Abstract
Background: The majority of diabetic cats in remission have abnormal glucose tolerance, and approximately one third relapse within 1 year. Greater understanding of the metabolic characteristics of diabetic cats in remission, and predictors of relapse is required to effectively monitor and manage these cats.Objectives: To identify and compare differences in plasma metabolites between diabetic cats in remission and healthy control cats using a metabolomics approach. Secondly, to assess whether identified metabolites are predictors of diabetic relapse.Animals: Twenty cats in diabetic remission for a median of 101 days, and 22 healthy matched control cats.Methods: Cats were admitted to a clinic, and casual blood glucose was recorded. After a 24 h fast, blood glucose concentration was measured, then a blood sample was taken for metabolomic (GCMS and LCMS) analyses. Three hours later, a simplified intravenous glucose tolerance test (1 g glucose/kg) was performed. Cats were monitored for diabetes relapse for at least 9 months (270 days) after baseline testing.Results: Most cats in remission continued to display impaired glucose tolerance. Concentrations of 16 identified metabolites differed (P ≤ 0.05) between remission and control cats: 10 amino acids and stearic acid (all lower in remission cats), and glucose, glycine, xylitol, urea and carnitine (all higher in remission cats). Moderately close correlations were found between these 16 metabolites and variables assessing glycaemic responses (most |r| = 0.31 to 0.69). Five cats in remission relapsed during the study period. No metabolite was identified as a predictor of relapse.Conclusion and clinical importance: This study shows that cats in diabetic remission have abnormal metabolism.
Highlights
Diabetic remission, described previously by our group as maintaining euglycemia for at least two weeks after insulin therapy has ceased, can be achieved in many newly diagnosed feline diabetics, with highest remission rates reported in cats with type 2-like diabetes enrolled in studies with early intervention, intensive long-acting insulin therapy and low carbohydrate diets [1, 2]
Fourteen remission cats had presumed type 2 diabetes, four cats had a history of corticosteroid administration prior to developing clinic signs, one cat had corticosteroid administration coupled with severe pancreatitis on diagnosis and another cat had moderate pancreatitis at diagnosis
Glucose tolerance testing (GTT) was unable to be performed on one cat that had metabolomic testing and it was retained in the study for some analyses
Summary
Diabetic remission, described previously by our group as maintaining euglycemia for at least two weeks after insulin therapy has ceased, can be achieved in many newly diagnosed feline diabetics, with highest remission rates reported in cats with type 2-like diabetes enrolled in studies with early intervention, intensive long-acting insulin therapy and low carbohydrate diets [1, 2]. 25–30% of cats in remission will relapse and require further insulin therapy [1, 3, 4]. The majority (76%) of diabetic cats in remission had impaired glucose tolerance (>5 h to return to ≤6.5 mmol/L), and some (19%) had impaired fasting glucose (≥ 6.6 mmol/L), indicating that these cats did not have normal glucose metabolism or clearance [4]. The majority of diabetic cats in remission have abnormal glucose tolerance, and approximately one third relapse within 1 year. Greater understanding of the metabolic characteristics of diabetic cats in remission, and predictors of relapse is required to effectively monitor and manage these cats
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