Endocrine

Question 1

Is there a correlation between canine adult-onset demodicosis and other diseases? - Pinsenschaum 2019 (Vet Rec)

Answer 1

Breeds - WHWT, Maltese, Shih Tzu. Concurrent DX in 40% - sig. hyperadrenocorticism, hypothyroidism, leishmaniosis.

Question 2

Electrocardiographic and echocardiographic evaluation in dogs with hypothyroidism before and after levothyroxine supplementation: A prospective controlled study - Glglielmini 2019 (JVIM)

Answer 2

HT sig. dec. HR, P wave amplitude, R wave amplitude, EPSSn, E max. After TX sig. inc. HR, P wave amplitude, FS, E max; sig. dec. LV end-diastolic volume; normalized systolic diameter EPSSn. HT induces mild and reversible changes of cardiac function - MPI does not have clinical importance of IDing dysfunction in affected dogs.

Question 3

Investigation of adrenal and thyroid gland dysfunction in dogs with ultrasonographic diagnosis of gallbladder mucocele formation - Aicher 2019 (PLOS One)

Answer 3

Case-control. 10% hyperadrenocorticism + sig. more had DHEAS inc. 26% hypothyroidism but no TgAA + sig. inc. UICR. Inc. capacity for cortisol synthesis + disrupted TH metabolism.

Question 4

Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele - Jaffey 2019 (Vet Journal)

Answer 4

Retrospective. CS - OR 4.2. Jaundice - OR 2.12. HAC - OR 1.94. Pomeranian - OR - 2.46. Bili - OR 1.03 (poor predictor Se 61% / Sp 63%). Age - OR 1.17. V - OR 0.48. No effect of HT or DM.

Question 5

Behavior in dogs with spontaneous hypothyroidism during treatment with levothyroxine - Hrovat 2019 (JVIM)

Answer 5

6 weeks - sig. inc. in activity. 6 months - no change in behavioral signs. No diff. in conc. of serotonin.

Question 6

Long-term survival of dogs treated for gallbladder mucocele by cholecystectomy, medical management, or both - Parkanzky 2019 (JVIM)

Answer 6

MST (sig. diff) - SX 1802 days, MM 1340 days, MM –> SX 203 days. Dec. survival - GBM type, ALP, Cr, P. Inc. survival in SX - biliary rupture on AUS. Best survival w/ SX, but MM is reasonable alternative when SX cannot be pursued.

Question 7

Comparison of 2 assays for measuring serum total thyroxine concentration in dogs and cats - Wolff 2020 (JVIM)

Answer 7

Diff. CTT4 and MTT4 affect interpretation at higher TT4 conc. ITT4 underestimates compared to MTT4. Serial measurements should be done with same assay.

Question 8

Recombinant human thyrotropin stimulation test in 114 dogs with suspected hypothyroidism: a cross-sectional study - Corsini 2021 (JSAP)

Answer 8

75 mcg/dog IV. Post > 2.2 - euthyroid. 40 HT / 74 ET. Post > 1.7 had NPV 100%. Post < 1.3 had PPV 94.9%. Highly reliable even with NTI or med. administration. Post > 1.7 suggests normal thyroid function.

Question 9

Prevalence of iatrogenic hypothyroidism in hyperthyroid cats treated with radioiodine using an individualised scoring system - Fernandez 2019 (JFMS)

Answer 9

After 6-9 months: overt - 40%; SC - 12.7%. Overt + AZO - 14.5%. Low T4 19 d - PPV 72.2% and NPV 80%. Inc TSH 19 d - PPV 75% and NPV 44.6%. Scoring system effective for I131 dosing but higher prev. HT than other protocols.

Question 10

Correlation of thyroid hormone measurements with thyroid stimulating hormone stimulation test results in radioiodine-treated cats - Wakeling 2020 (JVIM)

Answer 10

NTI did not affect TT4 after TSHSt. 85% HT + 14% ET had high TSH. 88% HT had low fT4. 1/5 ET with low fT4 had high TSH. Only 19% HT had low tT4. fT4 CLIA + TSH canine immunoassay can be used to DX iatrogenic HT in cats.

