Endocrine- EMS

Question 1

Associations between feeding and glucagon-like peptide-2in healthy ponies

Answer 1

Increase in GLP2 x3-4 after feeding. No apparent effect of light/dark
GLP2 administrations resulted in no signifant effect on metabolic responses to eating (slightly reduced blood glucose). GLP2 unlkely to have direct causal role in increased post prandial insulin in ID ponies. Further work required

Question 2

The effect of pre-dosing with metformin on the insulin response to oral sugar in insulin- dysregulated horses

Answer 2

Does not support the use of targeted metformin treatment to reduce post prandial hyperinsulinaemia in horses with naturally occuring ID. May still be worthwhile in individual (had significant effect in 1 individual), or in acute phases of HAL (AMK mimetic effects could modulate epithelial differentiation in the digit)

Question 3

Factors associated with insulin responses to oral sugars in a mixed breed cohort of ponies

Answer 3

Associated with high risk insulin T60 (>54.2uIu/ml) age, welsh, gelding, BCS, supraorbital fat, exercise.
-Associated with loginsulinT60: age, BCS, adiponectin (inverse), TG, basal insulin (in Spring + bulging supraopbital fat pads, welsh and gelding, in Autumn, turnout, ACTH).
-Season, owner reported and physical features explained 10-27% of the differences in InsulinT60 risk

–>don’t screen based just on phenotype/ owner reported factors
modifiable factors= exercise, particularly in autumn.
These were non-laminitic ponies and just focussed on insulint60

Question 4

Development of a body condition index to estimate adiposity in ponies and horses from morphometric measurements

Answer 4

BCI was well correlated to fat % (slightly worse than BCS), but was less variable than BCS with inexperienced observers. Obesity Se 79.4%, Sp 81.3%. Overconditioned 84%, Sp 87.5%. Not useful in Shetland/ minis as different body shape. Possibly less useful in horses cf ponies. Further work needed.

Question 5

Horse owner experiences and observations with the use of SGLT2i for the management of equine metabolic syndrome and hyperinsulinaemia-associated laminitis

Answer 5

Excessive Urination: 20.5% of owners reported their horses experienced excessive urination after starting SGLT2i treatment.
Excessive Drinking: 11.1% of owners observed their horses drinking excessively.
Excessive Weight Loss: 9.9% of owners reported excessive weight loss in their horses.
Dullness: 7.6% of owners noted a state of dullness in their horses.

Question 6

Use of FreeStyle Libre for continuous glucose monitoring in adult horses

Answer 6

-CGMS are promising for ID diagnostics but need further validation for diagnostic use- could use for CGIT.
-NSD test on post feed measurements
- tended to under estimate at higher concentrations (to do with delay with equilibration of glucose blood to interstitium)
- good agreement, except <25 mins from glucose administration
- unclear for diagnosis of IR- only 1 horse dysregulated
- sensors stayed in place for mean 4.2 days

Question 7

Diagnosis of Equine Endocrinopathies: The Value of Measuring Blood Glucose During an Oral Glucose Test

Answer 7

Post prandial blood glucose in OST in weakly correlated to insulin, but does have some (weak/most) correlations with crest neck score. Is still worth measuring but remember is variable.

Question 8

Effects of alpha-2-adrenoceptor agonism and antagonism on equine blood insulin and glucose concentrations after oral carbohydrate load

Answer 8

Vatinoxan is a peripherally acting alpha2 antagonists.
Alleviates the hyperglycaemic effects of detomidine (and produces hypoglycaemia when used alone) and delays insulin response.
Alpha2s reduce insulin by inhibiting release from pancreatic beta cellls
Vatinoxan also increases NEFAs but not TGs- ? mechanism

Question 9

Preliminary Observations on the Use of Ertugliflozin in Managing Hyperinsulinaemia and Laminitis

Answer 9

-significantly improved hyperinsulinaemia, reduced Obel score and body weight
- 88% hyperinsulinaemic at 30d but no c/s and reduced. No GGT change. Induced glucosuria, sign PU/PD

Question 10

Oral Sugar Test Responses to Ertugliflozin in Ten Horses with Insulin Dysregulation

Answer 10

EMS, SGLT2i, OST

Question 11

Variation in Insulin Response to Oral Sugar Test in a Cohort of Horses throughout the year and evaluation of risk factors for insulin dysregulation.

