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Melvin RL, Ruple A, Pearson EB, Olby NJ, Fitzpatrick AL, Creevy KE. A review of frailty instruments in human medicine and proposal of a frailty instrument for dogs. Front Vet Sci 2023; 10:1139308. [PMID: 37441560 PMCID: PMC10333704 DOI: 10.3389/fvets.2023.1139308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Over the last few decades, frailty has become a pillar of research and clinical assessment in human gerontology. This complex syndrome, characterized by loss of physiologic reserves leading to decreased resilience to stressors, is of critical importance because it predicts higher risks of poor health outcomes, including mortality. Thus, identifying frailty among the elderly human population has become a key focus of gerontology. This narrative review presents current scientific literature on frailty in both humans and animals. The authors discuss the need for an accessible frailty instrument for companion dogs suitable for general use in veterinary medicine and the advances that would be facilitated by this instrument. A phenotypic frailty instrument for companion dogs, utilizing components that are easily collected by owners, or in the general practice setting, is proposed. The authors elaborate on the domains (physical condition, physical activity, mobility, strength, cognitive task performance, and social behavior), factors that will be included, and the data from the Dog Aging Project that inform each domain.
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Affiliation(s)
- Rachel L. Melvin
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Elizabeth B. Pearson
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Natasha J. Olby
- Department of Clinical Sciences, NC State University College of Veterinary Medicine, Raleigh, NC, United States
| | | | - Kate E. Creevy
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, 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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Relationship between HbA1c, fructosamine and clinical assessment of glycemic control in dogs. PLoS One 2022; 17:e0264275. [PMID: 35213623 PMCID: PMC8880912 DOI: 10.1371/journal.pone.0264275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Background Serum fructosamine is a routine test used for clinical monitoring of diabetes mellitus (DM) but the usefulness of HbA1c for this purpose has not been extensively studied. Hypothesis The study aimed to compare the ability of blood HbA1c and serum fructosamine tests to correctly classify DM control determined using a clinically-based assessment. Animals 28 client-owned dogs with naturally-occurring diabetes mellitus. Methods Cross-sectional observational study. Ability of fructosamine and HbA1c tests to classify diabetes control in dogs was determined. Results Clinical assessment classified 50% of dogs as having good diabetic control and 82% as having acceptable diabetic control. Analysis using Cohen’s kappa test showed that agreements between fructosamine and HbA1c results and the clinical assessment ranged from poor to fair. Fructosamine and HbA1c results from each dog showed a moderate correlation. Overall, the HbA1c test showed the best agreement with the clinical assessment when diabetes control was considered either acceptable or unacceptable, although the strength of agreement was considered fair (kappa = 0.27). Conclusions and clinical importance The HbA1c concentration was found to be more consistent with clinical evaluation of diabetes control than was the serum fructosamine concentration. The HbA1c level is a useful tool for assessment of glycemic status in diabetic dogs but should be used alongside other tests for outpatient monitoring of clinically stable diabetic dogs.
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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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Ward CR, Christiansen K, Li J, Bryson WL, Jerrentrup KA, Kroh C. Field efficacy and safety of protamine zinc recombinant human insulin in 276 dogs with diabetes mellitus. Domest Anim Endocrinol 2021; 75:106575. [PMID: 33186842 DOI: 10.1016/j.domaniend.2020.106575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022]
Abstract
Twice-daily (BID) insulin injections are a major deterrence to owners treating dogs with diabetes mellitus (DM). The hypothesis for this study was that Protamine Zinc Recombinant Human Insulin (PZIR) is safe and efficacious as a once-daily (SID) treatment for canine DM. This was a prospective, baseline-controlled, multi-center study over 182 ± 5 d. Two hundred seventy-six client-owned dogs with naturally occurring DM (naïve or pre-treated with insulin) were enrolled in the study. Enrollment was based upon demonstration of hyperglycemia, glycosuria, and ≥1 diabetic clinical sign (polyuria (PU), polydipsia (PD), or weight loss). Insulin treatment was initiated at 0.5-1.0 IU/kg SID. An improvement in at least one lab parameter related to DM (mean BG, min BG, Fructosamine) and one clinical parameter (PU/PD, body weight) was achieved in 72% of dogs (80% of naive, 62% of pre-treated). Dogs treated SID and BID showed improvement in 71% and 74% of cases, respectively. In naïve dogs, mean and minimum BG and fructosamine were significantly decreased (P < 0.05) by d 7 and 21, respectively, and in pre-treated dogs by d 63. By d 84, PU/PD improved in 90% and 88% of dogs, respectively, and the mean successful insulin dose was 1.4 IU/kg/d. Safety parameters were measured in 276 dogs for up to 182 d; clinical hypoglycemia occurred in 8.9% of dogs. We conclude that PZIR safely and effectively improved glycemic parameters and clinical signs in naïve and pre-treated diabetic dogs. The significant percentage of dogs on SID treatment with improvement in hyperglycemia and clinical signs confirms the prolonged action of PZIR in many dogs.
