cats of which 24 were followed 1 year, and 13 healthy cats. METHODS Prospective study. Serum insulin, IGF-I, glucose, and fructosamine concentrations were measured. IGF-binding forms were determined by chromatography in 14 diabetic and 13 healthy cats; and IGF-I, IGF-II, IGFBP-3, and IGFBP-5 by mass spectrometry in 3 cats achieving remission. RESULTS Insulin-like growth factor-I median (interquartile range) before start of insulin treatment was 300 (160-556) ng/mL. Insulin-like growth factor-I was positively associated with TC (P < .0001) and endogenous insulin (P = .005) and negatively associated with fructosamine (P < .0001). Median IGF-I was higher 2-4 weeks after start of insulin treatment compared with baseline (300 versus 670 ng/mL, P = .0001) and predicted future remission (P = .046). In cats that went into remission, the amount of TC and IGFBP-3 increased, suggesting increase in IGF-I is dependent on TC formation. CONCLUSIONS Insulin treatment should be accounted for when interpreting IGF-I in diabetic cats. Insulin-like growth factor-I 2-4 weeks after initiation of insulin treatment shows promise as prognostic marker for remission in diabetic cats.
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Affiliation(s)
- Emma M Strage
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Clinical Pathology Laboratory, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Mårten Sundberg
- Department of Chemistry- BMC and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Bodil S Holst
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Margareta Ramström
- Department of Chemistry- BMC and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Moira Lewitt
- School of Health Nursing and Midwifery, University of the West of Scotland, Paisley, United Kingdom
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Schaefer S, Kooistra HS, Riond B, Suchodolski JS, Steiner JM, Prins M, Zini E, Reusch CE. Evaluation of insulin-like growth factor-1, total thyroxine, feline pancreas-specific lipase and urinary corticoid-to-creatinine ratio in cats with diabetes mellitus in Switzerland and the Netherlands. J Feline Med Surg 2017; 19:888-896. [PMID: 27578200 PMCID: PMC11104121 DOI: 10.1177/1098612x16664390] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives The aim of the study was to evaluate circulating insulin-like growth factor-1 (IGF-1), feline pancreas-specific lipase (fPLI) and total thyroxine (TT4) concentrations and urinary corticoid-to-creatinine ratio (UCCR) as indicators for the prevalence of acromegaly, pancreatitis, hyperthyroidism and hypercortisolism in cats with diabetes mellitus. Methods Blood and urine samples were collected from diabetic cats treated in primary care clinics in Switzerland and the Netherlands. Standardised questionnaires and physical examination forms provided clinical information from owners and veterinarians. Laboratory testing included serum biochemistry profile analysis and measurement of circulating fructosamine, IGF-1, fPLI, and TT4 concentrations and UCCR. CT of the pituitary gland was performed using a multidetector computed tomography scanner. Results Blood samples were available from 215 cats and urine samples were collected at home from 117 cats. Age ranged from 2-18 years (median 12 years) and body weight from 2.7-12.3 kg (median 5.5 kg). Sixty-five percent of the cats were castrated male and 35% were female (33% spayed); 82% were domestic shorthair cats. Eighty percent of cats received a porcine insulin zinc suspension, 19.5% insulin glargine and 0.5% a human neutral protamine hagedorn insulin. Thirty-six of 202 (17.8%) cats had IGF-1 concentrations >1000 ng/ml. Serum fPLI, and TT4 concentrations and UCCR were increased in 86/196 (43.9%), 9/201 (4.5%) and 18/117 cats (15.3%), respectively. Prevalence did not differ between countries. Conclusions Hyperthyroidism is rare, whereas increased fPLI concentration, possibly reflecting pancreatitis, is common in diabetic cats. The high UCCR may reflect activation of the hypothalamus-pituitary-adrenal axis, which also occurs in diabetic humans. The percentage of cats with increased IGF-1 was high but lower than reported in recent studies.
