Nutritional factors related to glucose and lipid modulation in diabetic dogs: literature review / Fatores nutricionais relacionados ao controle glicêmico e lipídico de cães diabéticos: revisão de literatura

Diabetes mellitus is a chronic disorder that results in hyperglycemia by absolute or relative insulin deficiency, sometimes leading to fatal complications. The successful treatment of diabetic dogs depends on nutritional management and insulin applications. Studies evaluating the nutrition of diabetic dogs focused on fiber as the main factor in glycemic control; however, new research describes the role of starch as key in postprandial glycemic fluctuation, also attributing a central role for body condition scores and feed management in the adequate glycemic control of diabetic dogs. The aim of this paper is to review nutritional aspects to better control diabetes in dogs.(AU)

Diabetes Mellitus é uma desordem crônica que resulta em hiperglicemia pela deficiência absoluta ou relativa de insulina, que gera complicações que podem levar à morte. O sucesso do tratamento do cão diabético depende da aplicação de insulina e do adequado manejo nutricional. Estudos que avaliaram aspectos nutricionais de cães diabéticos focavam na fibra dietética como o principal fator controlador da glicemia, porém novas pesquisas apontam o amido como principal responsável pelas respostas glicêmicas pós-prandiais e atribuem importante papel ao escore de condição corporal e ao manejo alimentar no adequado controle glicêmico de cães diabéticos. O objetivo deste trabalho é revisar os principais aspectos da nutrição de cães diabéticos para o melhor controle da doença.(AU)

Impact of commercially available diabetic prescription diets on short-term postprandial serum glucose, insulin, triglyceride and free fatty acid concentrations of obese cats.

Diet therapy is an important treatment component available for obese cats. In this study, the impact of four commercially available prescription diet regimens (1 for general use and 3 aimed at treating obesity and diabetes mellitus (DM)) on short-term postprandial serum glucose, insulin, triglyceride and nonesterified fatty acid (NEFA) concentrations was investigated with five obese cats. The diet regimens used were as follows: C/D dry (general use: moderate protein, moderate fat, high carbohydrate and low fiber), M/D dry (DM: high protein, high fat, low carbohydrate and high fiber), W/D dry (DM: high protein, low fat, high carbohydrate and high fiber) and Diabetic dry (DM: high protein, low fat, low carbohydrate and high fiber). A significant reduction (10-13%) in postprandial glucose (area under the curve; AUC) was observed with the M/D and Diabetic diets, which both contained lower concentrations of carbohydrates than the C/D diet. An accompanying significant reduction (30-36%) in postprandial insulin AUC was also observed with the three DM diets, which all had higher amounts of fiber, as compared with the C/D diet. Lastly, a significant increase (32-65%) in postprandial NEFA AUC was observed with the M/D and Diabetic diets as compared with the C/D diet. Therefore, dietary amounts of carbohydrates and fiber, as opposed to protein content or dietary fat, appear to have a very significant impact on postprandial glycemia and subsequent insulin requirement levels in obese cats. In addition, dietary amounts of carbohydrates may also impact lipid metabolism in obese cats.

The role of diet in the prevention and management of feline diabetes.

This article reviews the currently available evidence and focuses on how diet may play a role in lowering (or increasing) the risk of diabetes. The article also reviews the role of diet in treatment of diabetes. To the extent that it exists, evidence from published studies are cited; however, in areas where research evidence is lacking, clinical experience and physiologic principles are used as important sources of guidance.

Remission in cats: including predictors and risk factors.

This article summarizes current literature on diabetic remission in cats. Treatment options for diabetes mellitus are reviewed to highlight which protocols are most effective in achieving remission, as well as the importance of understanding the underlying pathophysiology that contributes to remission. In addition, current research into the glucose tolerance status of cats in diabetic remission and rates of relapse are discussed.

A survey of Southeastern United States veterinarians' preferences for managing cats with diabetes mellitus.

This study evaluated primary practitioners' perceptions of managing feline diabetics. Surveys distributed during local continuing education events achieved a response rate of 46% (90/195). A mean of 74% feline diabetics required chronic insulin; 26% were transient diabetics. Choice of insulin was most influenced by duration of action: human recombinant protamine zinc insulin was ranked first (42%) and glargine second (27%). Dietary management was always/usually recommended by 97% respondents, with prescription or proprietary low-carbohydrate, high-protein diets recommended in 93% responses. More recent graduates (P=0.0419), those who worked in larger practices (P=0.0315), and those who saw more transient diabetics (P=0.0288) were more likely to recommend dietary change. In-house blood glucose curves (BGCs) were the most popular method of assessing glycemic control, while at-home BGCs were least popular, although their use correlated positively with annual diabetic caseload (r=0.43, P=0.0239). Owners mishandling insulin was cited as the most common cause of poor glycemic control, while clinical signs of acromegaly were rarely recognized.