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Affiliation(s)
- C R Ward
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA.
| | - K Christiansen
- Boehringer Ingelheim Animal Health USA Ltd., St. Joseph, MO
| | - J Li
- Boehringer Ingelheim Animal Health USA Ltd., St. Joseph, MO
| | - W L Bryson
- Boehringer Ingelheim Animal Health USA Ltd., St. Joseph, MO
| | - K A Jerrentrup
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
| | - C Kroh
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
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Rankin AJ, KuKanich KS, Schermerhorn T, Bello NM, Huey JA, Fentiman KE, Meekins JM. Evaluation of diabetes mellitus regulation in dogs treated with ophthalmic preparations of prednisolone acetate versus diclofenac sodium. Am J Vet Res 2020; 80:1129-1135. [PMID: 31763946 DOI: 10.2460/ajvr.80.12.1129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and compare regulation of diabetes mellitus (DM) in dogs with cataracts and well-controlled DM that received an ophthalmic preparation of prednisolone acetate versus diclofenac sodium. ANIMALS 22 client-owned dogs with cataracts and well-controlled DM. PROCEDURES A prospective, randomized, double-masked, experimental study was conducted. On days 0 and 32, serum fructosamine concentrations (SFCs), clinical scores, and body weights were determined. Dogs were assigned to receive a topically administered ophthalmic preparation of either prednisolone acetate 1% or diclofenac sodium 0.1% in each eye 4 times daily for 28 days. Data analysis was conducted with generalized linear mixed models. RESULTS Findings indicated no meaningful differences in SFCs, clinical scores, or body weights between the treatment groups on days 0 or 32. Clinical score on day 0 was positively associated with SFC, as indicated by the corresponding rate of change such that each 1 -unit increase in clinical score was associated with an approximately 45.6 ± 9.4 μmol/L increase in SFC. In addition, the least squares mean ± SEM SFC was higher in spayed females (539.20 ± 19.23 μmol/L; n = 12) than in castrated males (458.83 ± 23.70 μmol/L; 8) but did not substantially differ between sexually intact males (446.27 ± 49.72 μmol/L; 2) and spayed females or castrated males regardless of the treatment group assigned. CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated no evidence for any differential effect on DM regulation (assessed on the basis of SFCs, clinical scores, and body weights) in dogs treated topically with an ophthalmic preparation of prednisolone versus an ophthalmic preparation of diclofenac. Additional research investigating plasma concentrations of topically applied ophthalmic glucocorticoid medications is warranted. (Am J Vet Res 2019;80:1129-1135).
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Norris OC, Schermerhorn T. The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs. PLoS One 2019; 14:e0219864. [PMID: 31335875 PMCID: PMC6650031 DOI: 10.1371/journal.pone.0219864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022] Open
Abstract
Serum hypertonicity may develop during diabetes mellitus due to hyperglycemia and other biochemical changes. Hypertonicity may produce detrimental cellular and systemic effects and has been identified as a serum marker for some clinical disorders. In non-diabetic dogs, the mean cell volume difference, a novel erythrocyte measure, is increased by serum hypertonicity. However, it is not known whether hyperglycemic hypertonicity produces a similar change. The hypothesis that the mean cell volume difference could detect serum hypertonicity in diabetes was investigated in a group of thirty-two dogs with naturally-occurring diabetes mellitus that were prospectively recruited over a 1-year period from the outpatient population of a veterinary teaching hospital. The effect of hyperglycemia on the mean cell volume difference and the ability of the mean cell volume difference to predict serum hypertonicity were examined. Serum hyperosmolality and hypertonicity due to hyperglycemia was present in 91% and 94% of dogs, respectively. Hyperglycemia was the principal cause identified for serum hypertonicity and hyperosmolality. Using a cut-off value of ≥ 3 μm3 for the mean cell volume difference, serum hypertonicity ≥ 320 mmol/kg was identified with 79% sensitivity and 61% specificity. The dMCV correlated with changes in serum glucose, tonicity, and measured osmolality. Dogs with a mean cell volume difference ≥ 3 μm3 were at risk for serum tonicity ≥ 320 mmol/kg (risk ratio = 2.2) and serum glucose ≥ 13.9 mmol/L (risk ratio = 2.3). In conclusion, the mean cell volume difference is a useful surrogate marker for detecting serum hypertonicity in diabetic dogs and elevated mean cell volume difference is associated with increased risks for clinically relevant serum hypertonicity and hyperglycemia.
