Evaluation of sensor sites for continuous glucose monitoring in cats with diabetes mellitus

Microneedle-enabled therapeutics delivery and biosensing in clinical trials

Microneedles (MNs) are micron-sized protrusions attached to a range of devices that are used in therapeutic delivery and diagnosis. Because MNs can be self-applied, are painless, and can carry multiple therapeutic agents, they have received extensive attention, and have been widely investigated, for local and systemic therapy. Many researchers are currently working to extend the use of MNs to clinical applications. In this review, we provide an update and analysis on MN-based clinical trials since their inception in 2007. The MNs in clinical trials are classified into five types based on their appearance and properties, including: hollow MNs, MN patches, radiofrequency MNs, MN rollers, and other MNs. The various aspects of MN trials are summarized, such as MN types, clinical trial time, and trial regions. This review aims to present an overview of MN development and provide insights for future research in this field. To our knowledge, this is the first review focused on MN clinical trials which showcases the latest applications of this advanced technology in medicine.

Monitoring of Diabetes Mellitus Using the Flash Glucose Monitoring System: The Owners' Point of View

The flash glucose monitoring system (FGMS) has recently become one of the most common monitoring methods in dogs and cats with diabetes mellitus. The aim of this study was to evaluate the impact of FGMS on the quality of life of diabetic pet owners (DPOs). Fifty DPOs were asked to answer a 30-question survey. More than 80% of DPOs considered FGMS easier to use and less stressful and painful for the animal compared to blood glucose curves (BGCs). Overall, 92% of DPOs reported that their pet had better diabetes control since using FGMS. The most challenging aspects of using the FGMS were ensuring proper sensor fixation during the wearing period (47%), preventing premature detachment (40%), and purchasing the sensor (34%). Moreover, 36% of DPOs reported that the device cost was difficult to afford in the long term. Comparing dogs and cats, a significantly higher number of dogs' owners found the FGMS to be well-tolerated (79% vs. 40%), less invasive than BGCs (79% vs. 43%), and easier to maintain in situ (76% vs. 43%). In conclusion, FGMS is considered by DPOs to be easy to use and less stressful compared to BGCs, while enabling better glycemic control. Nevertheless, the costs related to its long-term use might be difficult to sustain.

Continuous Glucose Monitoring in Dogs and Cats: Application of New Technology to an Old Problem

In recent years, glucose monitoring has been revolutionized by the development of continuous glucose monitoring systems (CGMS), which are wearable non/minimally invasive devices that measure glucose concentration almost continuously for several consecutive d/wk. The Abbott FreeStyle Libre is the CGMS used most commonly. It has adequate clinical accuracy both in dogs and cats, even though the accuracy is lower in the hypoglycemic range. It allows an accurate identification of glycemic excursions occurring throughout the day as well as of glucose variations during consecutive days, enabling the clinician to make a more informed decision about the insulin dose and frequency of administration.

Adipokines as potential biomarkers for type 2 diabetes mellitus in cats

Type 2 diabetes mellitus (T2DM) is no longer only a disease of humans, but also of domestic animals, and it particularly affects cats. It is increasingly thought that because of its unique characteristics, T2DM may belong not only to the group of metabolic diseases but also to the group of autoimmune diseases. This is due to the involvement of the immune system in the inflammation that occurs with T2DM. Various pro- and anti-inflammatory substances are secreted, especially cytokines in patients with T2DM. Cytokines secreted by adipose tissue are called adipokines, and leptin, adiponectin, resistin, omentin, TNF-α, and IL-6 have been implicated in T2DM. In cats, approximately 90% of diabetic cases are T2DM. Risk factors include older age, male sex, Burmese breed, presence of obesity, and insulin resistance. Diagnosis of a cat requires repeated testing and is complicated compared to human diagnosis. Based on similarities in the pathogenesis of T2DM between humans and cats, adipokines previously proposed as biomarkers for human T2DM may also serve in the diagnosis of this disease in cats.