Answer 11

No seasonable variation in OST or adiponectin. ID status was variable (unpredictably) so repeating OSTs may be justified. Lack of exercise, age and BCS/CNS was a RF

Question 12

A Starch-Rich Treat Affects Enteroinsular Responses in Ponies

Answer 12

Increased GLP2 response to feeding after feeding a starch rich treat (bread) for 10 days and increase in peak Dxylose absorption (intestinotrophic)
Glucose and insulin did not change but most ponies healthy= needs repeating in ID.

Question 13

Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors

Answer 13

• prevalence %
• RF: age, being female, more sedentary main activity, obesity, shorter periods on pasture during the summer, Welsh Sec A

Question 14

Comparison of a modified 2-step insulin response test performed with porcine zinc insulin and an oral glucose test to detect hyperinsulinemic Icelandic horses

Answer 14

IRT did not differ between ID vs non ID Icelanding horses (OST= dx).
-possible breed association- peripheral insulin resistance? Different insulin to that validated (recombinant human)

Question 15

Evaluating Insulin Dysregulation in Horses: Two-Step Insulin-Tolerance Test

Answer 15

Correlated well with recombinant humnan insulin (validated) but -Based on the Youden index, when using the ITT-PZI, an adjusted cut-off value for blood glucose reduction of 40 % at 30 min resulted in better test performance -> 100% Se, 55% Sp. Tests were then perfectly concordant
-icelandic horses and n=4 for ID,

Question 16

Comparison of One Novel and Four Established Diagnostic Tests for ID in Ponies

Answer 16

-oral responses are most sensitive due to contribution from incretins. Better than CGIT in this study
- proposed cereal test based on weetabix was se/sp but poorly palatable
-fasted insulin performed the worst

Question 17

Identifying Possible Thresholds for Nonstructural Carbohydrates in the Insulin Dysregulated Horse

Answer 17

ID horses had signifiamcntly increased response (insulin) to all diets where NSC >0.1g/kg vs NID- above this they had an incrementally increasing AUC for insulin curve.
But small number and demonstrated individualised responses
-The threshold for insulin response to starch was around 0.03–0.06 g/kg BW, while for water-soluble carbohydrates (WSC), it ranged from 0.08–0.11 g/kg BW.-> may have a lower tolerance for starch
-Unclear- long term effect and meal sizes (one feed only here)

Question 18

Insulin but Not Adiponectin Is Detectable in Equine Saliva Using an Automated, Commercial Assay

Answer 18

Insulin Is measurable (Tosoh not Immulite) but does not correlate with serum-> further work on significance/ diagnostic thresholds required.
Adpionectin not measurable in saliva
No measureable stress response recorded to sampling.

Question 19

Relationships between total adiponectin concentrations and obesity in native-breed ponies in England

Answer 19

-Obese ponies (BCS ≥ 7) had higher median TA concentrations compared to ideal-weight (BCS 4–5.5) and overweight ponies, challenging the notion that obesity uniformly reduces adiponectin.
greater prevalence of normal insulin and adiponectin profiles among obese ponies compared to ideal-weight ones
-A greater percentage of obese (54.6%) than ideal-weight ponies (33.1%, p < 0.001) had both normal [TA] and [basal insulin], and a greater percentage of ideal-weight (38.6%) than obese ponies (16.5%, p < 0.001) showed hypoadiponectinaemia.
-Attempts to develop predictive model for hypoadiponectinaemia were unsuccessful (poor models)

—–> adiponectin and insulin should be monitored in all at risk ponies regardless of obesity. Role of intra-abdominal adipose?

Question 20

Short-term induced hyperinsulinaemia and dexamethasone challenge do not affect circulating total adiponectin concentrations in insulin-sensitive ponies

Answer 20

One dose of dexamethasone challenge did not alter circulating [insulin] or [total adiponectin] at any timepoint, but significantly upregulated AdipoR1 and IGF-1R expression at 150 and 180 mi (early phsyiological adaptation to IR?)
-Ex vivo incubation of whole blood with dexamethasone did not alter expression of the genes examined-> effects are systemic, not local.
-There was no change in [total adiponectin] or expression of the genes examined associated with EHC-induced hyperinsulinemia. T-cadherin was undetetctable
-The relationship between insulin and adiponectin appears complex and may involve chronic rather than acute mechanisms, necessitating further research into long-term interactions.

