Glycemic variability in newly diagnosed diabetic cats treated with the glucagon-like peptide-1 analogue exenatide extended release

Abstract

Background: Glycemic variability (GV) is an indicator of glycemic control and can be evaluated by calculating the SD of blood glucose measurements. In humans with diabetes mellitus (DM), adding a glucagon-like peptide-1 (GLP-1) analogue to conventional therapy reduces GV. In diabetic cats, the influence of GLP-1 analogues on GV is unknown.

Objective: To evaluate GV in diabetic cats receiving the GLP-1 analogue exenatide extended release (EER) and insulin.

Animals: Thirty client-owned cats with newly diagnosed spontaneous DM.

Methods: Retrospective study. Blood glucose curves from a recent prospective placebo-controlled clinical trial generated 1, 3, 6, 10, and 16 weeks after starting therapy were retrospectively evaluated for GV. Cats received either EER (200 μg/kg) or 0.9% saline SC once weekly, insulin glargine and a low-carbohydrate diet. Mean blood glucose concentrations were calculated and GV was assessed by SD. Data were analyzed using nonparametric tests.

Results: In the EER group, GV (mean SD [95% confidence interval]) was lower at weeks 6 (1.69 mmol/L [0.9-2.48]; P = .02), 10 (1.14 mmol/L [0.66-1.62]; P = .002) and 16 (1.66 mmol/L [1.09-2.23]; P = .02) compared to week 1 (4.21 mmol/L [2.48-5.93]) and lower compared to placebo at week 6 (3.29 mmol/L [1.95-4.63]; P = .04) and week 10 (4.34 mmol/L [2.43-6.24]; P < .000). Cats achieving remission (1.21 mmol/L [0.23-2.19]) had lower GV compared to those without remission (2.96 mmol/L [1.97-3.96]; P = .01) at week 6.

Conclusions and clinical importance: The combination of EER, insulin, and a low-carbohydrate diet might be advantageous in the treatment of newly diagnosed diabetic cats.

Keywords: diabetes mellitus; feline; glycemic control; incretin; remission.

FIGURE 1

Standard deviation as marker for glycemic variability in the exenatide extended release (EER) and in the placebo group. Dots (EER group; n = 15) and squares (placebo group; n = 15) represent means and bars represent corresponding SDs. Horizontal bars represent significant differences in glycemic variability (GV) between reevaluations and groups. In the EER group, GV is significantly lower at weeks 6, 10, and 16 compared to week 1, whereas no difference was revealed in the placebo group. GV is significantly lower in the EER group compared to the placebo group at weeks 6 and 10. *P < .05

FIGURE 2

Standard deviation as marker for glycemic variability in all cats with and without remission. Triangles (cats with remission; n = 9) and diamonds (cats without remission; n = 21) represent means and bars represent corresponding SDs. Horizontal bars represent significant differences in glycemic variability (GV) between reevaluations and groups. In the remission‐group, GV is significantly lower at week 6 compared to week 1, whereas no difference was revealed in the nonremission group. GV is significantly lower in the remission group compared to the nonremission group at week 6. *P < .05

FIGURE 3

Standard deviation as marker for glycemic variability in exenatide extended release group with and without remission. Triangles (cats with remission; n = 6) and diamonds (cats without remission; n = 9) represent means and bars represent corresponding SDs. Horizontal bars represent significant differences in glycemic variability (GV) between reevaluations and groups (continuous line = remission group; interrupted line = nonremission group). In the remission group GV is significantly lower at week 6 compared to week 1. In the nonremission group GV was significantly lower at week 10 compared to week 1. GV is significantly lower in the remission group compared to the non‐remission group at week 6. *P < .05