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Background Velagliflozin is a sodium‐glucose cotransporter 2 inhibitor licensed for the treatment of diabetes mellitus (DM) in cats, but its use in cats with hypersomatotropism is not described. Hypothesis/Objectives To describe the use of velagliflozin in cats with DM and hypersomatotropism. Animals Eight client‐owned cats with DM and hypersomatotropism treated with velagliflozin. Methods Retrospective multicentric case series. Clinical data, including diabetic clinical score, insulin dose, and continuous glucose monitoring‐derived metrics were compared between the last follow‐up before velagliflozin introduction (T0) and the first (T1) and last (T2) follow‐ups after velagliflozin introduction. Results Diabetic clinical score improved in 6/8 cats after velagliflozin initiation. Median daily insulin dose decreased from 1.9 U/kg (range 0.8–7.1) at T0 to 0.5 U/kg (0–2.3) at T1 (median difference [MD] = −1.2 U/kg; 95% CI: −5.2 to 0.5; p = 0.02). Mean glucose was lower both at T1 (207 mg/dL, 96–326) and T2 (273 mg/dL, 155–350) than at T0 (435 mg/dL, 298–477; MD = −177 mg/dL, 95% CI: −238 to −92, p = 0.008 and MD = −113 mg/dL, 95% CI: −280 to −18, p = 0.03, respectively). Percentage of time in range was higher at T1 (71%, 21–98) and T2 (41%, 14–100) than at T0 (3%, 0–32; MD = 61%, 95% CI: 21 to 80, p = 0.008 and MD = 34%, 95% CI: 2 to 98, p = 0.03, respectively). Velagliflozin allowed for insulin discontinuation in two cats. One cat developed diabetic ketoacidosis on day 143, and one cat had acute kidney injury. Conclusions and Clinical Importance Velagliflozin improved diabetic control in cats with DM and hypersomatotropism, either in combination with insulin or as monotherapy.

Background In purpose‐bred dogs, insulin glargine 300 U/mL (IGla300) has long duration of action, peakless time‐action profile, and low potency, making it suitable for use as a basal insulin. Hypothesis To evaluate IGla300 in client‐owned diabetic dogs monitored using a flash glucose monitoring system (FGMS). Animals Ninety‐five client‐owned diabetic dogs, newly diagnosed or previously treated with other insulin formulations, with or without concurrent diseases. Methods Prospective multi‐institutional study. Clinical signs and standardized assessment of FGMS data, using treatment and monitoring guidelines established a priori, guided dose adjustments and categorization into levels of glycemic control. Results The initial IGla300 dose was 0.5 U/Kg q24h for newly diagnosed dogs and (median dose [range]) 0.8 U/Kg (0.2‐2.5) q24h for all dogs. Glycemic control was classified as good or excellent in 87/95 (92%) dogs. The IGla300 was administered q24h (1.9 U/kg [0.2‐5.2]) and q12h (1.9 U/kg/day [0.6‐5.0]) in 56/95 (59%) and 39/95 (41%) dogs, respectively. Meal‐time bolus injections were added in 5 dogs (0.5 U/kg/injection [0.3‐1.0]). Clinical hypoglycemia occurred in 6/95 (6%) dogs. Dogs without concurrent diseases were more likely to receive IGla300 q24h than dogs with concurrent diseases (72% vs 50%, respectively; P = .04). Conclusions and Clinical Importance Insulin glargine 300 U/mL can be considered a suitable therapeutic option for once‐daily administration in diabetic dogs. Clinicians should be aware of the low potency and wide dose range of IGla300. In some dogs, twice‐daily administration with or without meal‐time bolus injections may be necessary to achieve glycemic control. Monitoring with FGMS is essential for dose titration of IGla300.