Perception of veterinarians on monitoring diabetic cats with emphasis on the flash glucose monitoring system

ABSTRACT This study aimed to understand the perception of veterinarians regarding monitoring blood and interstitial glucose levels in cats with diabetes mellitus and/or diabetic ketoacidosis, with emphasis on the flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, Brazil). This research consisted of two stages. In all, 516 response forms were obtained, and of these, 480 (93%) were considered valid. In total, 333 (69.4%) veterinarians did not use the FGMS, while 147 (30.6%) did. The cost of the FGMS (116, 78%) was the greatest deterrent to acceptability. Veterinarians who use the device consider it indispensable in the hospital monitoring of diabetic ketoacidosis and a facilitator in the accurate monitoring of measurements. In addition, the preferred location for application of the sensor is the cranial lateral wall of the chest and it is quite tolerable. Monitoring a diabetic cat requires commitment from the owner and the veterinary team to ensure feline-friendly management.

Evaluation of the FreeStyle Libre, a flash glucose monitoring system, in client-owned cats with diabetes mellitus

Objectives

Home blood glucose monitoring using a portable blood glucose meter is important in the management of feline diabetes mellitus, but taking blood samples may be stressful for owners and cats. A flash glucose monitoring system measuring interstitial glucose, such as the FreeStyle Libre, overcomes some of these drawbacks. The aim of this study was to evaluate the practical use and analytical and clinical accuracy of the FreeStyle Libre in 41 client-owned diabetic cats.

Methods

In this prospective study, interstitial glucose concentrations were measured with the FreeStyle Libre and compared with blood glucose concentrations measured with a portable blood glucose meter (AlphaTRAK) on days 1, 7 or 8 and 14 after application of the device. Cat behaviour during application, location, skin reaction at the attachment site and owner satisfaction were assessed. Accuracy was determined by fulfilment of ISO 15197:2013 criteria, including Bland–Altman plotting and error grid analysis.

Results

Placing the device was easy, with 70% of cats showing no reaction. Most sensors were placed on the thoracic wall. Skin reactions at the attachment site were not present or mild in almost all cats. Owners were very satisfied with the use of the FreeStyle Libre. Median functional life of the sensor was 10 days (range 1–14). Good correlation was found between interstitial and blood glucose measurements (rho[r] = 0.88, P <0.0001). Fifty-three percent of interstitial glucose concentrations were within a maximum deviation of 15% from blood glucose concentrations and 92.7% were within the safe risk zones 0 and 1 of the surveillance error grid.

Conclusions and relevance

The flash glucose monitoring system was easy to use and owners of diabetic cats were satisfied with its use. Although the device did not completely fulfil ISO requirements, it is sufficiently accurate for glucose monitoring in diabetic cats.

Evaluation of a flash glucose monitoring system in nondiabetic dogs with rapidly changing blood glucose concentrations

Background

A flash glucose monitoring system (FGMS; FreeStyle Libre) is useful for monitoring hypoglycemic dogs with diabetes.

Objective

To assess the utility of this FGMS in dogs with induced hypoglycemia and rapid fluctuations in blood glucose (BG) concentrations.

Animals

Twenty‐four apparently healthy research (n = 10) and teaching (n = 14) dogs.

Methods

Prospective, observational study performed in tandem with a teaching laboratory. Regular insulin was administered to dogs and resulting hypoglycemia was corrected. Before insulin administration and every 10 minutes over a 90‐minute period, serial measurements of interstitial glucose (IG) with FGMS and BG with a portable blood glucose meter (PBGM) and clinical chemistry analyzer concentrations were made. Portable blood glucose meter and FGMS readings were compared to that of the clinical chemistry analyzer. Analytical and clinical accuracy were assessed using ISO 15197:2013 criteria, including Parkes error grid analysis.

Results

The proportions of readings in the low BG range (BG <100 mg/dL) for which the test method measurement was within ±15 mg/dL of the reference BG for the PBGM and FGMS were 81.7% (161/197) and 39.1% (72/184), respectively. The proportions of readings for the PBGM and FGMS, which were not likely to affect clinical outcome according to Parkes error grid analysis, were 97.9% (233/238) and 80.1% (177/221), respectively.

Conclusions and Clinical Importance

In this model, there was limited agreement between the FGMS and reference standard BG measurements. The FGMS (measuring IG concentrations) was compared to peripheral BG concentrations, not brain‐tissue glucose concentrations, and failed to reliably detect hypoglycemia.

