Abstract
Objectives The objective was to evaluate a nadir-led protocol for transitioning porcine lente insulin suspension (PLIS)-treated diabetic cats onto human recombinant protamine zinc insulin (PZIR). Methods Recently diagnosed (<5 months) diabetic cats, treated with PLIS q12h for ⩾6 weeks, were recruited. Fructosamine, 24 h blood glucose curve (BGC), quality of life assessment (DIAQoL-pet score) and Diabetic Clinical Score (DCS) were assessed at enrolment (PLIS-treated) and 2, 4 and 12 weeks after transitioning to PZIR (starting dose 0.2-0.7 U/kg q12h). Short duration of insulin action was defined as <9 h. Linear mixed effects modelling assessed for change in fructosamine, mean blood glucose (MBG) during BGCs, DIAQoL-pet score, DCS and q12h insulin dose. McNemar's tests compared the proportion of cats with hypoglycaemia at week 0 (PLIS-treated) and week 4 (PZIR-treated). Results Twenty-two cats were recruited. Median PLIS dose at enrolment was 0.5 U/kg (interquartile range 0.3-0.7 U/kg) q12h, equalling median PZIR starting dose (0.5 U/kg; interquartile range 0.3-0.7 U/kg q12h). Transitioning was followed by significant decreases in fructosamine ( P = 0.00007), insulin dose ( P = 0.02), DCS ( P = 8.1 × 10-8) and DIAQoL-pet score ( P = 0.003), indicating improved quality of life. MBG did not alter significantly ( P = 0.1). Five cats (22.7%) achieved remission. Hypoglycaemia was recorded in 30/190 12 h BGCs (15.8%) and five cats experienced clinical hypoglycaemia. The proportion of cats with hypoglycaemia did not differ between PLIS (week 0) and PZIR (week 4) ( P = 1.0). Duration of action was analysed in 19 cats. Six cats (31.6%) showed short duration of action on PLIS, compared with two cats (10.5%) after 4 weeks on PZIR. All six cats with short PLIS duration showed duration of ⩾9 h on PZIR. Conclusions and relevance Used alongside a low-carbohydrate diet, transitioning to PZIR was associated with significantly improved clinical signs and quality of life, with some cats achieving remission. Transition to PZIR should be considered for cats with short duration of action on PLIS.
Highlights
The major goals in managing feline diabetes mellitus (DM) are to reduce or eliminate diabetic clinical signs while avoiding hypoglycaemia and other complications.[1]
Several different insulin types have been used for feline DM, a number of recent guidelines and a systematic review on diabetic remission recommend the use of long-acting insulin preparations when treating diabetic cats.[3,4,5]
Overall, transitioning to PZIR was associated with an improvement in fructosamine, diabetic clinical signs, and pet and owner quality of life, and a proportion of cats entered diabetic remission after starting PZIR therapy
Summary
The major goals in managing feline diabetes mellitus (DM) are to reduce or eliminate diabetic clinical signs while avoiding hypoglycaemia and other complications.[1]. 2 Subcutaneous insulin q12h and a low-carbohydrate, high-protein diet are the mainstays of treatment.[3,4] several different insulin types have been used for feline DM, a number of recent guidelines and a systematic review on diabetic remission recommend the use of long-acting insulin preparations when treating diabetic cats.[3,4,5] Long-acting insulins include protamine zinc insulin (PZI) and the recombinant human insulin analogues glargine and detemir, and have been associated with a longer duration of action than porcine lente insulin suspension (PLIS),[6] which has an intermediate duration of action This longer duration of action could help eliminate diabetic clinical signs, and could increase a cat’s chance of diabetic remission because early, effective glycaemic control might reduce the deleterious effects of glucotoxicity on pancreatic beta-cells.[5,7,8] until recently, PLIS (Caninsulin®, MSD Animal Health) had been the only veterinary-licensed insulin in the United Kingdom and Europe
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