Question 21

Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation

Answer 21

Blood insulin and glucose concentrations modestly increased for 48 h
following IA TA. (18mg) in non ID horses. 8 horses achieved basal insulin >2-. But none >perceived safety limit-> unlikley to directly cause laminitis

Question 22

Postprandial Insulin Responses to Various Feedstuffs Differ in Insulin Dysregulated Horses compared with non-insulin
dysregulated controls

Answer 22

Ration NSC is the main driver for postprandial insulin.
ID horses have an exagerrated insulin response vs NID-> cannot extrapolate thresholds between

Question 23

Predictors of Laminitis Development in a Cohort of Nonlaminitic Ponies

Answer 23

t0 and t60 iunsulin best quantify the risk of future laminitis development in nonlaminitic ponies
-ACTH not asscoiated with laminitis as a sole measure. When measured in autumn and combined with basal insulin, was associated with laminitis.
3x more common in summer than winter but not retained in model
Only modifiable RF was exercise. Morphological was divergent hoof rings

Question 24

Association between insulin dysregulation and adrenocorticotropic hormone in aged horses and ponies with no clinical signs of pituitary pars intermedia dysfunction

Answer 24

Care with ID horses and ACTH measurement in autumn (particularly ponies) as they are significantly positively correlated. ACTH seasonal variation is greater in ID ponies

Question 25

Evaluation of field-testing protocols to diagnose insulin dysregulation in ponies using a Bayesian approach

Answer 25

Only 11% of ponies were positive on all 3 tests
Insulin dysregulation was diagnosed in 15% of ponies using BI, 38% using the OST and 54% using the ITT
The sensitivities and specificities of
-BI: 0.52. 0.97
- OST: 0.84, 0.6
-ITT: 0.85, 0.88

Only BI and OST associated with laminitis (and BCS)

Question 26

Repeatability of the hyperglycaemic clamp for assessment of b-cell response and insulin sensitivity in horses

Answer 26

Is most sensitive for the assessment of beta cell response than insulin sensitivity. Is highly repeatable and reliable.
Measure insulin response to a maintained BG concentration, and calculates the rate of glucose disposal (M= GIR- SC - UC where GIR is the glucose infusion rate (mg/kg/min), SC is the space correction (mg/kg/min) and UC is the rate of urinary glucose loss (mg/kg/min).)

Question 27

Genome-wide association study suggests genetic candidate loci of insulin dysregulation in Finnhorses

Answer 27

Significant SNPs were identified on chromosomes 7, 10, 15, and 17, associated with insulin regulation. The strongest association was observed on chromosome 7.
Candidate genes near these SNPs include ARGLU1, EFNB2, CUL4A, HMGN3, and SIK2, all of which have functions related to insulin secretion, glucose metabolism, and energy regulation.

Higher insulin concentrations were observed in horses carrying risk alleles, supporting the genetic influence on insulin dysregulation.
Horses with higher body condition scores (BCS) and cresty neck scores (CNS) showed a correlation with certain genetic markers, linking physical traits to metabolic risk.

The estimated heritability was calculated using a linear mixed model -> moderate to high (highest estimates for post-prandial insulin levels)

Functional Annotation:
The identified loci were enriched in pathways related to insulin signaling and adipogenesis, aligning with known mechanisms in other species.
No significant associations were found with genes known to influence equine pituitary function, suggesting distinct pathways for insulin regulation in Finnhorses.

Question 28

GLP-1 Response to Six Oral Carbohydrates in Ponies

Answer 28

soaking hay reduces NSC content and consequently attenuates GLP-1 response.
Is strongly positively correlated to insulin, but did not distinguish between ID/IR and not
Higher NSC feeds-> higher response. Very high after OGT
Has biphasic release (30 and 180mins)
Is not stable in sample

Question 29

Blood glucose and insulin concentrations after alpha-2-agonists administration in horses with and without insulin dysregulation

Answer 29

Both xylazine and detomidine caused time dependent hyperglycaemia- NSD ID vs non ID
Both dropped insulin also, but xylazine caused significant rebound hyperinsulinaemia in ID-> caution

Question 30

Effect of long-term overfeeding of a high-energy diet on glucose tolerance in Shetland pony mares

Answer 30

• all overfed ponies moved stiffly-The mean body weight of the high-energy group increased by 27% per highenergy feeding period. Total mean 51% bodyweight increase

-Glucose tolerance initially improved, evidenced by a reduced glucose area under the curve (AUC), likely due to metabolic adaptations facilitating glucose absorption.
-Over time, insulin responses became more pronounced, suggesting worsening insulin dysregulation (ID). AUC for insulin increased. -Mean basal plasma glucose concentration and peak plasma insulin concentrations were higher (P < .05) in the high-energy group than in the control group. The insulin peak was faster in the later tests.