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Affiliation(s)
- Olga C. Norris
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, United States of America
| | - Thomas Schermerhorn
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, United States of America
- * E-mail:
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Cartwright JA, Cobb M, Dunning MD. Pilot study evaluating the monitoring of canine diabetes mellitus in primary care practice. Vet Rec Open 2019; 6:e000250. [PMID: 31205722 PMCID: PMC6541103 DOI: 10.1136/vetreco-2017-000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/24/2018] [Accepted: 01/11/2019] [Indexed: 01/28/2023] Open
Abstract
Objectives This study aimed to describe how canine diabetes mellitus (CDM) is monitored in primary care practice (PCP) and to report outcomes. Design Retrospective case review. Setting PCP. Participants 40 dogs of 22 different pedigrees and five crossbreeds. Median age at diagnosis was nine years and six months (eight years six months to 10 years five months). Dogs were diagnosed with CDM between January 1, 2008 and December 30, 2012 and remained with the practice to the study end or until death. Primary and secondary outcome measures Stability achievement and death or euthanasia. Consultations for each dog were identified and recorded through records collected from the PCP (January 1, 2008 to December 30, 2012). Results A median of three consultations per dog occurred in the first month, subsequently falling to a median of one consultation every 19 days thereafter. After the first month postdiagnosis, weight and single blood glucose concentrations were most frequently recorded at 66.8 and 42 per cent of consultations respectively and a blood glucose curve was performed infrequently (17.4 per cent). Serum biochemistry was measured at 8 per cent of consultations and urine culture at only 0.8 per cent. Median survival time (MST) for all dogs was eight months (2–21 months). Eighteen dogs stabilised within three months of diagnosis and their MST was 20.5 months, (10.25–25.75 months), significantly longer than the 22 dogs not achieving stability within three months (MST 2.5 months, 0–5.5 months) (P<0.001). Those dogs not surviving beyond the first month had significantly fewer consultations than those still alive (P<0.005). Conclusions This pilot study indicates dogs with CDM managed solely in PCP experience limited monitoring tests and have lower MST than reported in the literature. Recruitment of a larger cohort of CDM cases from a larger number of PCP will help determine whether these results accurately represent this demographic and verify if infrequent testing is associated with a poor outcome. Importantly, prospective evaluation of decision-making around monitoring CDM in PCP is required, to help determine the effectiveness and feasibility of more frequent monitoring strategies, such as those recommended by the American Animal Hospital Association, particularly to influence MST.
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Affiliation(s)
| | - Malcolm Cobb
- School of Veterinary Medicine, University of Nottingham, Loughborough, UK
| | - Mark D Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
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Miller EJ, Brines CM. Canine Diabetes Mellitus Associated Ocular Disease. Top Companion Anim Med 2018; 33:29-34. [PMID: 29793726 DOI: 10.1053/j.tcam.2018.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/11/2018] [Accepted: 03/11/2018] [Indexed: 12/16/2022]
Abstract
Diabetes mellitus (DM) is a commonly encountered disease in companion animal veterinary practice. Ocular complications in dogs with DM are thought to be common but there are no reports of the overall incidence of DM-associated ocular disease. Some complications, such as cataracts and ocular surface disease, can lead to vision loss and significant morbidity among DM patients, therefore early recognition and intervention are essential for successful outcomes. The purpose of this article is to provide a review of several currently known or suspected ocular diseases associated with DM.
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Affiliation(s)
- Eric J Miller
- Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
| | - Courtenay M Brines
- Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats*. J Am Anim Hosp Assoc 2018; 54:1-21. [DOI: 10.5326/jaaha-ms-6822] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
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.
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Affiliation(s)
- Ellen Behrend
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Amy Holford
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Patty Lathan
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Renee Rucinsky
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
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Abstract
A dog with diabetes mellitus was treated for multiple dental fractures and refractory hyperglycemia. Five teeth were found to have endodontic infections. Three extractions and two root canal procedures were performed to resolve these infections, resulting in improved regulation of blood glucose levels. Treatment planning included special considerations in management of diabetes in the anesthetic and perioperative periods.