Question 11

Changes in thyroid and renal function after bilateral thyroidectomy in cats - Covey 2019 (JVIM)

Answer 11

Retrospective cross-sectional. 6 months - 22% recurrent hyperthyroidism; 49% hypothyroid. Long term - 44% recurrent hyperthyroidism, 83% transiently euthyroid, 17% hypothyroid. SDMA + Cr linearly associated but hyperthyroid had higher SDMA relative to Cr. Thyroid function changes for years after bilateral thyroidectomy and recurrence is common. SDMA + Cr both affected by thyroxine conc. and effect is greater in hyperthyroid cats.

Question 12

Relationship between total thyroxine, thyroid palpation and a clinical index in hyperthyroid and healthy cats and cats with other diseases - Wehner 2019 (JFMS)

Answer 12

80% hyperthyroid had palpable nodule, 20% healthy/NTI (hyperthyroid TPS ~ 2). Hyperthyroid older, lower BW + BCS. Hyperthyroid commonly had palpable nodules, but smaller than previously reported.

Question 13

Coagulation parameters in hyperthyroid cats before and after radioiodine treatment compared with healthy controls - Cui 2019 (JFMS)

Answer 13

Fibrinogen sig. higher and PT sig. shorter in hyperthyroid - persisted after I-131.

Inc. hypercoagulability after I-131 (fibrinogen, PT, TEG max. amp. and clot rigidity).

Hyperthyroid cats showed hypercoag. tendencies which inc. after I-131 - poss. transient radiation-induced thyroiditis.

Question 14

Serum thyroxine and thyrotropin concentrations decrease with severity of nonthyroidal illness in cats and predict 30-day survival outcome - Peterson 2020 (JVIM)

Answer 14

NTIs had lower T4/T3 but FT4 and TSH did not differ.

TT4/FT4/T3 prog. dec. with disease severity, and non-survivors had lower T3/T4/TSH (no diff. in FT4).

T4 + TSH predicted survival.

Consider eval. thyroid fxn with severe NTI to prognosticate before investing in TX.

Question 15

Prevalence of, and factors associated with, positive urine cultures in hyperthyroid cats presenting for radioiodine therapy - Keebaugh 2021 (JFMS)

Answer 15

5.1% positive UCs - all subclinical.

Microscopic bacteriuria sig. associated with PUC (60%) vs NUC (1.6%).

Lower than previous reports - all subclinical despite bacteriuria, which would not warrant TX.

Question 16

Comparison of free thyroxine measurement by chemiluminescence and equilibrium dialysis following 131I therapy in hyperthyroid cats - Stammeleer 2020 (JFMS)

Answer 16

Good correlation b/t ED + CLIA fT4, but CLIA consistently underestimated -5.4 and -4.9 pmol/L.

At T2, all euthyroid on TS - 40.9% CLIA dec. and 9.1% ED dec.

Good correlation b/t assays but sig. differences at both time points - reconsider RI? Routine fT4 after TX not advised.

Question 17

Concurrent thoracic pathology identified with radiology in hyperthyroid cats referred for radioiodine therapy - Kormpou 2020 (JFMS)

Answer 17

Pathology - 77%
Pulm (Br + BrI) - 59%
Skeletal - 57%
Cardiac (cardiomeg) - 43%
Sternal LN - 7%
Mediastinal - 3%
Esophageal - 2%
Pleural space - 0.5%

12 cats (6%) changed TX plan - 5/12 still received I-131.

Incidental findings common but sig. pathology had low prevalence.

Question 17

Establishing levels of retained radioactivity in cats receiving radioactive iodine treatment - Alonzi 2021 (Vet Rec)

Answer 17

> 11 MBq (UK reg) at day 11 in 49% and day 13 in 91%. Could be discharged with at-home regulations for subsequent ~ 2 weeks.

13 day isolation period compliant with current UK legislation.

Question 18

Liver-type fatty acid-binding protein and neutrophil gelatinase-associated lipocalin in cats with chronic kidney disease and hyperthyroidism - Kongtasai 2021 (JVIM)

Answer 18

CKD - sig. higher sL-FABP (13.50 vs 4.25) and uL-FABP (4.90 vs 0.46).