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Affiliation(s)
- Sandra Schaefer
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Barbara Riond
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Marrit Prins
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Eric Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
- The Veterinary Institute of Novara, Granozzo con Monticello, Italy
| | - Claudia E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Riederer A, Zini E, Salesov E, Fracassi F, Padrutt I, Macha K, Stöckle TM, Lutz TA, Reusch CE. Effect of the Glucagon-like Peptide-1 Analogue Exenatide Extended Release in Cats with Newly Diagnosed Diabetes Mellitus. J Vet Intern Med 2015; 30:92-100. [PMID: 26700409 PMCID: PMC4913624 DOI: 10.1111/jvim.13817] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/19/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022] Open
Abstract
Background Exenatide extended release (ER) is a glucagon‐like peptide‐1 analogue that increases insulin secretion, inhibits glucagon secretion and induces satiation in humans with type 2 diabetes mellitus. The use of exenatide ER is safe and stimulates insulin secretion in healthy cats. Objectives The objective of this study is to assess the safety of exenatide ER and its effect on body weight, remission and metabolic control in newly diagnosed diabetic cats receiving insulin and a low‐carbohydrate diet. Animals Thirty client‐owned cats. Methods Prospective placebo‐controlled clinical trial. Cats were treated with exenatide ER or 0.9% saline, administered SC, once weekly. Both groups received insulin glargine and a low‐carbohydrate diet. Exenatide ER was administered for 16 weeks, or in cats that achieved remission it was given for 4 weeks after discontinuing insulin treatment. Nonparametric tests were used for statistical analysis. Results Cats in the exenatide ER and placebo groups had transient adverse signs including decreased appetite (60% vs. 20%, respectively, P = .06) and vomiting (53% vs. 40%, respectively, P = .715). Body weight increased significantly in the placebo group (P = .002), but not in cats receiving exenatide ER. Cats on exenatide ER achieved remission or good metabolic control in 40% or 89%, respectively, whereas in control cats percentages were 20% or 58% (P = .427 and P = .178, respectively). Conclusion and clinical importance Exenatide ER is safe in diabetic cats and does not result in weight gain. Our pilot study suggests that, should there be an additional clinically relevant beneficial effect of exenatide ER in insulin‐treated cats on rate of remission and good metabolic control, it would likely approximate 20% and 30%, respectively.
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Affiliation(s)
- A Riederer
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Animal Medicine, Production and Healthy, University of Padova, Legnaro, Italy.,The Istituto Veterinario di Novara, Granozzo con Monticello, Italy
| | - E Salesov
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - F Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - I Padrutt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K Macha
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - T M Stöckle
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - T A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Zini E, Hafner M, Kook P, Lutz TA, Ohlerth S, Reusch CE. Longitudinal evaluation of serum pancreatic enzymes and ultrasonographic findings in diabetic cats without clinically relevant pancreatitis at diagnosis. J Vet Intern Med 2015; 29:589-96. [PMID: 25818213 PMCID: PMC4895493 DOI: 10.1111/jvim.12565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 11/24/2014] [Accepted: 01/28/2014] [Indexed: 12/18/2022] Open
Abstract
Background Cats with diabetes mellitus can have subclinical pancreatitis but prospective studies to confirm this are lacking. Metabolic control of diabetic cats with pancreatitis is difficult. Hypothesis Subclinical pancreatitis occurs in diabetic cats at the time diabetes is diagnosed or might develop during the follow‐up period, hampering diabetic remission. Animals Thirty cats with newly diagnosed diabetes without clinical signs of pancreatitis on admission. Methods Prospective study. On admission and 2 and 6 months later, serum Spec fPL and DGGR‐lipase were measured and the pancreas underwent ultrasonographic examination. Pancreatitis was suspected if serum markers were increased or ≥2 ultrasonographic abnormalities were detected. Cats were treated with insulin glargine and diabetic remission was defined as euglycemia ≥4 weeks after discontinuation of insulin. Nonparametric statistical tests were used for analysis. Results Subclinical pancreatitis at the time of diagnosis was suspected in 33, 50, and 31% of cats based on Spec fPL, DGGR‐lipase and ultrasonography, respectively; and in 60% when diagnostic criteria were combined. During the follow‐up period, suspected pancreatitis developed in additional 17–30% cats. Only 1 cat had transient clinical signs compatible with pancreatitis. Seventeen of the 30 cats (57%) achieved remission. Frequency of abnormal Spec fPL and DGGR‐lipase and abnormal ultrasonographic findings did not differ in cats achieving remission and those who did not. Cats achieving remission had significantly lower Spec fPL at 2 months (P < .001). Conclusions and Clinical Importance Based on laboratory and ultrasonographic measurements, many cats with diabetes might have pancreatitis, although without clinical signs. Cats with high Spec fPL might have a reduced chance of diabetic remission; however, this topic needs further studies in large cohorts of diabetic cats.
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Affiliation(s)
- E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; Department of Animal Medicine, Production and Health, University of Padova, Legnaro, PD, Italy; Istituto Veterinario di Novara, Granozzo con Monticello, NO, Italy
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