Validation of a flash glucose monitoring system in outpatient diabetic cats

BACKGROUND

Interstitial glucose (IG) concentration measurement using a flash glucose monitoring system (FGMS) is a noninvasive, affordable, and informative method to regulate patients with diabetes mellitus (DM) but has not been fully validated in outpatient cats with DM.

OBJECTIVES

To further validate the FreeStyle Libre FGMS in outpatient diabetic cats.

ANIMALS

Eight client-owned cats with DM.

METHODS

Prospective observational validation study. Tissue glue was used to attach the sensor to the cat. Lin's concordance correlation coefficient (ρc ) was used to compare IG concentrations measured by the FGMS to blood glucose concentrations measured using an automated biochemistry analyzer (ABA) and point-of-care glucometer (POCG).

RESULTS

Data from 15 sensor placements in 8 cats were analyzed. Paired IG and ABA glucose concentrations (139 samples) had excellent correlation (ρc  = 0.96) as did IG and POCG glucose concentrations (142 samples, ρc  = 0.92). Sensor failure or displacement were recorded for 12/15 (80%) sensor placements. Median time of sensor activity was 7 days (range, 2-13 days).

CONCLUSIONS AND CLINICAL IMPORTANCE

In outpatient cats with DM, the FGMS-measured IG concentration correlated well with ABA-measured blood glucose concentration, but a high rate of sensor failures was observed.

Accuracy of a flash glucose monitoring system in cats and determination of the time lag between blood glucose and interstitial glucose concentrations

Background

The FreeStyle Libre (Abbott Laboratories) is a flash glucose monitoring system (FGMS) that measures interstitial glucose concentration (IG). The system is factory‐calibrated, easy to use, inexpensive, and could be useful for monitoring diabetic cats.

Objectives

To evaluate the analytical and clinical accuracy of the FGMS in cats and establish the lag‐time between IG and blood glucose concentration (BG).

Animals

Twenty client‐owned diabetic cats and 7 purpose‐bred healthy cats.

Methods

Prospective study. Blood glucose concentration was measured using a portable glucose meter validated for use in cats that served as a reference method for IG, as measured by FGMS. In diabetic cats, data were collected for sensor wearing time with different methods of application and accuracy across glycemic ranges. Accuracy was determined by fulfillment of ISO15197:2013 criteria. In healthy cats, lag‐time between IG and BG was established after IV administration of exogenous glucose.

Results

Good agreement between IG and BG was obtained (r = .93). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% of the results in zones A + B of the Parkes consensus error grid analysis. In the immediate 30 minutes after an IV bolus of glucose, when BG was increasing rapidly (approximately 2%/min), IG increased slowly, resulting in a difference of as much as 579 mg/dL, and no positive correlation between BG and IG was found.

Conclusions and Clinical Importance

The FGMS did not fulfill ISO requirements but is sufficiently accurate for glucose monitoring in cats, while considering the lag between IG and BG during periods of rapid changes in BG.

The Influence of Skin Thickness on Flash Glucose Monitoring System Accuracy in Dogs with Diabetes Mellitus

Simple Summary

A flash glucose monitoring system (FGMS) has been validated for use in dogs with diabetes mellitus and diabetic ketoacidosis. It continuously measures the glucose in the interstitial fluid through a small filament (5 mm long) inserted under the skin. Interstitial glucose concentrations are reportedly comparable to whole blood glucose concentrations. However, several factors can influence the performance of interstitial sensors, including the proportion of interstitial fluid in a tissue. The influence of skin thickness on flash glucose monitoring system accuracy has not been investigated in previous studies; therefore, the aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. On the basis of our results, skin thickness seems to affect FGMS measurements; the mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness, and clinical accuracy according to ISO 15197:2013 criteria was observed only in dogs with skin thickness > 5 mm, with 99% of the results falling in zone A + B of the Parkes consensus error grid analysis. In dogs with thin skin (<5 mm), the clinical accuracy was low, and the results should be interpreted with caution.