Background The advantages of insulin degludec 100 U/mL (IDeg100) in the treatment of diabetes mellitus (DM) include consistent release, predictable glucose‐lowering effect, and minimal day‐to‐day variability. Hypothesis/Objectives To describe the use of IDeg100 in dogs with DM, level of diabetic control and adverse effects. Animals Thirty‐three client‐owned dogs with DM. Methods A prospective, multi‐institutional, uncontrolled study of newly diagnosed or previously insulin‐treated, with or without comorbidities and with or without concurrent medications. Clinical signs and continuous glucose monitoring data were monitored and guided insulin dose adjustments. A per‐protocol analysis was performed. Results The final dose of IDeg100 in dogs was 1.3 U/kg (median, range, 0.4‐2.2) achieved in 14 days (median, range, 3‐32). Seventy‐nine percent (26/33) of the dogs had comorbidities with 42% (11/26) having more than 1 comorbidity. Sixty‐four percent (21/33) of dogs were receiving concurrent medications with 62% (13/21) receiving more than 1 non‐insulin medication. Seventy‐six percent (25/33) were scored as having excellent/very good DM control. From baseline to study exit, dogs showed improvements in both ALIVE DM clinical score (from 3 [0‐8, 96.49% CI (2‐5)] to 1 [0‐7, 96.49% CI (1‐2)]; P = .0007) and average 3‐day interstitial glucose (from 332.8 ± 68.7 mg/dL, 95% CI [308.8‐357.2] to 229.0 ± 56.3 mg/dL [CI 209.0 ‐ 248.9]; P < .0001). Conclusions and Clinical Importance Insulin degludec 100 U/mL is effective for the treatment of dogs with DM. Eighty‐four percent (28/33) of dogs responded to once daily dose of IDeg100 with low frequency of clinical hypoglycemia.

Background Dogs with eunatremic, eukalemic hypoadrenocorticism (EEH) typically show signs of chronic gastrointestinal disease (CGD). Previous glucocorticoid administration (PGA) can give false‐positive results on the ACTH stimulation test (ACTHst). Hypothesis/Objectives To determine the prevalence of EEH in dogs with signs of CGD, and to identify clinical and clinicopathological features for EEH and PGA. Animals One hundred twelve dogs with CGD (101 non‐PGA and 11 PGA), 20 dogs with EEH. Methods Multicenter prospective cohort study. Basal serum cortisol (BSC) concentration was measured in dogs with signs of CGD. When BSC was <2 μg/dL and in PGA dogs, ACTHst plus measurement of endogenous ACTH (eACTH) were performed. Records of dogs with EEH from 2009 to 2021 were reviewed. Results The BSC concentration was <2 μg/dL in 48/101 (47.5%) non‐PGA and in 9/11 (82%) PGA dogs. EEH was diagnosed in 1/112 dog (prevalence 0.9%; 95% CI, 0.1%‐4.8%); the ACTHst provided false‐positive results in 2/11 PGA dogs. PGA dogs showed lower C‐reactive protein‐to‐haptoglobin ratio (median 0.01, range 0.003‐0.08; P = .01), and higher haptoglobin (140, 26‐285 mg/dL; P = .002) than non‐PGA dogs (0.04, 0.007‐1.5; 38.5, 1‐246 mg/dL, respectively). eACTH was higher (P = .03) in EEH (396, 5‐>1250 pg/mL) than in non‐PGA dogs (13.5, 7.3‐46.6 pg/mL). Cortisol‐to‐ACTH ratio was lower (P < .0001 and P = .01, respectively) in EEH (0.002, 0.0002‐0.2) than in non‐PGA (0.1, 0.02‐0.2) and PGA dogs (0.1, 0.02‐0.2). Conclusions and Clinical Importance The prevalence of EEH in dogs with signs of CGD was lower than previously reported. The clinical and clinicopathological features herein identified could increase the index of suspicion for EEH or PGA in dogs with an unclear history of glucocorticoid administration.