HT - sig. higher uL-FABP (0.94) than healthy at T0, but sig. dec. at T2 (0.54).

For CKD detection - uL-FABP had Se 100% and Sp 93.2%.

L-FABP but NOT NGAL is potential biomarker for early CKD detection in cats. Unknown utility for predicting azotemia after hyperthyroid TX.

Question 19

Assessment of symmetric dimethylarginine as a biomarker of renal function in hyperthyroid cats treated with radioiodine - Buresova 2019 (JVIM)

Answer 19

SDMA > 14 in 6/47 at T0 and normalized after TX in 4/6. All nonazotemic after TX.

Low corr. b/t GFR + SDMA (not sig); mod. corr. b/t GFR + Cr (sig)

Carefully interpret mild SDMA elevation with normal Cr in hyperthyroid cats - may normalize after TX. In this pop SDMA poorly correlated with GFR.

Question 20

Symmetric dimethylarginine in hyperthyroid cats before and after treatment with radioactive iodine - DeMonaco 2020 (JFMS)

Answer 20

Inc. SDMA in 7% (baseline), 19% (1 month), 20% (3 month), 32% (6 month).

Inc. Cr in 0% (baseline), 6% (1 month), 15% (3 month), 15% (6 month).

Med. baseline SDMA sig. higher in azotemic (13 vs 10). Se 15.4% and Sp 94.4%.

SDMA inc. in I-131 TX cats and likely reflects GFR changes. Inc. SDMA before TX has high Sp but poor Se for predicting post-TX azotemia.

Question 21

Clinical features and outcome of functional thyroid tumours in 70 dogs - Scharf 2020 (JSAP)

Answer 21

MST 35.1 - 83% at 1 year and 49% at 3 years.

MST ~ 72.6 months with SX but ~ 15.7 months without.

64% hypothyroid after surgery.

Met ~ 3%.

May survive for long periods after SX but iatrogenic hypothyroidism common.

Question 22

Outcomes for dogs with functional thyroid tumors treated by surgical excision alone - Frederick 2020 (JAVMA)

Answer 22

PU/PD - 56%. Weight loss - 44%. 2 had hyperthyroidism incidentally found.

1 dog with mets at DX. 85% malignant.

MST ~ 1072 days. No sig. prognostic factors.

Dogs with resectable tumors had good prog. with SX alone. MST similar to previous studies inc. nonfunctional tumors.

Question 23

Complications and outcomes associated with unilateral thyroidectomy in dogs with naturally occurring thyroid tumors: 156 cases (2003-2015) - Reagan 2019 (JAVMA)

Answer 23

Perioperative complications - 19.9%. Hemorrhage - 7.7%. 5/12 required transfusion.

Postop - AP 3.2%.

Survival to discharge - 98.1%.
MST ~ 911 days.

Unilateral thyroidectomy - perioperative mortality ~ 1.9% and complication ~ 19.9% (hemorrhage + AP). Long-term survival not uncommon.

Question 24

Prevalence of canine primary hyperparathyroidism recurrence in Keeshond and non-Keeshond dogs after curative parathyroidectomy - Thompson 2020 (Vet Rec)

Answer 24

Keeshond sig. more likely to recur (50% vs 7%). Median time to recurrence in Keeshond ~ 35 months. Keeshond sig. younger at initial detection (108 months vs 126 months). **All dogs with parathyroidectomy should be monitored lifelong for recurrence, esp. Keeshond. Recommend early screening of Keeshond, even if apparently healthy.**

Question 25

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats - Coady 2019 (Front Vet Sci)

Answer 25

Hypercalcemia (dogs) - malignancy (12.9%), parathyroid (4.6%), Addison's (1.7%). Dogs with mod - severe more likely to have hyperparathyroid, malignancy, or Vit D tox. Hypocalcemia (dogs) - critical illness (17.4%), renal (10.4%), tox (7.5%). Mod - severe more likely hypoparathyroidism, renal, eclampsia, critical illness. Hypercalcemia (cats) - malignancy (22.7%), renal (13.4%), idiopathic (12.6%). Cats with mod - severe more likely to have malignancy or idiopathic. Hypocalcemia (cats) - renal (21.6%), UO (15.1%), critical illness (14.7%). Mod - severe more likely renal, trauma, UO. **Mild Ca disturbances commonly non-pathologic/transient. Malignancy most common cause of elevated iCa in dogs and cats. Critical illness and renal freq. cause of low iCa in both species.**