Abstract

A flash glucose monitoring system (FGMS) has been validated for use in diabetic dogs. However, it is unknown whether skin thickness affects FGMS measurements. The aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. Fourteen client-owned diabetic dogs on insulin treatment were prospectively enrolled in the study. The dogs were divided into two groups according to their ultrasound-measured skin thickness: dogs with skin thickness < 5 mm (Group 1) and dogs with skin thickness > 5 mm (Group 2). On days 1, 7 and 14, glucose curves were obtained simultaneously using the FGMS and a validated portable blood glucose meter. Paired measurements were used to calculate the mean bias and to determine accuracy according to ISO 15197:2013 criteria. The mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness. Clinical accuracy was observed only in Group 2, with 99% of the results in zone A + B of the Parkes consensus error grid analysis. In conclusion, skin thickness seems to affect FGMS measurements, and the device is accurate in dogs with thicker skin (>5 mm); in dogs with thin skin (<5 mm), the clinical accuracy is low, and the results should be interpreted with caution.

Evaluation of a flash glucose monitoring system in dogs with diabetic ketoacidosis

The flash glucose monitoring system (FGMS) Freestyle Libre provides estimates of blood glucose by constantly measuring the glucose concentration of the interstitial fluid through a sensor inserted in the subcutaneous space. The aim of this study was to evaluate the applicability and accuracy of the FGMS in dogs with diabetic ketoacidosis (DKA). Seven dogs with DKA examined at the Veterinary Hospital of the State University of Londrina were included in this study. The sensor was placed on the dorsal cervical region, shortly after the diagnosis of DKA was confirmed and maintained for 5 d. The measurement of blood glucose was performed simultaneously with the veterinary portable blood glucose meter (PBGM) AlphaTRAK 2 every 2 to 4 h and with the hexokinase method every 12 h. The PBGM's precision was evaluated following the ISO15197:2013 criteria. Blood glucose estimates were strongly associated (r = 0.89; P < 0.0001), and the mean absolute relative difference in relation to the PBGM was 25.2% (-70.4% to 101.9%). The evaluation of these data using the consensus error grid analysis showed that 95.4% and 94.8% of the samples were in Zones A and B (clinically acceptable) using the PBGM and the hexokinase method as a reference, respectively. The ISO15197:2013 criteria were not met. There was no difference in the accuracy of the device among days (P = 0.74); however, there was a difference between the hydration status (P = 0.019) and blood glucose ranges (hypoglycemic, euglycemic, and hyperglycemic; P < 0.0001), in which it was less precise in measuring the blood glucose range in hypoglycemic dogs. Therefore, it can be concluded that in spite of the fact that the device did not meet the ISO 15197:2013 criteria, the FGMS evaluated presents good clinical precision and can be a valuable tool in treating dogs with diabetic DKA.

Use of the "FreeStyle Libre" glucose monitoring system in diabetic cats

The aim of this study was to assess the "FreeStyle Libre" flash glucose monitoring system regarding its measurement accuracy and tolerability in cats. Results from 66 sensors applied to 34 predominantly diabetic cats are included. The behaviour during the attachment, wearing, and removal of the sensor and the skin site of attachment were assessed. Blood samples were regularly collected for comparative measurements (hexokinase method). Minimal signs of discomfort were noted, although the sensor was additionally fixed using individual skin stitches. Sensors, which stopped working in situ (70% [46/66]), had a median functional life of 8.3 (1.6-14) days. Skin reactions on the adhesive surface occurred after removal of 39% (23) of 59 sensors with assessable skin reaction (mild erythema: n = 21; superficial dermatitis: n = 2). Due to the upper limit of the measurement range of 27.8 mmol/l (500 mg/dl), the reading device displayed "Hi" in 62% (17/34) of cats repeatedly and/or for periods >1 h. Results were highly correlated with those of the reference method (r_S = 0.90, n = 359). 67.7% (243/359) of the "FreeStyle Libre" measurement values had a maximum deviation of 15% from reference measurements and 99.4% (357/359) were within the zones A and B of Parkes Consensus error grid analysis. In conclusion, the device proved to be practicable, less stressful for the animals and generated in general acceptable results. Although the upper limit of the measurement range is a limiting factor, the device promises to significantly facilitate the management of diabetic cats.

Accuracy of a flash glucose monitoring system in dogs with diabetic ketoacidosis

Background

A factory‐calibrated flash glucose monitoring system (FGMS; FreeStyle Libre) recently was evaluated in dogs with uncomplicated diabetes mellitus. It is not known if this system is reliable during diabetic ketoacidosis (DKA).

Objectives

To assess the performance of the FGMS in dogs with DKA and to determine the effect of severity of ketosis and acidosis, lactate concentration, body condition score (BCS), and time wearing the sensor on the accuracy of the device.