Reversal of Insulin Dysregulation:
-After 17 weeks on a hay-only diet, ponies showed normalization of insulin responses despite maintaining obesity, indicating that diet composition plays a critical role in reversing ID.
-The improvement in insulin regulation highlights the importance of reducing dietary non-structural carbohydrate (NSC) intake, rather than focusing solely on weight reduction.

Rapid Recurrence of ID: -Resuming the HE diet caused a rapid return of hyperinsulinemia, suggesting that ponies remain metabolically predisposed to ID even after dietary intervention.
-Adaptations such as increased glucose absorption via upregulated sodium-glucose cotransporters (SGLT1) and changes in enteroinsular signaling may explain the initial improvement in glucose handling.

Insulin appears to be more significant than hyperglycaemia for laminitis

Question 31

Expression of the GCG gene and secretion of active glucagon-like peptide-1 varies along the length of

Answer 31

Secretion of ~GLP-1 greatest in ileum and colon, but L cells present throughout.
ID-> increased post prandial GLP-1
Differences are not due to a change in GCG sequence (exon only, no epigenetics)

Question 32

Prolonged hyperinsulinemia increases the production of inflammatory cytokines in equine digital lamellae but not in striated muscle

Answer 32

All horses developed Obel Grade 2 laminitis
- Upregulated in laminitic digital lamellae: IL-1β,A2M, HSP90 and fibrinogen α, β isoforms
-protein expression of cytokines and acute phase proteins in heart and skeletal muscle was unchanged following hyperinsulinemia
-IL-1β is a key pro-inflammatory cytokine involved in acute-phase protein synthesis. Blocking IL-1β has been effective in managing inflammation in human diabetes, suggesting potential as a therapeutic target for laminitis.

Question 33

Metabolic changes induced by oral glucose tests in horses and their diagnostic use

Answer 33

Induction of low-grade inflammation during the OGT (The kynurenine ratio increased)
Plasma arginine and carnitine concentrations were lower in horses with high insulin response and could constitute potential therapeutic targets.
A 7 marker metabolomic profile showed promise for distinguising ID vs non ID.
Dihydroxyphenylalanine (DOPA), a precursor of dopamine, increased, which has not been reported in other species. This could indicate a link between glucose metabolism and dopaminergic pathways, particularly in horses with pituitary pars intermedia dysfunction (PPID).

Question 34

Carbohydrate pellets to assess insulin dysregulation in horses

Answer 34

• Was 84% palatable, better in ponies than horses, better in UK than Aus/Switzerland.
  -produced predictable glycaemic responses with thresholds align with previously established cut-offs for similar tests using different carbohydrate sources, making the pellets a comparable alternative.
• insulin responses correlated wtih clinical signs of EMS (e.g., 80% concordance with CNS>3)
  -more validation required, but may be easy alternative.

Question 35

Thromboelastography in obese horses with insulin dysregulation compared to healthy control

Answer 35

Obese, insulin-dysregulated horses are hypercoagulable compared to healthy controls- maximum amplpitude and G value (overall clot strength) increased and predicted metabolic group. Implications for laminitis pathophys and treatment of hypercoagulable EMS patients

Question 36

Short-term effects of canagliflozin on glucose and insulin responses in insulin dysregulated horses: A randomized, placebo-controlled, double-blind, study

Answer 36

-Canagliflozin treatment significantly decreased the postprandial insulin response during the oral sugar test (OST), with an average reduction of over 66% compared to placebo.
-The drug reduced β-cell responsiveness to glucose, as indicated by a 56.8% decrease in the ΔAUCinsulin/ΔAUCglucose ratio, suggesting improved regulation of insulin secretion.
=Canagliflozin reduced both maximal glucose concentrations (Cmax) and the glucose area under the curve (AUC) during the OST, contributing to better glycemic control.
-The drug decreased postprandial glucose levels but had no significant effect on fasting glucose concentrations, consistent with its mechanism as a sodium-glucose cotransporter 2 (SGLT2) inhibitor.
-Similar to velagliflozin, canagliflozin effectively reduced postprandial hyperinsulinemia. However, canagliflozin also resulted in weight loss, which was not observed in velagliflozin-treated horses, possibly due to differences in feeding regimens.
- Also produced hypertriglyceridaemia

The reduction in hyperinsulinemia is attributed to:
-Decreased glycemic response via inhibition of renal glucose reabsorption.
-Improved β-cell responsiveness to glucose, potentially resulting from reduced glucotoxicity and improved insulin sensitivity.

