Have you seen the most recent talk on the treatment of Diabetes Mellitus DM in dogs and cats? Over the past few days, I read about two different treatments for DM. One I read on Clinician's Brief (https://www.cliniciansbrief.com/) on ULA, once weekly insulin, and the FDA approval of bexagliflozin ( Bexacat; Increvet Inc), an SGLT2 inhibitor.
The new treatment for dogs is a novel ultra-acting insulin (ULA) that is given once a week to control DM. Imagine, treating DM once a week!! For owners (and the pet) this would be a game changer in the treatment of DM. DM is not only emotionally taxing, it is also life-changing. Insulin being a time-sensitive treatment would mean that the schedule must change or arrangements are made to make sure that the pet gets its medication.
Before we get ahead of ourselves, the study was only done on five patients, previously managed on twice daily insulin and clinically doing well, with glucose levels monitored using an implanted flash glucose monitoring system. The initial result seem to be positive but the development of anti-drug antibodies in one of the dogs in the studied cause that patient to be restarted on twice daily injections. With the development of these antibodies, this patient could not be successfully restarted on the ULA insulin protocol. This study is the first of its kind, but hopefully brings hope for further studies in the near future.
Bexagliflozin(Bexacat; Increvet Inc)is an oral treatment for DM in cats that is administered twice a day. Bexagliflozin is the first sodium-glucose cotransporter 2 (SGLT2) inhibitor. It works by preventing the reabsorption of glucose in the kidneys and lowering serum glucose levels. This treatment is best used in newly diagnosed patients with DM and is carefully monitored similarly to those when using standard DM treatments. Weight loss, lethargy, and complications like diabetic ketoacidosis are potential side effects and owners should monitor for these signs.
Some of my initial thoughts on these treatments include the following:
This would be a great advancement in the treatment of DM in dogs and cats
bexagliflozin is a flavored tablet: What flavor is it? What about patients with allergies?
Would the absorption and efficacy of this new treatment be affected by GI disease, kidney disease, and concurrent endocrine conditions?
I can see a significant improvement in client compliance, DM management, and the quality of life for the pet and the owner.
Client education is still going to be a significant part of the treatment of this condition. The utilization of the veterinary technician in this regard is paramount (and significantly underutilized). A client caring for a diabetic patient must be provided with the necessary tools to continue the care and management of their pet. The increase in veterinary visits and pet care, especially in older veterinary patients means that the caseload and workload for veterinarians and veterinary staff are even higher. Alleviation of this "load" and improvement of post-hospitalization care comes in the form of the utilization of knowledgeable CVT, LVT, and RVT.
Licensed veterinary technicians can spend time explaining the disease process to owners. Understanding how the disease manifests will support and cement the treatment recommendations by the veterinarian. LVTs can also explain and demonstrate the proper use of treatments if it is insulin injections, regardless of the treatment protocol(BID, weekly) and the way to successfully administer oral medication.
DM requires careful monitoring and licensed technicians can clients the requirements for monitoring at home, answer most questions that an owner might have, and explain the importance and need for repeat veterinary visits. For the owner, establishing a relationship with a well-versed technician can increase the level of comfort with the veterinary care team and in some cases cost-effective options like technician recheck appointments and telemedicine updates. Owners might be more comfortable relying upon information from a credentialed technician if they feel they may be judged for non-compliance.
As thrilled as I am to see the progress in the availability of treatment for chronic, conditions like DM, I cannot help but the of the limited utilization of these licensed, educated professionals as it pertains to client education. Regardless of the choice of treatment, education from the appropriate, direct, first-line source ( sorry Dr. Google) of information for clients and subsequently our patient population.
Hulsebosch SE, Pires J, Bannasch MJ, Lancaster T, Delpero A, Ragupathy R, Murikipudi S, Zion T, Gilor C. Ultra-long-acting recombinant insulin for the treatment of diabetes mellitus in dogs. J Vet Intern Med. 2022 Jul;36(4):1211-1219. doi: 10.1111/jvim.16449. Epub 2022 May 27. PMID: 35621084; PMCID: PMC9308417.
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