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Affiliation(s)
- Eric Van Nice
- Advanced Veterinary Specialty Group, Tustin, CA 92780, USA.
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Gemensky-Metzler AJ, Sheahan JE, Rajala-Schultz PJ, Wilkie DA, Harrington J. Retrospective study of the prevalence of keratoconjunctivitis sicca in diabetic and nondiabetic dogs after phacoemulsification. Vet Ophthalmol 2014; 18:472-80. [DOI: 10.1111/vop.12238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Anne J. Gemensky-Metzler
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | | | - Paivi J. Rajala-Schultz
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | - David A. Wilkie
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | - Jay Harrington
- Veterinary Emergency and Referral Group; 318 Warren St. Brooklyn NY 27320 USA
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Kumar P, Kumari RR, Kumar M, Kumar S, Chakrabarti A. Current practices and research updates on diabetes mellitus in canine. Vet World 2014. [DOI: 10.14202/vetworld.2014.952-959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hess RS, Drobatz KJ. Glargine insulin for treatment of naturally occurring diabetes mellitus in dogs. J Am Vet Med Assoc 2014; 243:1154-61. [PMID: 24094263 DOI: 10.2460/javma.243.8.1154] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of twice-daily glargine insulin administration in dogs with diabetes mellitus. DESIGN Open-label, prospective clinical trial. ANIMALS 10 dogs with naturally occurring diabetes mellitus. PROCEDURES Dogs with poorly regulated or newly diagnosed diabetes mellitus were enrolled if their owners agreed to return them to the hospital at 1- to 3-week intervals for 4 follow-up visits. During each follow-up visit, blood glucose concentrations were measured every 2 hours for at least 10 hours after feeding a diet high in insoluble fiber and after administration of glargine insulin (time 0). The initial glargine insulin dosage was 0.5 U/kg (0.23 U/lb) SC twice daily. RESULTS All dogs had well-regulated diabetes mellitus at a mean ± SD of 38 ± 14 days (median, 43 days; range, 7 to 55 days) following study enrollment. At the time diabetes mellitus was well regulated, mean glargine insulin dosage was 0.5 ± 0.15 U/kg (0.23 ± 0.068 U/lb; median, 0.5 U/kg; range, 0.32 to 0.67 U/kg [0.15 to 0.30 U/lb]) twice daily, and 3 dogs were receiving a dosage < 0.4 U/kg (0.18 U/lb). In dogs with well-regulated diabetes mellitus, the mean minimum blood glucose concentration (163 ± 89 mg/dL; 95% confidence interval, 100 to 227 mg/dL) was detected 2 hours after administration of glargine insulin and the mean maximum blood glucose concentration (230 ± 95 mg/dL; 95% confidence interval, 64 to 323 mg/dL) was detected 12 hours after administration of glargine insulin. There was no significant difference between mean minimum and mean maximum blood glucose concentrations nor were there significant differences between blood glucose concentrations measured at other time points. Blood glucose concentration < 80 mg/dL was measured at least once in 7 of 10 dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study suggested that, in diabetic dogs fed a diet high in insoluble fiber, glargine insulin is a peakless insulin that does not induce a distinct blood glucose concentration nadir. For glargine insulin, 0.3 U/kg (0.136 U/lb) SC twice daily is recommended as an initial dosage.