Background The FreeStyle Libre (Abbott Laboratories) is a flash glucose monitoring system (FGMS) that measures interstitial glucose concentration (IG). The system is factory‐calibrated, easy to use, inexpensive, and could be useful for monitoring diabetic cats. Objectives To evaluate the analytical and clinical accuracy of the FGMS in cats and establish the lag‐time between IG and blood glucose concentration (BG). Animals Twenty client‐owned diabetic cats and 7 purpose‐bred healthy cats. Methods Prospective study. Blood glucose concentration was measured using a portable glucose meter validated for use in cats that served as a reference method for IG, as measured by FGMS. In diabetic cats, data were collected for sensor wearing time with different methods of application and accuracy across glycemic ranges. Accuracy was determined by fulfillment of ISO15197:2013 criteria. In healthy cats, lag‐time between IG and BG was established after IV administration of exogenous glucose. Results Good agreement between IG and BG was obtained (r = .93). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% of the results in zones A + B of the Parkes consensus error grid analysis. In the immediate 30 minutes after an IV bolus of glucose, when BG was increasing rapidly (approximately 2%/min), IG increased slowly, resulting in a difference of as much as 579 mg/dL, and no positive correlation between BG and IG was found. Conclusions and Clinical Importance The FGMS did not fulfill ISO requirements but is sufficiently accurate for glucose monitoring in cats, while considering the lag between IG and BG during periods of rapid changes in BG.

Background In dogs, duration of hypothalamic‐pituitary‐adrenal (HPA) axis suppression after systemic glucocorticoid treatment is reported to vary from a few days to up to 7 weeks after glucocorticoid discontinuation. These data are derived mainly from experimental studies in healthy dogs and not from animals with spontaneous disease. Hypothesis and Objective To determine the timeline for recovery of the HPA axis in a group of ill dogs treated with intermediate‐acting glucocorticoids (IAGCs). Animals Twenty client‐owned dogs that received IAGC for at least 1 week. Methods Single‐center prospective observational study. An ACTH stimulation test, endogenous ACTH concentration, serum biochemistry profile, and urinalysis were performed at T0 (2‐6 days after IAGC discontinuation) and then every 2 weeks (eg, T1, T2, T3) until HPA axis recovery was documented (post‐ACTH cortisol concentration > 6 μg/dL). Results The median time of HPA axis recovery was 3 days (range, 2‐133 days). Eleven of 20 dogs showed recovery of the HPA axis at T0, 6/20 at T1, and 1 dog each at T2, T5, and T9. Dose and duration of treatment were not correlated with timing of HPA axis recovery. Activities of ALT and ALP were significantly correlated with the post‐ACTH cortisol concentration (rs = −0.34, P = .03; rs = −0.31, P = .05). Endogenous ACTH concentration was significantly correlated with pre (r = 0.72; P < .0001) and post‐ACTH cortisol concentrations (r = 0.35; P = .02). The timing of HPA axis recovery of the dogs undergoing an alternate‐day tapering dose was not different compared to dogs that did not (3.5 vs 3 days, P = .89). Conclusion and Clinical Importance Most dogs experienced HPA axis recovery within a few days after IAGC discontinuation. However, 2/20 dogs required >8 weeks.

Background Basal serum cortisol (BSC) ≥2 μg/dL (>55 nmol/L) has high sensitivity but low specificity for hypoadrenocorticism (HA). Objective To determine whether the urinary corticoid:creatinine ratio (UCCR) can be used to differentiate dogs with HA from healthy dogs and those with diseases mimicking HA (DMHA). Animals Nineteen healthy dogs, 18 dogs with DMHA, and 10 dogs with HA. Methods Retrospective study. The UCCR was determined on urine samples from healthy dogs, dogs with DMHA, and dogs with HA. The diagnostic performance of the UCCR was assessed based on receiver operating characteristics (ROC) curves, calculating the area under the ROC curve. Results The UCCR was significantly lower in dogs with HA (0.65 × 10−6; range, 0.33‐1.22 × 10−6) as compared to healthy dogs (3.38 × 10−6; range, 1.11‐17.32 × 10−6) and those with DMHA (10.28 × 10−6; range, 2.46‐78.65 × 10−6) (P < .0001). There was no overlap between dogs with HA and dogs with DMHA. In contrast, 1 healthy dog had a UCCR value in the range of dogs with HA. The area under the ROC curve was 0.99. A UCCR cut‐off value of <1.4 yielded 100% sensitivity and 97.3% specificity in diagnosing HA. Conclusions and Clinical Importance The UCCR seems to be a valuable and reliable screening test for HA in dogs. The greatest advantage of this test is the need for only a single urine sample.