A diet lower in digestible carbohydrate results in lower postprandial glucose concentrations compared with a traditional canine diabetes diet and an adult maintenance diet in healthy dogs.

The aim of this study was to compare the effects of three diets with varying macronutrient and fibre contents on postprandial plasma glucose, triglyceride, free fatty acid, and insulin concentrations over a 12 h period in 12 healthy neutered lean dogs. Each diet was fed to each dog for 3 weeks in a three-period cross-over study. Plasma analyte concentrations were measured prior to and after a meal at the end of the third week of each period. Postprandial glucose concentrations for the moderate carbohydrate and fibre diet were 0.4-0.7 mmol/L (8-12 mg/dL) lower than for both higher carbohydrate diets (p≤0.02). Postprandial glucose, insulin, and triglyceride concentrations in some dogs did not return to baseline by 12 h after feeding of each of the three diets. These results indicate that the moderate carbohydrate and fibre diet warrants evaluation in diabetic dogs. Variables should be measured over at least 12 h after feeding to fully evaluate postprandial dietary effects on these analytes.

Comparison of three commercially available prescription diet regimens on short-term post-prandial serum glucose and insulin concentrations in healthy cats.

Dietary therapy is an important treatment component for diabetes mellitus (DM). In this study, the impact of three different commercially available diet regiments (1 general use and 2 aimed for treating obesity and DM) on short-term post-prandial serum glucose and insulin concentrations of five healthy cats to better understand what impact each of these diets may have for diabetic cats. The diet regiments used in this study were as follows: C/D dry (General Use- Low protein, High fat, High carbohydrate, and Low fiber), M/D dry (DM- High protein, High fat, Low carbohydrate, and High Fiber), and W/D dry (DM- Low Protein, Low Fat, High Carbohydrate, and High Fiber). No significant difference in post-prandial serum glucose levels were observed with the C/D (84.6 +/- 1.5 mg/dl) and W/D (83.8 +/- 1.4 mg/dl) dry diets when compared to pre-prandial fasting levels (83.9 +/- 1.4 mg/dl). However, a significant reduction was observed with the M/D diet (78.9 +/- 0.8 mg/dl) which had 50-60% less carbohydrates than either C/D or W/D diet. Unlike what was observed with post-prandial glucose levels, an interesting pattern emerged with post-prandial insulin levels, which were increasing with W/D, C/D, and M/D diets in that order (1.1 +/- 0.2, 1.7 +/- 0.2, and 2.3 +/- 0.2 ng/ml respectively). Most surprising, though, was the fact that the W/D diet did not seem to stimulate insulin secretion as compared to pre-prandial levels (1.1 +/- 0.1 ng/ml) in healthy cats. Interestingly, the W/D diet had high levels of carbohydrate and low levels of protein. Coincidentally, the only diet (M/D) which had a significant reduction in post-prandial glucose also showed the highest increase in post-prandial insulin in healthy cats. Therefore, dietary amounts of carbohydrate, fat, protein and fiber can all have an individual impact on post-prandial glycemia and subsequent insulin requirement levels. Just as concepts regarding dietary management of people with DM are evolving, investigators are reassessing what constitutes the ideal diet for the diabetic feline. As such, having a better understanding for each dietary component, may lead us to better understand how we can synergize certain dietary components to aid in DM management.

Changes in body weight, hematology and serum chemistry in captive plains viscachas (Lagostomus maximus) with presumptive diabetes type II after a diet change.

We report body weights (BW) and blood and serum analyses for 6 fully mature and 8 not-yet-mature captive plains viscachas before and 3, 6 and 9 months after switching from a low-fiber, high-energy diet to a high-fiber, low-energy diet. Initially, body weights, serum glucose, fructosamine and cholesterol levels were above the reference range in the fully mature animals. Furthermore, 4 of these animals had bilateral cataracts. After the diet change, these parameters dropped into the reference range. However, 9 months later, a slightly increased BW became evident again. The findings are consistent with a type II diabetes mellitus and underline the importance of dietary prevention.

Oxidative stress and innate immunity in feline patients with diabetes mellitus: the role of nutrition.

This study was undertaken to test the hypothesis that oxidative stress is increased and neutrophil function is decreased in cats with diabetes mellitus (DM). Measures of oxidative stress and neutrophil function were evaluated in 20 control and 15 diabetic cats. Cats were then fed a diet designed specifically for feline diabetics (Purina DM Dietetic Management Feline Formula) for 8 weeks, after which all assays were repeated. Cats with DM had significantly less plasma superoxide dismutase (SOD) than control cats, consistent with a greater degree of oxidative stress in the DM group. Following 8 weeks of consuming a diabetes-specific diet glutathione peroxidase, an antioxidant enzyme increased significantly in both groups. Other parameters of oxidative stress, as well as neutrophil function, were similar between groups and did not change following dietary intervention. The DM cats were significantly older and heavier than the control cats, which may have contributed to differences in parameters of oxidative stress and levels of antioxidant enzymes between these groups, but the decreased level of SOD enzyme in the diabetic group would appear to support the continued development of targeted antioxidant supplementation for this cats with this disease.