Question 26

Efficacy of hypophysectomy for the treatment of hypersomatotropism-induced diabetes mellitus in 68 cats - Fenn 2021 (JVIM)

Answer 26

85.3% alive 4 weeks postop. Complications - hypoglycemia (9/68 - 13%), electrolytes (9/68 - 13%), CHF (5/68 - 7%). 55/58 survivors (95%) had improved DM control with remission 41/58 (71%) with median ~ 9 days. 4 week IGF-1 nadir sig. lower in cats w/ remission (20 vs 324). All cats received levothyroxine and hydrocortisone PO; 72% desmopressin. DM recurrence 5/41 (12%) at median ~ 248 days. MST ~ 853 days. **Hypophysectomy is effective TX for cats with HST + DM with favorable long-term outcome compared to existing options.**

Question 27

Increased insulin-like growth factor 1 concentrations in a retrospective population of non-diabetic cats diagnosed with hypertrophic cardiomyopathy - Steele 2021 (JFMS)

Answer 27

6.7% of HCM cats had IGF > 1000. 0% of control cats had IGF > 1000. **Consider other non-diabetic manifestations of hypersomatotropism.**

Question 28

Anaesthetic management and complications during hypophysectomy in 37 cats with acromegaly - Neilson 2019 (JFMS)

Answer 28

Hypothermia, hypotension (lower incidence if alpha-agonists used), bradycardia, airway obstruction (higher incidence if fentanyl vs remifentanyl). 8% mortality at 24 hours. Subjectively assessed anesthesia recovery associated with length of ICU stay. **Described anesthetic protocol effective but intraoperative complications common (but not associated with 24 hour outcome).**

Question 29

Ultrasound evaluation of adrenal gland size in clinically healthy dogs and in dogs with hyperadrenocorticism - Melian 2021 (Vet Rec)

Answer 29

L healthy - 5.1 mm (>2.5-5 kg), 5.5 mm (>5-10 kg), 6.4 mm (>10-20 kg), 7.3 mm (>20-40 kg). R healthy - 5.3 mm (>2.5-5 kg), 6.8 mm (>5-10 kg), 7.5 mm (>10-20 kg), 8.7 mm (>20-40 kg). Se for HAC - 95.6%. Could differentiate PDH/ADH in 56% but 39.6% equivocal. **Se of AUS for adrenomegaly is high when using 4 weight categories. Equivocal adrenal asymmetry common.**

Question 31

Concurrent pituitary and adrenocortical lesions on computed tomography imaging in dogs with spontaneous hypercortisolism - van Bokhorst 2019 (JVIM)

Answer 31

Dex-suppressible - 78/201 (64%) had enlarged pituitary (0.43) and 2 had concurrent adrenal lesions. Dex-resistant - 47/79 (59%) had enlarged pituitary (0.57) and 8/47 (17%) had concurrent adrenal lesions. Of 32 dex-resistant dogs w/o pituitary enlargement, 27 had ADH (last 5 diagnosed with PDH). **Concurrent pituitary + adrenal lesions in ~ 5% dogs overall and ~ 10% dexamethasone resistant.**

Question 32

Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England - Schofield 2020 (Vet Rec)

Answer 32

MST from diagnosis ~ 510 days. Trilostane in ~ 94.1%. PDH/ADH differentiated in ~ 20.1%. >15 kg (HR 1.51) and >13 years (HR 3.74) had inc. hazard of all-cause mortality. Dogs with initial trilostane dose inc. had favorable prognosis (HR 0.49). **Survival from diagnosis fair for many dogs and provides prognostic benchmark.**

Question 33

Calcium and phosphate homeostasis in dogs with newly diagnosed naturally occurring hypercortisolism - Corsini 2020 (JVIM)