Animals

Fourteen client‐owned dogs with DKA.

Methods

The interstitial glucose (IG) measurements were compared with blood glucose (BG) measurements obtained using a validated portable glucometer. The influence of changes in metabolic variables (β‐hydroxybutyrate, pH, bicarbonate, and lactate) and the effect of BCS and time wearing on sensor performance were evaluated. Accuracy was determined by fulfillment of ISO15197:2013 criteria.

Results

Metabolic variables, BCS, and time wearing were not associated with the accuracy of the sensor. Good agreement between IG measurements and BG was obtained both before and after DKA resolution (r = .88 and r = .93, respectively). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% and 99.6% of results in zones A + B of the Parkes consensus error grid analysis before and after DKA resolution, respectively.

Conclusions and Clinical Importance

Changes in metabolic variables, BCS, and time wearing do not seem to affect agreement between IG and BG. Despite not fulfilling the ISO requirements, the FGMS provides clinically accurate estimates of BG in dogs with DKA.

Comparison of the pharmacodynamics of protamine zinc insulin and insulin degludec and validation of the continuous glucose monitoring system iPro2 in healthy cats

With the aim to improve current therapeutic and monitoring options for diabetic cats, the present study compared pharmacodynamic parameters of protamine zinc insulin (PZI) and insulin degludec and validated the continuous glucose monitoring system (CGMS) iPro2 with Sof-sensor and Enlite-sensor focusing on the low glycemic range. Three doses (0.1, 0.2 and 0.3IU/kg) of the two insulin preparations and the CGMS iPro2 with two different sensors were tested in six healthy cats. After each insulin administration, onset of action, time to glucose nadir and duration of action were calculated by measuring glucose concentrations with a portable blood glucose meter (PBGM). After sensor placement, paired PBGM and sensor glucose measurements were done and analytical and clinical accuracy were calculated according to the ISO 15197:2013 criteria. Onset of action, time to glucose nadir and glucose nadir were similar for both insulin formulations. Duration of action of insulin degludec was significantly longer than those of PZI at 0.1IU/kg (P=0.043) and 0.2IU/kg (P=0.043). Overall, 166/191 (87%) Sof-sensor measurements and 106/121 (88%) Enlite-sensor measurements met ISO criteria for analytical accuracy, and all sensor measurements fulfilled ISO criteria for clinical accuracy. Insulin degludec was well tolerated in healthy cats and showed longer duration of action than PZI. Further studies on the use of insulin degludec in diabetic cats might be recommended. Both sensors had good clinical accuracy, when used with the CGMS iPro2, but the analytical accuracy was below the minimum set by ISO 15197:2013.

Effect of sensor location in dogs on performance of an interstitial glucose monitor

OBJECTIVE To identify variations in glucose values concurrently obtained by use of a continuous glucose monitoring system (CGMS) at the same site, reliability of results for each site, lag time for each site, and influence of site thickness on CGMS accuracy. ANIMALS 8 random-source research dogs. PROCEDURES In experiment 1, 8 CGMS sensors were implanted bilaterally at 1 site (4 sensors/side) in 4 dogs. In experiment 2, 2 CGMS sensors were implanted bilaterally at each of 4 sites (1 sensor/side) in 8 dogs; 4 of those 8 dogs then were subjected to a glycemic clamp technique. The CGMS results were compared among sensors and with criterion-referenced results during periods of euglycemia for all 8 dogs and during hyperglycemia and hypoglycemia for 4 dogs during the glycemic clamp procedure. RESULTS Differences (median, -7 mg/dL; interquartile range [IQR], -18.75 to 3 mg/dL) between CGMS and criterion-referenced glucose concentrations differed significantly among dogs and sites; during euglycemia, they were not different from the expected normal variation between multiple sensors concurrently implanted at the same site. Differences (median, -35 mg/dL; IQR, -74 to -15 mg/dL) between CGMS and criterion-referenced concentrations were greater during changes in glucose concentrations. Thoracic sensors were most accurate but had the shortest mean functional life. CONCLUSIONS AND CLINICAL RELEVANCE Significant differences were detected between CGMS and criterion-referenced glucose concentrations. Overall clinical utility of CGMS was acceptable at all sites, with most of the values from all sensors, sites, and dogs meeting guidelines for point-of-care glucometers.