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Affiliation(s)
- Rebecka S Hess
- Department of Clinical Studies-Philadelphia, Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Herring IP, Panciera DL, Werre SR. Longitudinal prevalence of hypertension, proteinuria, and retinopathy in dogs with spontaneous diabetes mellitus. J Vet Intern Med 2014; 28:488-95. [PMID: 24417733 PMCID: PMC4858021 DOI: 10.1111/jvim.12286] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/24/2013] [Accepted: 11/21/2013] [Indexed: 12/01/2022] Open
Abstract
Background The prevalence and progression of vascular complications of spontaneous diabetes mellitus (DM) in dogs have not been described. Objectives To investigate the effects of duration of disease, as estimated by time since DM diagnosis, and glycemic control on prevalence of systemic hypertension, proteinuria, and diabetic retinopathy in dogs with spontaneous DM. Animals Seventeen client‐owned dogs with spontaneous DM. Methods Prospective, longitudinal observational study. Dogs with DM of less than 1 year's duration were recruited and evaluated once every 6 months for 24 months. Recorded measures included indirect BP, urine albumin, protein and creatinine concentrations, serial blood glucose and serum fructosamine concentrations, ophthalmic examination, and a standardized behavioral questionnaire. Results Eleven dogs completed the 2‐year follow‐up period, during which the highest recorded prevalence of systolic and diastolic hypertension was 55 and 64%, respectively. Prevalence of microalbuminuria and elevated urine protein:creatinine ratio (UPC) ranged up to 73 and 55%, respectively. Prevalence of retinopathy ranged up to 20%. No significant effect of time since DM diagnosis or glycemic control was detected for any of the measures examined. Additionally, no significant associations between BP, urine albumin concentration, UPC and retinopathy were detected. Conclusions and Clinical Relevance With the exception of proteinuria, which was substantial in some cases, clinically deleterious diabetic vascular complications were not identified in dogs in this study.
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Affiliation(s)
- I P Herring
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
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Borin-Crivellenti S, Crivellenti LZ, Tinucci-Costa M. The carpal pad as an alternative sampling site for blood glucose testing in dogs. J Small Anim Pract 2012; 53:684-6. [DOI: 10.1111/j.1748-5827.2012.01299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Borin-Crivellenti
- Clinics and Surgery of Small Animals, Via de Acesso Professor Paulo Donato Castellani; Universidade Estadual Paulista (UNESP); s/n CEP 14884-900; Jaboticabal; São Paulo; Brazil
| | - L. Z. Crivellenti
- Clinics and Surgery of Small Animals, Via de Acesso Professor Paulo Donato Castellani; Universidade Estadual Paulista (UNESP); s/n CEP 14884-900; Jaboticabal; São Paulo; Brazil
| | - M. Tinucci-Costa
- Clinics and Surgery of Small Animals, Via de Acesso Professor Paulo Donato Castellani; Universidade Estadual Paulista (UNESP); s/n CEP 14884-900; Jaboticabal; São Paulo; Brazil
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Rucinsky R, Cook A, Haley S, Nelson R, Zoran DL, Poundstone M. AAHA diabetes management guidelines. J Am Anim Hosp Assoc 2010; 46:215-24. [PMID: 20439947 DOI: 10.5326/0460215] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Palm CA, Boston RC, Refsal KR, Hess RS. An investigation of the action of Neutral Protamine Hagedorn human analogue insulin in dogs with naturally occurring diabetes mellitus. J Vet Intern Med 2009; 23:50-5. [PMID: 19175720 DOI: 10.1111/j.1939-1676.2008.0249.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Neutral Protamine Hagedorn human analogue insulin (Humulin N) is commonly used for treatment of canine diabetes mellitus (DM). However, blood glucose and serum insulin concentrations in Humulin N-treated dogs with naturally occurring DM have not been reported. OBJECTIVE To investigate blood glucose and serum insulin concentrations in the clinical setting of client-owned Humulin N-treated dogs with naturally occurring, well-regulated DM. ANIMALS Ten client-owned dogs with naturally occurring, well-regulated DM. METHODS In this clinical study, blood glucose and serum insulin concentrations were measured when dogs received food and insulin (T(0)), at approximately every half hour for the next 2 hours, and then approximately every 2 hours for an additional 8 hours. Insulin duration of action was defined as the number of hours from T(0) to the lowest blood glucose concentration and until blood glucose concentration returned to an interpolated value of 70% of basal blood glucose concentration (Glucose(b)). RESULTS Mean percent of insulin-induced blood glucose suppression was 49.9 +/- 17.1% (median, 46%; range, 29-78%). Insulin duration of action ranged from 4 to 10 hours. Blood glucose concentration increased initially and returned to Glucose(b) within 0.6-2.2 hours after T(0) in 5 dogs. This initial blood glucose surge then was followed by blood glucose suppression in all 5 dogs. CONCLUSIONS AND CLINICAL IMPORTANCE These results suggest that Humulin N administered SC twice daily is an effective mode of treatment for dogs with naturally occurring DM. Postprandial hyperglycemia is present in some well-regulated diabetic dogs treated with Humulin N.
