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Urbanschitz T, Huber L, Tichy A, Burgener IA, Zeugswetter FK. Short-term glycemic variability in non-diabetic, non-obese dogs assessed by common glycemic variability indices. Res Vet Sci 2024; 169:105156. [PMID: 38340380 DOI: 10.1016/j.rvsc.2024.105156] [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] [Received: 11/13/2022] [Revised: 12/14/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Glycemic variability (GV) refers to swings in blood glucose levels and is an emerging measure of glycemic control in clinical practice. It is associated with micro- and macrovascular complications and poor clinical outcomes in diabetic humans. Although an integral part of patient assessment in human patients, it is to a large extent neglected in insulin-treated diabetic dogs. This prospective pilot study was performed to describe canine within-day GV in non-diabetic dogs with the aim to provide a basis for the interpretation of daily glucose profiles, and to promote GV as an accessible tool for future studies in veterinary medicine. Interstitial glucose concentrations of ten non-diabetic, non-obese beagles were continuously measured over a 48-h period using a flash glucose monitoring system. GV was assessed using the common indices MAGE (mean amplitude of glycemic excursion), GVP (Glycemic variability percentage) and CV (coefficient of variation). A total of 2260 sensor measurements were obtained, ranging from 3.7 mmol/L (67 mg/dL) to 8.5 mmol/L (153 mg/dL). Glucose profiles suggested a meal-dependent circadian rhythmicity with small but significant surges during the feeding periods. No differences in GV indices were observed between day and night periods (p > 0.05). The MAGE (mmol/L), GVP (%) and CV (%) were 0.86 (± 0.19), 7.37 (± 1.65), 6.72 (± 0.89) on day one, and 0.83 (± 0.18), 6.95 (± 1.52), 6.72 (± 1.53) on day two, respectively. The results of this study suggest that GV is low in non-diabetic dogs and that glucose concentrations are kept within narrow ranges.
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Affiliation(s)
- Tobias Urbanschitz
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Lukas Huber
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Alexander Tichy
- University of Veterinary Medicine Vienna Platform for Bioinformatics and Biostatistics Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Iwan Anton Burgener
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Florian Karl Zeugswetter
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
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Vaitaitis G, Webb T, Webb C, Sharkey C, Sharkey S, Waid D, Wagner DH. Canine diabetes mellitus demonstrates multiple markers of chronic inflammation including Th40 cell increases and elevated systemic-immune inflammation index, consistent with autoimmune dysregulation. Front Immunol 2024; 14:1319947. [PMID: 38318506 PMCID: PMC10839093 DOI: 10.3389/fimmu.2023.1319947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Canine diabetes mellitus (CDM) is a relatively common endocrine disease in dogs. Many CDM clinical features resemble human type 1 diabetes mellitus (T1DM), but lack of autoimmune biomarkers makes calling the disease autoimmune controversial. Autoimmune biomarkers linking CDM and T1DM would create an alternative model for drug development impacting both human and canine disease. Methods We examined peripheral blood of diagnosed CDM dog patients comparing it to healthy control (HC) dogs. Dogs were recruited to a study at the Colorado State University Veterinary Teaching Hospital and blood samples collected for blood chemistry panels, complete blood counts (CBC), and immunologic analysis. Markers of disease progression such as glycated albumin (fructosamine, the canine equivalent of human HbA1c) and c-peptide were addressed. Results Significant differences in adaptive immune lymphocytes, innate immune macrophages/monocytes and neutrophils and differences in platelets were detected between CDM and HC based on CBC. Significant differences in serum glucose, cholesterol and the liver function enzyme alkaline phosphatase were also detected. A systemic immune inflammation index (SII) and chronic inflammation index (CII) as measures of dynamic changes in adaptive and innate cells between inflammatory and non-inflammatory conditions were created with highly significant differences between CDM and HC. Th40 cells (CD4+CD40+ T cells) that are demonstrably pathogenic in mouse T1DM and able to differentiate diabetic from non-diabetic subjects in human T1DM were significantly expanded in peripheral blood mononuclear cells. Conclusions Based on each clinical finding, CDM can be categorized as an autoimmune condition. The association of significantly elevated Th40 cells in CDM when compared to HC or to osteoarthritis, a chronic but non-autoimmune disease, suggests peripheral blood Th40 cell numbers as a biomarker that reflects CDM chronic inflammation. The differences in SII and CII further underscore those findings.