Answer 33

Higher P (4.81 mg/dL vs 3.86 mg/dL). Higher FECa (0.43% vs 0.15%). Higher wPTH (54.6 pg/mL vs 24.6 pg/mL). Lower 25-(OH)D (70.2 pg/mL vs 106.3 pg/mL). Lower FGF-23 (316.6 pg/mL vs 448.7 pg/mL). **Urine Ca loss + hyperphosphatemia could contribute to adrenal secondary hyperparathyroidism.**

Question 34

Laboratory assessment of trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism - Bermejo 2020 (JVIM)

Answer 34

Overlap in pre- and post-trilostane ACTH for dogs with resolved and ongoing symptoms at all time points. USG, UCCR, and ACTHstim did not discriminate clinically resolved and clinically ongoing. Trilostane suppresses within ~ 1 hour and duration in most PDH dogs < 8 hours. **No single variable or group of variables discriminated clinically resolved vs clinically ongoing dogs during trilostane treatment for PDH.**

Question 35

Changes in systolic blood pressure in dogs with pituitary dependent hyperadrenocorticism during the first year of trilostane treatment - San Jose 2021 (JVIM)

Answer 35

Prevalence of HT decreased (36/51 - 70%) --> (17/37 --> 46%). Most pronounced BP decrease in severely HT, while normotensive dog BP increased slightly. BP NOT associated with disease control. 31/51 (61%) required antihypertensives and 13/31 (42%) required dual therapy. 1/3 nonhypertensive dogs at T0 required antihypertensives b/c HT developed during follow-up. **Measure BP at every visit for PDH dogs regardless of BP at diagnosis or disease control.**

Question 36

Retrospective study of aldosterone and progesterone secreting adrenal tumors in 10 cats - Harro 2021 (JVIM)

Answer 36

10/10 cats had DM + biochemical features of hyperaldosteronism (hypoK). 3/3 had high corticosterone. AUS revealed unilateral AT in 10/10 and 5/10 had atrophied or undetectable contralateral AG. 3/4 developed hypoadrenocorticism after adrenalectomy. 3/4 achieved diabetic remission after adrenalectomy. Survival after adrenalectomy - 2/4 > 1 year, 1 survived 6.5 months, and 1 alive at 5.5 months. Survival > 1 year in 2/4 medically managed cats. **Both surgical and medical amangement can result in long-term survival, but DM remission only documented in adrenalectomized cats.**

Question 37

Prevalence and characterization of hypoadrenocorticism in dogs with signs of chronic gastrointestinal disease: a multicenter study - Hauck 2020 (JVIM)

Answer 37

Prospective - 151 dogs with chronic GI signs. BC < 3 in 80/151 (53%), <2 in 42/151 (28%), and <1 in 9/151 (6%). HA in 6/151 (4%). No diff. in HX, PE, BW but 4/6 HA dogs had melena or hematochezia. No hyperkalemia/hyponatremia in any dog. **Adrenal testing should be standard screening test in dogs with chronic GI signs.**

Question 38

Hypoadrenocorticism in dogs under UK primary veterinary care: frequency, clinical approaches and risk factors - Schofield 2020 (JSAP)

Answer 38

177 Addisonians (72 confirmed, 105 presumed). Overall prevalence ~ 0.06%. PCs - lethargy (77.3%), anorexia (66.7%), vomiting (66.7%). Hyperkalemia - 47/53 (88.7%). Hyponatremia - 46/53 (86.6%). Na:K - median 19. Standard Poodle - OR 51.38 (WHWT + Labradoodle also had inc ORs).

Question 39

Semiquantitative acid-base analysis in dogs with typical hypoadrenocorticism -Osborne 2021 (JVECC)

Answer 39

33 new Addisonians - BW collected on presentation before treatment. Normal acid-base 1/33. Simple respiratory acid-base in 2/33. Simple metabolic acidosis in 14/33. Mixed disorder 16/33. Semiquant IDed abnormalities in all cases. All dogs > 1 acidifying process; 29/33 both acidifying + alkalinizing. Acidosis from excess free water in all dogs, and acidifying phosphate effect in 27/33. Hyperlactatemia in 8/33 (median 1.5 mmol/L). **Untreated Addisonians have complex acid-base derangements - semiquant approach provides greater insights into underlying mech, particularly b/c lactic acidosis appears to be a minor influence.**