Point-of-Care Glucose and Ketone Monitoring

Early and rapid identification of hypo- and hyperglycemia as well as ketosis is essential for the practicing veterinarian as these conditions can be life threatening and require emergent treatment. Point-of-care testing for both glucose and ketone is available for clinical use and it is important for the veterinarian to understand the limitations and potential sources of error with these tests. This article discusses the devices used to monitor blood glucose including portable blood glucose meters, point-of-care blood gas analyzers and continuous glucose monitoring systems. Ketone monitoring options discussed include the nitroprusside reagent test strips and the 3-β-hydroxybutyrate ketone meter.

Continuous glucose monitoring system in the operating room and intensive care unit: any difference according to measurement sites?

Given the benefit of glucose control in the perioperative period, we evaluated the accuracy and performance of the continuous glucose monitoring system (CGMS) depending on different measurement sites in the operating room (OR) and in the intensive care unit (ICU). Patients over 18 years of age scheduled for elective surgery and ICU admission were enrolled prospectively. Two CGMS sensors were inserted into the subcutaneous tissue of the proximal lateral thigh and the lateral abdomen. The rate of successful measurements from thigh and abdomen in the OR and in the ICU were calculated separately. Each CGMS values were compared with the time-matched arterial blood glucose measurements. CGMS values from both measurement sites were also compared. A total of 22 patients undergoing cardiac surgeries were studied. The rate of successful measurements was higher in the ICU (73.2 %) than in the OR (66.0 %) (P = 0.01); however, that from thigh (72.9 %) and from abdomen (58.7 %) showed statistically significant difference only in the OR (P = 0.04). The Pearson correlation coefficient of thigh and abdomen versus arterial values was 0.67 and 0.60, respectively (P < 0.001). In Clarke error grid analysis, 94.6 % (89.3 % in the OR and 96.1 % in the ICU) of values from thigh fell into clinically acceptable zones compared to 93.7 % (89.0 % in the OR and 95.4 % in the ICU) from abdomen. There were no statistically significant differences in the accuracy according to measurement sites. The CGMS showed high measurement failure rate, especially in the OR. In the OR, the rate of successful measurement was higher from thigh than from abdomen. The CGMS showed low accuracy compared to arterial reference values. Nevertheless, there was no difference in the accuracy of the CGMS between two measurement sites. Perioperative performance of the CGMS still needs to be improved considering relatively low successful measurement rates.

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.

Intensive intravenous infusion of insulin in diabetic cats

Background

Remission occurs in 10–50% of cats with diabetes mellitus (DM). It is assumed that intensive treatment improves β‐cell function and increases remission rates.

Hypothesis

Initial intravenous infusion of insulin that achieves tight glycemic control decreases subsequent insulin requirements and increases remission rate in diabetic cats.

Animals

Thirty cats with newly diagnosed DM.

Methods

Prospective study. Cats were randomly assigned to one of 2 groups. Cats in group 1 (n = 15) received intravenous infusion of insulin with the goal of maintaining blood glucose concentrations at 90–180 mg/dL, for 6 days. Cats in group 2 (n = 15) received subcutaneous injections of insulin glargine (cats ≤4 kg: 0.5–1.0 IU, q12h; >4 kg 1.5–2.0 IU, q12h), for 6 days. Thereafter, all cats were treated with subcutaneous injections of insulin glargine and followed up for 6 months. Cats were considered in remission when euglycemia occurred for ≥4 weeks without the administration of insulin. Nonparametric tests were used for statistical analysis.

Results

In groups 1 and 2, remission was achieved in 10/15 and in 7/14 cats (P = .46), and good metabolic control was achieved in 3/5 and in 1/7 cats (P = .22), respectively. Overall, good metabolic control or remission occurred in 13/15 cats of group 1 and in 8/14 cats of group 2. In group 1, the median insulin dosage given during the 6‐month follow‐up was significantly lower than in group 2 (group 1: 0.32 IU/kg/day, group 2: 0.51 IU/kg/day; P = .013).

Conclusions and Clinical Importance

Initial intravenous infusion of insulin for tight glycemic control in cats with DM decreases insulin requirements during the subsequent 6 months.