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Affiliation(s)
- Gisela Vaitaitis
- Department of Medicine, The University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tracy Webb
- Department of Clinical Sciences, The Colorado State University Veterinary Teaching Hospital, Fort Collins, CO, United States
| | - Craig Webb
- Department of Clinical Sciences, The Colorado State University Veterinary Teaching Hospital, Fort Collins, CO, United States
| | - Christina Sharkey
- Department of Clinical Sciences, Montclaire Animal Clinic, Denver, CO, United States
| | - Steve Sharkey
- Department of Clinical Sciences, Montclaire Animal Clinic, Denver, CO, United States
| | - Dan Waid
- Op-T, LLC, Fitzsimmons Innovation Bioscience, Aurora, CO, United States
| | - David H. Wagner
- Department of Medicine, The University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Op-T, LLC, Fitzsimmons Innovation Bioscience, Aurora, CO, United States
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Kuzi S, Mazaki-Tovi M, Hershkovitz S, Yas E, Hess RS. Long-term field study of lispro and neutral protamine Hagedorn insulins treatment in dogs with diabetes mellitus. Vet Med Sci 2023; 9:704-711. [PMID: 36795089 PMCID: PMC10029897 DOI: 10.1002/vms3.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The long-term clinical and biofhemical effects of basal-bolus insulin treatment with lispro and NPH in dogs with diabetes mellitus are undocumented. OBJECTIVES To perform a prospective pilot field study of the long-term effects of lispro and NPH on clinical signs and serum fructosamine concentrations (SFC) in dogs with diabetes mellitus. METHODS Twelve dogs received combined lispro and NPH insulins treatment twice a day and were examined every 2 weeks for 2 months (visits 1-4), and every 4 weeks for up to 4 additional months (visits 5-8). Clinical signs and SFC were recorded at each visit. Polyuria and polydipsia (PU/PD) were scored as absent (0) or present (1). RESULTS Median (range) PU/PD scores of combined visits 5-8 (0, 0-1) were significantly lower than median scores of combined visits 1-4 (1, 0-1, p = 0.03) and at enrolment (1, 0-1, p = 0.045). Median (range) SFC of combined visits 5-8 (512 mmol/L, 401-974 mmol/L) was significantly lower than SFC of combined visits 1-4 (578 mmol/L, 302-996 mmol/L, p = 0.002) and at enrolment (662 mmol/L, 450-990 mmol/L, p = 0.03). Lispro insulin dose was significantly and negatively, albeit weakly, correlated with SFC concentration during visits 1 through 8 (r = -0.3, p = 0.013). Median duration of follow up was 6 months (range 0.5-6) and most dogs (8, 66.7%) were followed for 6 months. Four dogs withdrew from the study within 0.5-5 months because of documented or suspected hypoglycaemia, short NPH duration or sudden unexplained death. Hypoglycaemia was noted in 6 dogs. CONCLUSIONS Long-term lispro and NPH combination therapy may improve clinical and biochemical control of some diabetic dogs with comorbidities. Risk of hypoglycaemia should be addressed with close monitoring.
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Affiliation(s)
- Sharon Kuzi
- Department of Small Animals Internal Medicine, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animals Internal Medicine, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Shai Hershkovitz
- Department of Small Animals Internal Medicine, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Einat Yas
- Department of Small Animals Internal Medicine, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Rebecka S Hess
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Pennsylvania, Philadelphia
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Kuzi S, Mazaki-Tovi M, Ahmad WA, Ovadia Y, Aroch I. Clinical utility of serum fructosamine in long-term monitoring of diabetes mellitus in dogs. Vet Rec 2023; 192:e2236. [PMID: 36180819 DOI: 10.1002/vetr.2236] [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] [Received: 03/17/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Serum fructosamine (sFA) is used to assess glycaemic control in dogs with diabetes mellitus (DM). Nevertheless, its interpretation is hindered by several limitations. METHODS This retrospective study evaluates the long-term diagnostic performance of sFA for monitoring clinical control of DM. sFA, bodyweight, appetite, presence of polyuria/polydipsia and clinical scores (CS; well-controlled DM, CS-0; uncontrolled DM, CS-1) were recorded. RESULTS The study included 75 dogs (321 visits; median 3 visits/dog; range 1-19). Mean sFA was higher (p < 0.001) on visits with CS-1 (584 μmol/L; 95% confidence interval [95% CI] 561-608) than on visits with CS-0 (506 μmol/L; 95% CI 484-528). Increases in sFA increased the odds ratio for CS-1 (1.37; 95% CI 1.24-1.52, p < 0.001). sFA was moderately predictive of the CS (area under receiver operating characteristic curve = 0.75; 95% CI 0.70-0.80; p < 0.0001), with a 486 μmol/L cutoff yielding 80% sensitivity and 59% specificity. Mean sFA was lower (p = 0.005) when hypoglycaemic episodes were suspected (496 μmol/L; 95% CI 450-541) than in their absence (572 μmol/L; 95% CI 548-596). sFA is moderately accurate for classifying CS in diabetic dogs. Decreasing sFA over follow-ups indicates improved CS but might suggest occurrence of hypoglycaemic episodes. LIMITATIONS Retrospective design, variable treatments and comorbidities are limitations of this study. CONCLUSION sFA has a moderate clinical utility in the long-term monitoring of diabetic dogs, but may serve as a first-line, accessible diagnostic tool. Discordant CS and sFA evaluation, or decreased sFA, warrants additional monitoring (i.e., continuous glucose monitoring).