Question 37

Effect of phenylbutazone on insulin secretion in horses withinsulin dysregulation

Answer 37

In horses with ID, phenylbutazone treatment significantly decreased glucose concentration, glucose area under the curve, insulin concentration and insulin area under the curve in response to an OGT. No significant effect was detected in control horses
Mechanism of Action:
-The exact mechanism remains unclear but may involve: Improved insulin sensitivity due to reduced low-grade inflammation, a condition associated with ID in horses. Modulation of incretin secretion, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which influence insulin secretion. Altered prostaglandin E2 (PGE2) dynamics, as phenylbutazone inhibits PGE2 production. PGE2 inhibition may decrease incretin effects or directly influence insulin sensitivity.
CANNOT YET BE APPLIED TO LAMINITIC HORSES- but warrants further examination

Question 38

Strip-grazing: Reduces pony dry matter intakes and changes in bodyweight and morphometrics

Answer 38

-strip grazing effectively reduces DM compared to unrestricted grazing; showed lower cumulative weight gain and more stable body condition scores
-Ponies in the TA group consumed significantly more pasture (2.33% of body weight per day) than those in the SG1 (1.82%) or SG2 (1.59%) groups.
-The TA ponies preferentially grazed the younger, more nutritious sward early in the trial, which likely contributed to their higher weight gains, especially during the first two weeks.

Question 39

Influence of endocrine disease on l-lactate concentrations inblood of ponies

Answer 39

-Blood l-lactate concentrations were significantly lower in obese compared to nonobese ponies ( P = .01). No other significant correlations were detected.
-No differences were detected between ponies with and without increased autumnal ACTH concentrations and with and without ID. (incl ACTH, adiponectin and OST)
- all ponies were clinically healthy so any endocrine abnormalities mild and well compensated. No hyperglycaemia detected

Question 40

The effect of diet-induced obesity and pasture on blood pressure and serum cortisol in Standardbred mares

Answer 40

A linear relationship was observed between ?BCS and SAP/MAP/DAP -Blood pressure increased significantly during the weight gain period and remained elevated during the pasture phase, suggesting obesity-induced hypertension independent of insulin sensitivity.
-Serum cortisol concentrations increased with weight gain and remained elevated during the pasture period. Possibly due to hypothalamic-pituitary-adrenal (HPA) axis dysregulation.
‘-Insulin sensitivity; not affected by weight gain. Insulin sensitivity improved during the pasture phase-unexpectedly low content of NSC in the grass and horses ceased to gain weight -increase in physical activity
-Unlike humans and other animals where insulin resistance plays a central role in obesity-induced hypertension, this study found no link between decreased insulin sensitivity and increased blood pressure in these horses. The increase in blood pressure may instead reflect obesity-related vascular changes, such as endothelial dysfunction or enhanced vasoconstriction.
-Elevated cortisol may contribute to blood pressure changes through: Glucocorticoid-mediated vascular effects, such as increased vascular contractility. Alterations in cardiac output and fluid balance. Inhibition of nitric oxide synthase, which impairs vasodilation.
-The study’s 22-week weight gain period might have been insufficient to induce significant insulin resistance, as observed in other species where prolonged obesity leads to metabolic changes.

Question 41

Changes in metabolic and physiological biomarkers in Mangalarga Marchador horses with induced obesity

Answer 41

Poor study-Horses fed a hypercaloric diet (2x Daily DE) developed significant hypercholesterolemia within 30 days, with increases in LDL, HDL, and total cholesterol (CHOL). These correlated with results of a low dose insulin test. But no control or info on weigh gain or numbers for insulin sensitivity. Unvalidated test

Question 42

Associations of plasma sphingolipid profiles with insulin response during oral glucose testing in Icelandic horses

Answer 42

-Plasma sphingolipid profiles remained unchanged following the acute glucose challenge during OGT.
-Elevated concentrations of certain sphingolipids, particularly ceramides, were strongly correlated with increased insulin response (measured as the area under the insulin curve, AUCins).
-Ceramides are known to impair insulin signaling by dephosphorylating protein kinase B (Akt) and interfering with its intracellular trafficking.
-Increased plasma ceramide concentrations likely indicate an upregulation of sphingolipid metabolism in insulin-dysregulated horses.
-SMs are precursors in the sphingomyelinase pathway, which converts SMs to ceramides under specific physiological stimuli (e.g., cytokine signaling).

