Canine diabetes mellitus: what is new?

Abstract

Recent developments in genetic research have increased our understanding of the most common form of diabetes affecting pet dogs. This research starts to explain why certain breeds seem more susceptible to developing diabetes; in the long run it could lead to revolutionary screening and prevention strategies. Nevertheless, the genetics do not completely explain the ultimate establishment of the diabetic state, therefore the search continues for other (epigenetic and environmental) factors involved in this process. Clinicians should remain open-minded for the existence of a variety of different types of canine diabetes mellitus. Knowing the aetiology is important, since this will enable development of superior treatment strategies. An entire female diabetic dog usually benefits from prompt neutering, since diabetic remission is possible in a subset of cases and achieving diabetic control will prove easier even if remission is not achieved. Currently, routine treatment of diabetic dogs is based on matching insulin activity, usually provided by twice-daily insulin injections, with post-prandial hyperglycaemia. Being strategic in the timing of injection versus feeding can prove beneficial. Studies with relatively novel drugs such as GLP-1 agonists are currently ongoing and seem promising. In the future, canine diabetes mellitus will probably best be treated through complete pancreatic beta-cell replacement, either by transplantation, regenerative medicine or the use of an artificial pancreas. Gene therapy could play a distinct role and has already been implemented in small trials. Development of a veterinary practice-based diabetes team working closely with dog owners will enable individualisation and optimisation of diabetic pet care whichever shape it takes in the future. Veterinary nurses should play a crucial role in such a team, mirroring the situation in human diabetic care. Where possible, clinic-wide diabetes protocols should be adapted and made flexible, paying particular attention to co-morbidities and their impact on glycaemic control, as well as on the quality of life of the diabetic dog and owner. The use of available quality of life measurement tools should be actively encouraged by any clinic taking individualised diabetic care seriously.