Treatment choices for diabetic cats

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Cats should not small dogs and due to this fact have to be handled accordingly. This assertion is much more true in relation to diabetes, as diabetes presents in a different way in felines than it does in canines, defined Cynthia Ward, VMD, PhD, DACVIM, professor on the University of Georgia College of Veterinary Medicine in Athens.

Dogs typically have sort 1 diabetes mellitus (insulin dependent), whereas cats extra generally have sort 2 diabetes mellitus. Type 2 diabetes happens when the pancreas secretes insulin usually however cell receptors don’t acknowledge it as insulin, so glucose can not activate the cell. This results in an overproduction of insulin that may, time beyond regulation, result in relative insulin failure, hyperglycemia, and leads to sort 2 diabetes mellitus, Ward defined in her 2023 Veterinary Meeting & Expo lecture.¹

“We all recognize how important the owners are in terms of us designing and implementing a treatment strategy. You can evaluate your patient perfectly. You can have the best treatment strategy ever, and the owner can ruin that for you every time by not doing what you say. How many people have had owners that lie to them about what they’ve done? Or they swear they’ve done all these things and they bring the insulin bottle in and it hasn’t even been touched. We all know the owners can sabotage us in terms of treatment, so I like to remind myself how important it is for us to get the owner on board,” Ward mentioned.

With any methodology of diabetes therapy, Ward defined that the target is to manage polyuria and polydipsia, polyphagia, neuropathies, regain vitality and regain muscle mass. Treatment additionally wants to stop emergencies involving ketosis, hypoglycemia, and hyperosmolality.

Traditional therapy choices

First, Ward defined {that a} cat needing therapy needs to be steady, which means their blood glucose is lower than 350 mg/dL and they don’t seem to be ketotic. From there, some preliminary therapy choices embody switching to a low-carbohydrate food regimen, common train, and insulin injections twice a day. “Another big thing is calorie control. We know fat is an inflammatory organ on its own. We want [diabetic cats] to have enough nutrients, but we don’t want them to be overconditioned, because any extra fat they have is going to fight the insulin’s ability to do its job,” Ward mentioned.

“Insulin therapy has become overly complicated because we have all these insulins on the market. It’s so confusing—all the choices you have, all the insulins you can use. And in the United States, [we] are not restricted to not using insulins off-label, [which] opens up the ability for us to use human insulin in our animal patients. And we all know people want to save every dime they can, so if they’re on insulin, the first thing they want to know is [whether] they can use their insulin on their cat,” she mentioned. Ward personally recommends protamine zinc recombinant human insulin (Prozinc; Boehringer Ingelheim) to her purchasers, however she additionally talked about that porcine insulin zinc suspension (Vetsulin; Merck Animal Health) and U-300 insulin glargine (Toujeo; Sanofi-Aventis) had been additionally choices.

New therapy choices

Sodium-glucose cotransporter-2 (SGLT2) inhibitors at the moment are utilized in human drugs to deal with grownup sort 2 diabetes. According to the FDA,2 SGLT2 inhibitors are a category of prescription medicines which are permitted by the company to be used with food regimen and train to decrease blood glucose by inflicting the kidneys to take away sugar from the physique by way of the urine. Medicines within the SGLT2 inhibitor class embody canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These are available as single-ingredient merchandise and together with different medicines, corresponding to metformin, for managing diabetes.

There are a number of recent research^3-6 testing the results of SGLT2 inhibitors in cats. The examine on bexagliflozin in cats⁵ discovered a major discount in insulin requirement and reduce in blood glucose and fructosamine, all with no hypoglycemia.⁶ On December 8, 2022, the FDA permitted the primary oral animal drug to enhance glycemic management in cats with diabetes mellitus not beforehand handled with insulin. Bexagliflozin (Bexacat; Elanco Animal Health Incorporated) can also be the primary SGLT2 inhibitor animal drug permitted by the FDA.⁷ On August 14, 2023, the FDA permitted the primary oral liquid medicine to deal with diabetes in cats; velagliflozin oral answer (Senvelgo; Boehringer Ingelheim) is a once-a-day therapy administered in meals or instantly within the cat’s mouth.⁸

Ward mentioned these new therapy choices have the potential to save lots of quite a lot of cats’ lives, and that different positives embody controlling hyperglycemia and medical indicators and the power to make use of oral medicines with no injections or needles. However, Ward additionally talked about the potential challenges, together with that not each cat might qualify for these therapy choices, as they should have sufficient useful ß cells.

References

1. Ward C. Don’t sugar coat it: therapy choices within the diabetic cat. Presented at: Veterinary Meeting & Expo; January 14-18, 2023; Orlando, FL.
2. Sodium-glucose cotransporter-2 (SGLT2) inhibitors. FDA. August 20, 2018. Accessed August 31, 2023. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors#:~:text=SGLT2%20inhibitors%20are%20a%20class,canagliflozin%2C%20dapagliflozin%2C%20and%20empagliflozin
3. Gal A, Burton SE, Weidgraaf Okay, et al. The impact of the sodium-glucose cotransporter type-2 inhibitor dapagliflozin on glomerular filtration charge in wholesome cats. Domest Anim Endocrinol. 2020;70:106376. doi:10.1016/j.domaniend.2019.07.004
4. Hoenig M, Clark M, Schaeffer DJ, Reiche D. Effects of the sodium-glucose cotransporter 2 (SGLT2) inhibitor velagliflozin, a brand new drug with therapeutic potential to deal with diabetes in cats. J Vet Pharmacol Ther. 2018;41(2):266-273. doi:10.1111/jvp.12467
5. Benedict SL, Mahony OM, McKee TS, Bergman PJ. Evaluation of bexagliflozin in cats with poorly regulated diabetes mellitus. Can J Vet Res. 2022;86(1):52-58. Published correction seems in Can J Vet Res. 2023;87(2):152.
6. Hadd MJ, Bienhoff SE, Little SE, et al. Safety and effectiveness of the sodium-glucose cotransporter inhibitor bexagliflozin in cats newly recognized with diabetes mellitus. J Vet Intern Med. 2023;37(3):915-924. doi:10.1111/jvim.16730
7. First oral diabetes therapy for cats receives FDA approval. dvm360. December 8, 2022. Accessed August 31, 2023. https://www.dvm360.com/view/first-oral-diabetes-treatment-for-cats-receives-fda-approval
8. McCafferty C. FDA approves first oral liquid medicine to deal with diabetes in cats. dvm360. August 14, 2023. Accessed August 31, 2023.