Question 40

Evaluation of a low-dose desoxycorticosterone pivalate treatment protocol for long-term management of dogs with primary hypoadrenocorticism - Sieber-Ruckstuhl 2019 (JVIM)

Answer 40

Prospective - 17 dogs. Dose adj to achieve injection interval ~ 28 - 30 days and normal electrolytes. Starting dose (1.5 mg/kg) sufficient in all but 2 dogs and had to be sig decreased after 2-3 months to med dose 1.1 mg/kg. Younger dogs needed sig higher doses, but still below 2.2 mg/kg rec by manufacturer. **Starting dose 1.5 mg/kg effective in controlling CS + serum electrolytes in majority of dogs. Additional dose reduction often needed to maintain interval 28 - 30 days. Young growing animals need higher dosages.**

Question 41

Randomised clinical non-inferiority trial comparing two formulations of desoxycortone pivalate for the treatment of canine primary hypoadrenocorticism - Farr 2020 (Vet Rec)

Answer 41

2.2 mg/kg SQ Zycortal (test) or Percorten-V (control). Day 90 success rates similar between groups (Zycortal 87/101 [86.2%] vs Percorten-V 29/34 [85.1%]). Zycortal NON-INFERIOR to Percorten-V. PU/PD most common CS. **Both products (combined w/ glucocorticoids) safe and effective.**

Question 42

Evaluation of a flash glucose monitoring system in nondiabetic dogs with rapidly changing blood glucose concentrations - Howard 2020 (JVIM)

Answer 42

24 research/teaching dogs - induced hypoglycemia + rapid fluctuations. Accuracy of readings (+/- 15) for BG < 100 - PBGM 81.7%; FGMS 39.1%. Proportion of readings that would not have affected clinical outcome - PBGM 97.9%; FGMS 80.1%. **Limited agreement b/t FGMS + reference. FGMS failed to reliably detect hypoglycemia.**

Question 43

Use of lispro insulin for treatment of diabetic ketoacidosis in cats - Malerba 2019 (JFMS)

Answer 43

9 cats per group. No sig. diff. in time to resolution of hyperglycemia, ketosis, or acidosis. 2 regular insulin cats became hypoglycemic. 3 regular insulin cats + 1 lispro cats became hypophosphatemic. **Lispro CRI has few SFX and appears equally effective as regular insulin CRI for treatment of DKA cats.**

Question 44

Lispro insulin and electrolyte supplementation for treatment of diabetic ketoacidosis in cats - Anderson 2019 (JVIM)

Answer 44

12 DKA cats. Lispro CRI - 0.09 U/kg/hr. 0.9% NaCl. Median time to BG < 250 sig. shorter in lispro group vs regular insulin. 2 cats had nonclinical hypoglycemia (BG 40). Most rapid change in Na conc was 0.7 mmol/L/hr. HypoNa, hypoK, hypoP, and hypoMg 3 times more common than hyper- despite supp. with highly conc. electrolyte solutions. **Lispro at 0.09 U/kg/hr + NaCl for IVF are safe and effective for DKA treatment in cats.**

Question 45

Efficacy and Safety of Intramuscular Insulin Lispro vs. Continuous Intravenous Regular Insulin for the Treatment of Dogs With Diabetic Ketoacidosis - Malerba 2020 (Front Vet Sci)

Answer 45

Lispro 0.25 U/kg IM. Repeated q1h if BG dropped < 10% or q3h if BG dropped > 10%. Reduced to 0.125 U/kg IM q3h once BG < 250. Median time to resolution of ketosis sig shorter in lispro group (12 h vs 23 h). No sig. diff. in time to resolution of acidemia (13 h vs 22 h) or ketoacidosis (17.5 h vs 23.5 hr). No sig. diff. in length of hospitalization or freq/severity of adverse events. **IM lispro protocol appears safe and effective for treatment of canine DKA.**

Question 46

Epidemiological study of dogs with diabetes mellitus attending primary care veterinary clinics in Australia - Yoon 2020 (Vet Rec)