Effects of diet on glucose control in cats with diabetes mellitus treated with twice daily insulin glargine.

The purpose of this study was to evaluate the effects of dietary modification in addition to twice daily insulin glargine. Cats were treated with insulin glargine twice daily and randomized to receive either a low carbohydrate, high protein (LCHP) diet (n=6) or a control diet (n=6) for 10 weeks. Re-evaluations of clinical signs, blood glucose curves, and serum fructosamine concentrations were performed at weeks 1, 2, 4, 6, and 10. Two of 12 cats achieved complete remission by the end of the study but remission rate was not different between diet groups. Using twice daily insulin glargine and frequent monitoring, all cats in both diet groups achieved successful glycemic control. Frequent monitoring is key to achieving glycemic control in diabetic cats; potential benefits of dietary modification require further evaluation.

Feline diabetes mellitus: diagnosis, treatment, and monitoring.

Advances in the treatment and monitoring of diabetes mellitus in humans are being applied to feline patients. The authors present the current approaches to the treatment of diabetic cats as well as their experience with the use of new monitoring technology.

Feline diabetes mellitus: low carbohydrates versus high fiber?

Treatment of diabetes mellitus (DM) in the cat relies primarily on the adequate insulin therapy and controlled dietary intake. The goals of managing DM in the cat have changed from attaining glycemic control to achieving diabetic remission (transient diabetes) in a large proportion of cases. Remission rates of up to 68% have been published. The used of low-carbohydrate foods for cats improves the odds of achieving diabetic remission by fourfold. Nonetheless, some cats show an improved response to high-fiber food. Clinical judgement, trial, and personal preference to currently dictate which diet to offer an individual animal.

Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus.

This study compared the effects of a moderate carbohydrate-high fiber (MC-HF) food and a low carbohydrate-low fiber (LC-LF) food on glycemic control in cats with diabetes mellitus. Sixty-three diabetic cats (48 male castrated, 15 female spayed) were randomly assigned to be fed either a canned MC-HF (n = 32) food or a canned LC-LF (n = 31) food for 16 weeks. Owners were blinded to the type of diet fed. CBC, urinalysis, serum chemistry panel, fructosamine concentration and thyroxine concentration were determined on initial examination, and a complete blood count, serum chemistry panel, urinalysis and serum fructosamine concentration were repeated every 4 weeks for 16 weeks. Insulin doses were adjusted as needed to resolve clinical signs and lower serum fructosamine concentrations. Serum glucose (P = 0.0001) and fructosamine (P = 0.0001) concentrations significantly decreased from week 0 to week 16 in both dietary groups. By week 16, significantly more of the cats fed the LC-LF food (68%, 22/31), compared to the cats fed the MC-HF food (41%, 13/32), had reverted to a non-insulin-dependent state (P = 0.03). Cats in both groups were successfully taken off of insulin regardless of age, sex, type of insulin administered or duration of clinical disease before entering the study. There was no significant difference in the initial or final mean body weights or in the mean change in body weight from week 0 to week 16 between dietary groups. Diabetic cats in this study were significantly more likely to revert to a non-insulin-dependent state when fed the canned LC-LF food versus the MC-HF food.

Increased iron absorption in lemurs: quantitative screening and assessment of dietary prevention.

Iron storage disease (ISD) in lemurs has been reported since as early as the 1960s, and in the 1980s was demonstrated to be a consistent finding in postmortem investigations of captive lemurs. Since then this disease has consistently been diagnosed at the point of necropsy. In the current study we describe a preclinical screening procedure, as well as the quantified preventive effects of dietary intervention upon iron absorption. Twenty-three individual lemurs of four species were initially tested with the transferrin saturation test (%TS); 21 of these animals were on conventional zoo diets, and two were fed a specific diabetic diet. Initially, 20 of 21 lemurs on conventional zoo diets were demonstrated to have %TS levels above the normal range for humans; 17 of these lemurs were in the category (for humans) of excessive iron absorption. A dietary change aimed at reducing dietary iron and vitamin C levels and increasing the levels of iron-chelating tannins and/or phytates was instigated. After the animals were retested, a matched-pair comparison of %TS values before and after the diet change revealed significantly (P=0.038, n=7) lower %TS values after the diet change. All species averages were in the human hyperabsorption range on conventional zoo diets (n=21). No species averages were in that range after the dietary change (n=18). The results indicate that further investigations into the use of %TS testing in lemur husbandry, and specific preventive dietary measures, should be conducted.