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Affiliation(s)
- C A Palm
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
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Bluwol K, Duarte R, Lustoza M, Simões D, Kogika M. Avaliação de dois sensores portáteis para mensuração da glicemia em cães. ARQ BRAS MED VET ZOO 2007. [DOI: 10.1590/s0102-09352007000600009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliou-se a precisão analítica e clínica de dois sensores portáteis para mensuração da glicemia em cães. Os valores da mensuração da glicemia obtidos com os sensores foram comparados com aqueles obtidos pelo método padrão da glicose oxidase, por meio da análise de correlação e da análise da grade de erros. Os resultados gerados pelos sensores não foram diferentes do método padrão. Conclui-se que ambos os sensores são adequados para mensuração da glicemia em cães.
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Behrend EN. Update on Drugs Used to Treat Endocrine Diseases in Small Animals. Vet Clin North Am Small Anim Pract 2006; 36:1087-105, vii. [PMID: 16984828 DOI: 10.1016/j.cvsm.2006.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug therapy for the endocrine system is implemented to replace a hormone deficiency or to prevent or reduce the formation or effects of excess hormone. Treatment of endocrine disorders covers diseases of the pituitary, adrenal, parathyroid, and thyroid glands as well as the endocrine pancreas. This article focuses on new therapies currently available for specific diseases. Administration of trilostane for treatment of hyperadrenocorticism and use of insulin glargine, protamine zinc insulin (PZI), and porcine Lente insulin for diabetes mellitus are discussed. In addition, transdermal methimazole therapy for treatment of feline hyperthyroidism and administration of progestins for pituitary dwarfism are considered.
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Affiliation(s)
- Ellen N Behrend
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
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Abstract
OBJECTIVES To compare Schirmer tear test (STT) values, corneal sensitivity, tear film break up times (TFBUTs), and tear glucose concentrations in relation to conjunctival microflora, and conjunctival cytologic and histologic findings among diabetic cataractous, nondiabetic cataractous, and nondiabetic noncataractous dogs. Procedures Fifteen dogs in each category underwent neuro-ophthalmic examination; aerobic, anaerobic and fungal conjunctival cultures; assessment of corneal touch threshold (CTT), STT, tear glucose, TFBUT; and conjunctival cytology and histology (in certain cases only). Degree of cataract and uveitis were critically graded. Glycemic control was estimated using serum fructosamine and glycosylated hemoglobin. RESULTS STT values were significantly lower in diabetic cataractous than nondiabetic noncataractous dogs. CTT of diabetic cataractous dogs was significantly lower than that of nondiabetic noncataractous dogs. Mean TFBUTs were significantly less in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Tear glucose concentrations were significantly higher in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Conjunctival microbial isolates did not differ among groups. There were no significant differences in degree of cataract or uveitis between diabetic cataractous and nondiabetic cataractous groups. There was mild submucosal inflammatory infiltrate in conjunctival specimens from diabetic dogs. Conjunctival epithelial dysplasia and/or squamous metaplasia was/were detected in conjunctival biopsies of 5/7 diabetic dogs. Reductions in conjunctival goblet cell (GC) densities were noted in 4/7 diabetic dogs; there were no significant differences in mean GC densities among the three groups. CONCLUSIONS Diabetic cataractous dogs have significantly altered keratoconjunctival characteristics compared to nondiabetic cataractous and nondiabetic noncataractous dogs.
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Affiliation(s)
- Cheryl L Cullen
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3.
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Monroe WE, Laxton D, Fallin EA, Richter KP, Santen DR, Panciera DL, Towell TL, Williams KA, Hart JR, Hill S, Finkler MR, Shinn JS. Efficacy and Safety of a Purified Porcine Insulin Zinc Suspension for Managing Diabetes Mellitus in Dogs. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02745.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ristic JME, Herrtage ME, Walti-Lauger SMM, Slater LA, Church DB, Davison LJ, Catchpole B. Evaluation of a continuous glucose monitoring system in cats with diabetes mellitus. J Feline Med Surg 2005; 7:153-62. [PMID: 15922222 DOI: 10.1016/j.jfms.2004.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 07/30/2004] [Indexed: 11/17/2022]
Abstract
A continuous glucose monitoring system (CGMS) was evaluated in 14 cats with naturally occurring diabetes mellitus. The device measures interstitial fluid glucose continuously, by means of a sensor placed in the subcutaneous tissue. All cats tolerated the device well and a trace was obtained on 15/16 occasions. There was good correlation between the CGMS values and blood glucose concentration measured using a glucometer (r=0.932, P<0.01). Limitations to the use of the CGMS are its working glucose range of 2.2-22.2 mmol/l (40-400 mg/dl) and the need for calibration with a blood glucose measurement at least every 12 h. When compared to a traditional blood glucose curve, the CGMS is minimally invasive, reduces the number of venepunctures necessary to assess the kinetics of insulin therapy in a patient and provides a truly continuous glucose curve.