Answer 46

Overall prevalence 0.33-0.39%. Inc risk breeds - Australian terriers (OR 7.93), husky (6.24), English springer spaniel (5.37), WHWT (4.85), mini schnauzer (3.47), poodle (3.41), bichon (3.41), schnauzer (3.18), CKCS (1.84). Low risk breeds - GSD (0.11), Golden (0.09), Boxer (none). Neutered males higher than intact males or spayed females. Comorbidities - pancreatitis (OR 10.58), cataracts (9.80), Cushing's (6.21), UTI (5.09), hypothyroid (4.10). **At risk breeds inc Aus Terrier, Husky, English SS. Neutered males in Aus predisposed (females reported elsewhere).**

Question 47

A dose titration protocol for once-daily insulin glargine 300 U/mL for the treatment of diabetes mellitus in dogs - Tardo 2024 (JVIM)

Answer 47

Initial dose 0.5 U/kg SQ q24h (range 0.2 - 2.5 U/kg). Good/excellent glycemic control in 87/95 (92%). 56/95 (59%) received q24h; 39/95 (41%) received q12h. 5 dogs received meal-time bolus injections (0.5 U/kg/injection). Clinical hypoglycemia in 6/95 (6%). Dogs w/o concurrent disease more likely to receive IGla300 than with (72% vs 50%). **IGla300 is suitable therapeutic option for q24h dosing in diabetic dogs. Be aware of low potency and wide dose range. q12h +/- mealtime bolus may be necessary. FGMS monitoring essential for dose titration.**

Question 48

The accuracy and precision of insulin administration using human and veterinary pen-injectors and syringes for administration of insulin - Malerba 2021 (JVIM)

Answer 48

All pen-injectors delivered less than intended dose (underdose inversely proportional to insulin dose). Diff b/t intended + administered not sig w/ JuniorSTAR or VetPen 0.5-8U at 0.5, 1, 2, 4 U doses; 30U/0.3 mL syringe at 4 U; or 40 U/mL syrige at 4, 8, 16 U. With all devices, precision inc with inc insulin doses. Coefficient of variation <8% for pen injectors but 12.08% for 30 U/0.3 mL syringe and 9.39% for 40 U/mL. **JuniorSTAR and VetPen 0.5-8 U more accurate than other devices when < 2 U. Delivery of 8 and 16 U was more accurate using 40 U/mL syringes.**

Question 49

Owner preference for insulin delivery device and glycaemic control in diabetic dogs - Del Baldo 2023 (JSAP)

Answer 49

Owners who used syringe first did not have sig preference. Owners who used pen first expressed sig preference for VetPen > syringes. No sig diff in number of dogs with good vs poor glycemic control (clinical score, fructosamine, A1c). **Overall TX satisfaction and preference was similar, but VetPen preferred by owners who used this device first. Glycemic control did not appear to be affected by insulin delivery device.**

Question 50

Survival estimates and outcome predictors in dogs with newly diagnosed diabetes mellitus treated in a veterinary teaching hospital - Tardo 2019 (Vet Rec)

Answer 50

MST ~ 964 days. Survival shorter for dogs with higher HCT (HR 1.06) and phosphate (HR 1.83). Phosphate above RR in 24/65 (37%) dogs. **Diabetic dogs have good life expectancy. Hyperphosphatemia common in newly diagnosed DM + represents negative prognostic factor. Pancreatitis may not be associated with unfavorable outcome.**

Question 51

Metabolic Profiling of Diabetic Cats in Remission - Gottlieb 2020 (Front Vet Sci)

Answer 51

Maj of cats in remission have abnormal glucose tolerance and 1/3 relapse w/in 1 year. Most cats in remission had impaired glucose tolerance. Conc 16 metabolites differed b/t remission and control - 10 AAs and stearic acid (all lower in remission) and glucose, glycine, xylitol, urea, and carnitine (all higher in remission). Mod correlation b/t these metabolites and variables assessing glycemic responses. 5 cats in remission relapsed during study (9 months). No metabolite predicted relapsed. **Cats in remission have abnormal metabolism.**

Question 52

The daytime feeding frequency affects appetite-regulating hormones, amino acids, physical activity, and respiratory quotient, but not energy expenditure, in adult cats fed regimens for 21 days - Camara 2020 (PLOS One)

