Research Updates: Giving glargine insulin to newly diagnosed diabetic cats may increase the likelihood of remission - Veterinary Medicine
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Research Updates: Giving glargine insulin to newly diagnosed diabetic cats may increase the likelihood of remission


VETERINARY MEDICINE


COMMENTARY

The results of this study support the hypothesis that when administered to newly diagnosed diabetic cats, glargine insulin results in a higher rate of short-term diabetic remission than do other insulin types. This study also demonstrated a higher rate of remission with glargine insulin than previously reported.1 Glargine insulin was administered in this study twice daily (vs. once daily as previously reported), which may explain this increased remission success but also allowed the authors to conclude that a dosage of 0.25 to 0.5 IU/kg twice a day is safe and efficient at attaining glycemic control.

Both in vitro and in vivo studies in diabetic cats and people have suggested that patients are unlikely to have lost function of all of their pancreatic beta cells at the time of first diagnosis of disease. Early and aggressive glycemic control may protect the remaining functional cells from continued glucotoxicity, may allow partial recovery from the unidentified insult that first resulted in diabetes mellitus, and may eventually allow reversion to a noninsulin-dependent (diabetic remission) state.

If this theory is true, however, any insulin regimen that results in strict glycemic regulation should produce the same results. The theoretical advantage of glargine insulin vs. other insulins commonly used in cats is its more consistent duration of action without producing a sharp nadir, thus allowing tighter control of serum glucose concentration and a minimal risk of clinically relevant hypoglycemia. Concurrent feeding of a diabetes-appropriate diet (low-carbohydrate content) prevents larger fluctuations in blood glucose concentration throughout the day and may further prevent glucotoxicity by minimizing beta cell burnout at times of higher insulin requirement.

Possible biases of this study include the nonrandomized allocation of cats into three treatment groups, the unintentional allocation of initially ketoacidotic patients into the nonglargine insulin groups, a relatively short monitoring period (112 days), and a less stringent definition of achieving remission than in other studies (two weeks without insulin vs. four weeks). Although cats that first present with diabetic ketoacidosis may also achieve diabetic remission, their rate of relapse (requiring insulin therapy again) may be greater than that of cats with uncomplicated diabetes.2

Longer follow-up is required before any statement can be made about the success rate of any insulin at producing permanent remission status.

Marshall RD, Rand JS, Morton JM. Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins. J Feline Med Surg 2009;11(8):683-691.

The information in "Research Updates" was provided by Erika Meler, DVM, MS, and Barrak Pressler, DVM, PhD, DACVIM, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

REFERENCES

1. Weaver KE, Rozanski EA, Mahony OM, et al. Use of glargine and Lente insulins in cats with diabetes mellitus. J Vet Intern Med 2006;20(2):234-238.

2. Sieber-Ruckstuhl NS, Kley S, Tschuor F, et al. Remission of diabetes mellitus in cats with diabetic ketoacidosis. J Vet Intern Med 2008;22(6):1326-1332.


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Source: VETERINARY MEDICINE,
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