Question 43

Evaluation of an HMGA2 variant contribution to heightand basal insulin concentrations in ponies

Answer 43

-The A allele was strongly negatively correlated with height. Genotype accounted for a significant portion of the phenotypic variation in height: 21% in Welsh ponies. 44% in Shetland ponies. A/A ponies were, on average, 10–12 cm shorter than G/G or G/A ponies.
-The A allele was positively correlated with basal insulin levels. Genotype contributed to 7.1% of the total variation in insulin concentrations across breeds, with higher contributions within specific breeds (e.g., Shetland ponies). A/A and G/A individuals had significantly higher basal insulin concentrations compared to G/G individuals.
-Pleiotropic Effects: The HMGA2 variant influences both height (through its impact on skeletal development) and basal insulin levels, suggesting pleiotropic genetic effects. Differences in the inheritance patterns for height (additive) and basal insulin (dominant) were observed, highlighting the complexity of genetic influence on these traits.
-Farm (environmental factors) accounted for the largest variation in insulin concentrations, emphasizing the role of diet, exercise, and management.
-Despite environmental influences, HMGA2’s effect on insulin concentrations remained significant, indicating a genetic predisposition to insulin dysregulation (ID).

Question 44

Palatability, glycemic, and insulinemic responses to various carbohydrate formulations: Alternatives for the diagnosis of insulin dysregulation in horses?

Answer 44

-Palatability and Feasibility: The pelleted glycemic challenge (GC) formulation (DysChEq™) had excellent palatability and was completely consumed by all horses within the 10-minute timeframe, demonstrating its suitability for field use. Liquid GC formulations were less palatable when offered freely but were well accepted when administered via syringe.
-Both GC pellets and GC syrups demonstrated glycemic and insulinemic responses comparable to the nasogastric tube oral glucose test (tube OGT), which served as the reference standard.
-Strong positive correlations between insulin concentrations at 120 minutes for tube OGT and GC pellets (r = 0.717, P < .001) and between tube OGT and GC syrup (r = 0.913, P < .001) were observed.#
-GC pellets elicited higher insulin responses compared to tube OGT in both healthy and ID horses, potentially due to enhanced enteroinsular stimulation from mastication.

Question 45

Insulin Dysregulation in Finnhorses and Phenotypic Obesity Markers

Answer 45

High incidence of obesity in this group. (60%) Obesity associated with ID

Question 46

Epidemiological Investigation of Insulin Dysregulation in Shetland and Welsh Ponies in Australia

Answer 46

-ID was present in 61% of the study population, with 55% exhibiting insulin resistance (IR), 15% basal hyperinsulinaemia (BHI), and 31–32% dynamic hyperinsulinaemia (DHI) at 60 and 90 minutes post-oral sugar test (OST).
-The prevalence of ID in ponies was higher than in light-breed horses
- Factors associated with insulin concentrations 60 min post OST were: age, CNS ≥3/5, VASo (≥7/9) (BCS)
-Factors associated with insulin 90 min post-OST were: age, CNS (≥3/5), VASo (≥7/9) and sex (male)
- Factors associated with worse ITT (=sensitivity): age, sex (female) and VASo (≥7/9)
-Ponies with DHI, IR, or PPID were at significantly increased risk for laminitis: DHI: 4.6 times higher risk. IR: 3.7 times higher risk. PPID: 11.75 times higher risk.
-Combined diagnoses of PPID and ID exacerbated laminitis severity, suggesting additive effects.

Question 47

Obesity and Metabolic Disease in Connemara Ponies in Ireland

Answer 47

29.5% had a BCS ≥7, 29.0% had a CNS ≥2.5 and 67.5% had regionalised adiposity; 68.5% ponies had at least one of these abnormalities.
-Owner-reported history or clinical evidence of chronic laminitis was found in 92 ponies (46.0%).
-Hyperinsulinaemia was confirmed in 32 ponies (16.0%), including 23 of 91 (25.3%) detected by OST and 9 of 109 (8.3%) by BIC.