{"id":1052,"date":"2014-05-01T01:10:56","date_gmt":"2014-05-01T01:10:56","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1052"},"modified":"2022-02-16T16:07:46","modified_gmt":"2022-02-16T16:07:46","slug":"journal-club-focus-on-diabetes-mellitus","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/endocrinology\/journal-club-focus-on-diabetes-mellitus\/","title":{"rendered":"Focus on Diabetes Mellitus"},"content":{"rendered":"

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Diabetes mellitus <\/strong>(DM) is a common endocrinopathy of dogs and cats, and management can be challenging. A great deal of individual variability exists with regard to insulin type and dosing, and there are several potentially life-threatening sequelae of poor management. In this Journal Club column, synopses of several recent publications, with relevant clinical implications regarding management of DM, are presented.<\/p>\n

Glargine insulin is typically used for treatment of feline DM; however, Hess and colleagues <\/strong>explored the use of glargine in diabetic dogs<\/strong>. Patients that received 0.5 U\/kg Q 12 H achieved clinically significant diabetic regulation by 38 \u00b1 14 days, and exhibited relatively flat blood glucose concentrations during curves. The major adverse effect was hypoglycemia, sometimes accompanied by seizures. This finding prompts a recommended starting dose\u2014for dogs\u2014of 0.3 U\/kg Q 12 H.<\/p>\n

Glargine was investigated as a treatment for feline diabetic ketoacidosis <\/strong>(DKA) by Marshall and colleagues<\/strong>. In lieu of short-acting insulin, 15 cats experiencing DKA received IM \u00b1 SC glargine at variable intervals through hospitalization. Hypokalemia, hypophosphatemia, and hypoglycemia were common; however, these imbalances were likely attributable to DKA per se. All 15 cats survived to discharge, demonstrating a promising role of glargine in DKA treatment.<\/p>\n

A retrospective analysis by Callegari and colleagues <\/strong>evaluated prognosis and survival times in newly diagnosed diabetic cats<\/strong>. The overall median survival time was 516 days, with 46% of patients living > 24 months. Nearly 34.2% of patients initially presented in DKA, and 32% survived > 36 months. DKA did not correlate significantly with survival time, but patients with elevated creatinine demonstrated a shorter survival time.<\/p>\n

In human DM, vascular complications <\/strong>are common. Herring and colleagues <\/strong>reported significant hypertension (> 180 mm Hg) in 36% of diabetic dogs, but retinopathies were very uncommon. Proteinuria was also present in 36% of affected dogs at the study start. Interestingly, significant progression of complications was not observed over the 2-year study period; however, larger studies are needed given this study\u2019s small sample size.<\/p>\n

\u2014David Bruyette, DVM, Diplomate ACVIM, Medical Director, VCA West Los Angeles Animal Hospital<\/em><\/p>\n

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\n<\/span>\"Screen<\/a>Longitudinal Prevalence of Hypertension, Proteinuria, and Retinopathy in Dogs with Spontaneous Diabetes Mellitus<\/h2>\n

Herring IP, Panciera DL, Werre SR. JVIM<\/em> 2014; 28:488-495.<\/span><\/h3>\n

Vascular complications are common sequelae of DM in humans, and systemic hypertension, proteinuria, and retinopathy have been documented in dogs with spontaneous DM. However, little is known about the prevalence of these conditions, their progression, and their relationship to disease duration and control.<\/p>\n

The aims of this prospective, longitudinal, observational study were to document the prevalence of vascular complications, and determine the impact of DM duration and glycemic control on these complications, in dogs with DM.<\/p>\n

Study Results<\/span><\/h3>\n