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Affiliation(s)
- Sharon Kuzi
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Wiessam Abu Ahmad
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yael Ovadia
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Zeugswetter FK, Beer R, Schwendenwein I. Evaluation of fructosamine concentration as an index marker for glycaemic control in diabetic dogs. Vet Rec 2021; 190:e244. [PMID: 33870504 DOI: 10.1002/vetr.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although fructosamine is a commonly used surrogate marker to assess glycaemic control in diabetic dogs, its diagnostic accuracy has been questioned. The main objective of this study was to evaluate the reliability of fructosamine measurements to diagnose well and poorly controlled diabetes mellitus (DM), using continuous glucose monitoring as a gold standard. METHODS Twenty-four dogs with treated DM and continuous glucose monitoring for mean (±SD) 13.1 (±1.7) days were retrospectively analysed. Two assessment strategies were applied to categorize glycaemic control, and fructosamine concentrations were determined shortly after sensor cessation using a colorimetric assay. RESULTS Correlations of individual fructosamine concentrations with mean glucose as well as percentage of measurements > 15 mmol/L were not significant (p = 0.372, p = 0.129). Fructosamine did not differ between dogs with and without hypoglycaemic episodes (p = 0.64). Receiver operating characteristic analysis for fructosamine to diagnose either good or poor glycaemic control revealed AUC values of 0.71 (p = 0.025) indicating moderate accuracy, and 0.7 (p = 0.135) indicating AUC is non-discriminatory, respectively. The respective positive likelihood ratios for the optimal cutoffs to identify good (<396 μmol/L) and poor control (>449 μmol/L) were three. CONCLUSIONS Fructosamine measurement is an imperfect surrogate marker for classifying glycaemic control in diabetic dogs and can only complement serial glucose measurements.
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Affiliation(s)
- Florian K Zeugswetter
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Raphael Beer
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ilse Schwendenwein
- Department of Pathobiology, Central Laboratory, University of Veterinary Medicine Vienna, Vienna, Austria
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Zeugswetter FK, Sellner A. Flash glucose monitoring in diabetic dogs: a feasible method for evaluating glycemic control. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2020; 48:330-338. [PMID: 33086409 DOI: 10.1055/a-1239-4739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To alleviate clinical signs and avoid life-threatening complications in dogs with diabetes mellitus, individualized treatment plans and frequent reassessments are necessary. Performing blood glucose profiles every 7-14 days following insulin adjustments and monthly thereafter, is recommended. In 2016, a factory calibrated continuous blood glucose monitoring system was presented as a possible alternative to glucometer readings. The objectives of this study were to summarize the experiences with this new technology and to show, that in combination with simple rules, already the first measurement period can improve glycemic control. MATERIAL AND METHODS The electronic database of the endocrine unit of the clinic was retrospectively searched for diabetic dogs with flash glucose monitoring. In case of repeated sensor implantations, only the first sensor was considered. The recordings of day A (starting at midnight after sensor placement) were compared to the measurements of day B (day before sensor failure) and all owners were contacted to fill in a standardized questionnaire. RESULTS The final study population consisted of 24 dogs weighing 3.4 to 36 kg. Although the clicking noise during sensor placement irritated most dogs, the application was considered easy and painless. Waiting for disinfectant evaporation and fixation of the sensor disc with forceps helped to avoid sensor detachment when removing the application device. Although transient mild to moderate skin irritations were observed in 80 % of the dogs, 95 % of the owners were highly satisfied with this new monitoring technology. Mean and maximum glucose (p = 0.043, p = 0.003) as well as glucose readings ≥ 11.1 mmol/l (p = 0.032) decreased from day A to B, whereas markers of glycemic variability did not change. CONCLUSION AND CLINICAL RELEVANCE Flash glucose monitoring is a feasible, safe method with high user satisfaction and offers a possibility to improve glycemic control in diabetic dogs.
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Affiliation(s)
- Florian K Zeugswetter
- Diabetes mellitus, sensorbasiertes Glukosemonitoring, glykämische Variabilität, MAGE
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