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Landry MP, Herring IP, Panciera DL. Funduscopic findings following cataract extraction by means of phacoemulsification in diabetic dogs: 52 cases (1993-2003). J Am Vet Med Assoc 2004; 225:709-16. [PMID: 15457664 DOI: 10.2460/javma.2004.225.709] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine prevalence of retinal hemorrhages and microaneurysms in dogs with diabetes mellitus following cataract extraction by means of phacoemulsification and identify potential risk factors. DESIGN Retrospective study. PROCEDURE Medical records of dogs undergoing phacoemulsification between 1993 and 2003 were reviewed, and information was recorded on signalment, history, physical examination findings, ophthalmic examination findings, results of laboratory testing, electroretinographic findings, and surgical findings. Glycemic control was classified as poor, intermediate, or good on the basis of baseline blood glucose concentration, perioperative body weight loss, daily insulin dosage, and presence of glucosuria and ketonuria. Data from diabetic and nondiabetic dogs were analyzed to determine prevalence and risk factors for development of retinal hemorrhages or microaneurysms following phacoemulsification. RESULTS 11 of the 52 (21%) dogs with diabetes mellitus developed ophthalmoscopic signs of retinal hemorrhages or microaneurysms, compared with 1 of the 174 (0.6%) nondiabetic dogs. Median time from onset of diabetes mellitus to diagnosis of retinopathy was 1.4 years (range, 0.5 to 3.2 years). No risk factors for development of retinopathy were identified. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that retinal hemorrhages and microaneurysms may be more common and develop earlier in diabetic dogs than previously reported. This may affect treatment, as diabetic dogs survive longer with improved glycemic control.
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Affiliation(s)
- Matthew P Landry
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061-0442, USA
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Fleeman LM, Rand JS. Evaluation of day-to-day variability of serial blood glucose concentration curves in diabetic dogs. J Am Vet Med Assoc 2003; 222:317-21. [PMID: 12564593 DOI: 10.2460/javma.2003.222.317] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate day-to-day variability of serial blood glucose concentration curves in dogs with diabetes mellitus. DESIGN Prospective clinical study. ANIMALS 10 dogs with diabetes mellitus. PROCEDURE Paired 12-hour serial blood glucose concentration curves performed during 2 consecutive days were obtained on 3 occasions from each dog. Dogs received the same dose of insulin and meal every 12 hours on both days. For each pair of curves, comparison was made between the results of days 1 and 2. RESULTS Mean absolute difference (without regard to sign) between days 1 and 2 for each parameter was significantly > 0, disproving the hypothesis that there is minimal day-to-day variability of serial blood glucose concentration curves when insulin dose and meals are kept constant. Coefficient of variation of the absolute difference between days 1 and 2 for each parameter ranged from 68 to 103%. Evaluation of the paired curves led to an opposite recommendation for adjustment of the insulin dose on day 2, compared with day 1, on 27% of occasions. Disparity between dosage recommendations was more pronounced when glucose concentration nadir was < 180 mg/dL (10 mmol/L) on 1 or both days. In this subset of 20 paired curves, an opposite recommendation for dosage adjustment was made on 40% of occasions. CONCLUSIONS AND CLINICAL RELEVANCE There is large day-to-day variation in parameters of serial blood glucose concentration curves in diabetic dogs. Day-to-day variability of serial blood glucose concentration curves has important clinical implications, particularly in dogs with good glycemic control.