Answer 52

1 meal vs 4 meals daily. No effect on body weight. 4x had lower conc GIP, GLP-1, and PYY. 4x had greater physical activity, but overall energy expenditure similar. No diff in leptin or BG. 1x had greater postprandial AA response, ghrelin, and insulin. 1x had lower fasting respiratory quotient. **Feeding 1x may be beneficial feeding management strategy for indoor cats to promote satiet and lean body mass.**

Question 53

Safety, Tolerability, and Proof-Of-Concept Study of OKV-119, a Novel Exenatide Long-Term Drug Delivery System, in Healthy Cats - Klotsman 2021 (Front Vet Sci)

Answer 53

Subdermal implantation/delivery of GLP-1RA exenatide for~ 6 months. In anesthetized cats, duration of insertion/removal 1-2 minutes. Easily ID'ed on radiographs and well-tolerated without site reactions. Exenatide conc observed for up to 35 days. Plasma conc correlated to weight loss. **OKV-119 could be easily inserted/removed during routine visit and could safely and effectively deliver exenatide. Future studies needed for even longer release warranted to determine whether metabolic improvements, weight loss, and/or minimal impact on owner lead to improved outcome for obese diabetic cats.**

Question 54

Glycemic variability in newly diagnosed diabetic cats treated with the glucagon-like peptide-1 analogue exenatide extended release - Kramer 2020 (JVIM)

Answer 54

EER group had lower varability at weeks 6 (1.69), 10 (1.14), and 16 (1.66) compared to week 1 (4.21). EER had lower variability than placebo at week 6 (3.29) and 10 (4.34). Cats acheiving remission had lower variability than those without (1.21 vs 2.96). **EER + insulin + low carb diet may be advantageous in treatment of newly diagnosed diabetic cats.**

Question 55

Safety and effectiveness of the sodium-glucose cotransporter inhibitor bexagliflozin in cats newly diagnosed with diabetes mellitus - Hadd 2023 (JVIM)

Answer 55

15 mg PO q24h. 68/81 (84%) were treatment success - dec in mean BG, frucotsamine, and BHBA; subjective improvement in neuro status, musculature, and haircoat. Owner QOL (owner and cat) favorable. SFX - vomiting, diarrhea, anorexia, lethargy, dehydration. 8 cats had severe adverse events (3 resulting in death or euthanasia). **Euglycemic DKA in 3 cats and presumed in fourth.** **Bexagliflozin dec hyperglycemia and clinical signs. As once-daily PO medication, may simplify management of DM in cats.**

Question 56

Risk factors for Candida urinary tract infections in dogs and cats - Reagan 2019 (JVIM)

Answer 56

ABX in ~ 30 days before diagnosis in dogs associated with inc risk of Malassezia (OR 26.4) compared to controls with bacterial UTI (14.5). In cats associated w/ Malassezia (15.7). Immunosuppression associated with Malassezia in dogs (4.2) but not sig diff than bacterial UTI (2.7). LUTD other than infection associated with Malassezia in cats (6.7) but not dogs (2.5). Neither DM nor prev hosp was associated with Malassezia in either species. **Recent admin of ABX is risk factor for candiduria in dogs and cats.**

Question 57

Assessment of the association between diabetes mellitus and chronic kidney disease in adult cats - Perez-Lopez 2019 (JVIM)

Answer 57

11.9% cats had CKD + 2.9% had DM. 11% without DM and 44% with DM had CKD (diagnosed simultaneously in 6 cats, whereas DM preceded CKD in others). DM sig associated with CKD (OR 4.47). Age and mixed breed also associated with CKD. **Association b/t DM + CKD in adult cats when adjusted for age.**

Question 58

Prednisolone-induced diabetes mellitus in the cat: a historical cohort - Nerhagen 2021 (JFMS)

Answer 58

Prednisolone > 1.9 mg/kg/d for > 3 weeks. 14/143 (9.7%) diagnosed with prednisolone-induced DM (PIDM). 12/14 (85.7%) developed DM within 3 months of starting therapy. **Cats requiring high-dose prednisolone should be closely monitored for DM over first ~ 3 months of therapy.**