The flash glucose monitoring system (FGMS) has recently become one of the most common monitoring methods in dogs and cats with diabetes mellitus. The aim of this study was to evaluate the impact of FGMS on the quality of life of diabetic pet owners (DPOs). Fifty DPOs were asked to answer a 30-question survey. More than 80% of DPOs considered FGMS easier to use and less stressful and painful for the animal compared to blood glucose curves (BGCs). Overall, 92% of DPOs reported that their pet had better diabetes control since using FGMS. The most challenging aspects of using the FGMS were ensuring proper sensor fixation during the wearing period (47%), preventing premature detachment (40%), and purchasing the sensor (34%). Moreover, 36% of DPOs reported that the device cost was difficult to afford in the long term. Comparing dogs and cats, a significantly higher number of dogs’ owners found the FGMS to be well-tolerated (79% vs. 40%), less invasive than BGCs (79% vs. 43%), and easier to maintain in situ (76% vs. 43%). In conclusion, FGMS is considered by DPOs to be easy to use and less stressful compared to BGCs, while enabling better glycemic control. Nevertheless, the costs related to its long-term use might be difficult to sustain.

Background The use of adrenocorticotropic hormone stimulation test as method to monitor efficacy of trilostane treatment of hypercortisolism (HC) in dogs has been questioned. Objectives To evaluate and compare 12 methods with which to monitor efficacy of trilostane treatment in dogs with HC. Animals Forty‐five client‐owned dogs with HC treated with trilostane q12h. Methods Prospective cross‐sectional observational study. The dogs were categorized as well‐controlled, undercontrolled, and unwell through a clinical score obtained from an owner questionnaire. The ability to correctly identify trilostane‐treatment control of dogs with HC with the following variables was evaluated: before trilostane serum cortisol (prepill), before‐ACTH serum cortisol, post‐ACTH serum cortisol, plasma endogenous ACTH concentrations, prepill/eACTH ratio, serum haptoglobin (Hp) concentration, serum alanine aminotransferase (ALT), gamma‐glutamyl transferase (γGT) and alkaline phosphatase activity, urine specific gravity, and urinary cortisol : creatinine ratio. Results Ninety‐four re‐evaluations of 44 dogs were included; 5 re‐evaluations of 5 unwell dogs were excluded. Haptoglobin was significantly associated with the clinical score (P < .001) and in the receiver operating characteristic analysis, Hp cutoff of 151 mg/dL correctly identified 90.0% of well‐controlled dogs (specificity) and 65.6% of undercontrolled dogs (sensitivity). Alanine aminotransferase (P = .01) and γGT (P = .009) were significantly higher in undercontrolled dogs. Cutoff of ALT and γGT greater than or equal to 86 U/L and 5.8 U/L, respectively, were significantly associated with poor control of HC by trilostane. Conclusions and Clinical Importance Of all the 12 variables, Hp, and to a lesser degree ALT and γGT, could be considered additional tools to the clinical picture to identify well‐controlled and undercontrolled trilostane‐treated dogs.

The novel Eversense XL continuous glucose monitoring system (Senseonics, Inc., Germantown, Maryland) has recently been developed for monitoring diabetes in humans. The sensor is fully implanted and has a functional life of up to 180 days. The present study describes the use of Eversense XL in three diabetic dogs (DD) with good glycemic control managed by motivated owners. The insertion and use of the device were straightforward and well tolerated by the dogs. During the wearing period, some device-related drawbacks, such as sensor dislocation and daily calibrations, were reported. A good correlation between the glucose values measured by the Eversense XL and those obtained with two commercially available devices, previously validated for use in DD, was found (rs = 0.85 and rs = 0.81, respectively). The life of the sensor was 180 days in two of the DD and provided high satisfaction. This innovative device might be considered a future alternative for home glucose monitoring in DD.