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Affiliation(s)
- Linda M Fleeman
- Department of Companion Animal Sciences, School of Veterinary Science, The University of Queensland, St Lucia, QLD 4072, Australia
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Good KL, Maggs DJ, Hollingsworth SR, Scagliotti RH, Nelson RW. Corneal sensitivity in dogs with diabetes mellitus. Am J Vet Res 2003; 64:7-11. [PMID: 12518871 DOI: 10.2460/ajvr.2003.64.7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare aesthesiometer-determined corneal sensitivity between diabetic and nondiabetic dogs and to investigate the correlation between corneal sensitivity and duration of diabetes or status of glycemic control, as estimated by use of glycated blood protein concentrations. ANIMALS 23 diabetic and 29 nondiabetic normoglycemic dogs. PROCEDURE A Cochet-Bonnet aesthesiometer was used to measure corneal touch threshold (CTT) in 5 corneal regions of each dog. At the time of ocular examination, duration of diabetes mellitus was estimated from the history, and blood was drawn for assessment of blood glycosylated hemoglobin and serum fructosamine concentrations. RESULTS Median CTT for central, nasal, dorsal, temporal, and ventral corneal regions in nondiabetic dogs (1.6, 2.3, 2.8, 2.8, and 5.1 g/mm2, respectively) was significantly lower than in diabetic dogs (2.8, 4.0, 5.1, 5.1, and 6.6 g/mm2, respectively). Median regional CTT in diabetic dogs was not significantly correlated with estimated duration of diabetes mellitus or blood glycated protein concentrations. No significant difference was found in regional CTT between eyes of normoglycemic dogs with unilateral cataracts. CONCLUSIONS AND CLINICAL RELEVANCE Diabetic dogs have significantly reduced corneal sensitivity in all regions, compared with nondiabetic normoglycemic dogs. Regional variation in corneal sensitivity is similar in diabetic and normoglycemic dogs. Neither glycemic control nor duration of diabetes, as estimated, is significantly correlated with corneal hyposensitivity. Corneal nerve dysfunction may be associated with recurrent or nonhealing ulcers in diabetic dogs for which no other underlying cause can be found.
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Affiliation(s)
- Kathryn L Good
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Abstract
An insulinoma was diagnosed in an eight-year-old, male golden retriever. Four fasted serum glucose concentrations were within the reference values over a seven-week period. Two serum fructosamine values over the same seven-week period were both low. An exploratory laparotomy and histopathology of an excised pancreatic nodule confirmed the diagnosis of insulinoma. This report demonstrates that a dog with a histologically confirmed insulinoma can have normal fasting serum glucose concentrations on multiple assays. It also demonstrates that fructosamine assays may be helpful in the diagnostic evaluation of normoglycaemic dogs with clinical signs suggestive of insulinoma.
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Affiliation(s)
- R J Mellanby
- Queen's Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 OES
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Duarte R, Simoes DM, Franchini ML, Marquezi ML, Ikesaki JH, Kogika MM. Accuracy of Serum β-Hydroxybutyrate Measurements for the Diagnosis of Diabetic Ketoacidosis in 116 Dogs. J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb01258.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Webb CB. Troubleshooting the diabetic small animal patient. CLINICAL TECHNIQUES IN SMALL ANIMAL PRACTICE 2002; 17:79-85. [PMID: 12219721 DOI: 10.1053/svms.2002.33037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Effective troubleshooting for a diabetic small animal patient starts with the initial diagnosis of diabetes. Preempting trouble with a thorough and complete history, physical examination, laboratory assessment, and extensive and thoughtful client education before discharge, are crucial first steps toward avoiding trouble altogether. As problems arise, careful consideration of the many variables that contribute to effective diabetic control is necessary. As monitoring strategies evolve and treatment options expand, the clinician's ability to accurately assess and adjust the glycemic control in his or her troubled diabetic patient improves. Common causes of trouble in diabetic patients are reviewed and various strategies for the diagnosis and management of these disorders are discussed in this article. Every effort was made to draw from recently published reports of clinical cases. Few diseases will tie together owner, patient, and therapy as intimately as diabetes mellitus, and few problems will be solved without fully considering all potential factors.
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Affiliation(s)
- Craig B Webb
- Colorado State University, Veterinary Teaching Hospital, 300 West Drake Rd, Ft. Collins, CO 80523, USA
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Abstract
The majority of diabetic dogs appear to have a form of type 1 diabetes analogous to the latent autoimmune diabetes of adults (LADA) in humans. Evidence of acute or chronic pancreatitis occurs in about 40% of diabetic dogs. Blindness caused by cataract formation eventually occurs in the majority of diabetic dogs and is not dependent on glycemic control. Insulin is the mainstay of therapy for diabetic dogs, and a conservative approach to insulin therapy is crucial. Most diabetic dogs require twice-daily dosing with lente or NPH insulin to adequately control their clinical signs. The diet fed should primarily be palatable and nutritionally balanced. Improved glycemic control may be achieved in some dogs if the diet contains increased insoluble fiber.
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Affiliation(s)
- L M Fleeman
- Department of Companion Animal Sciences, Companion Animal Centre for Diabetes and Obesity, University of Queensland, St Lucia, Australia
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