Tabitha Hookey

Background: Obesity is associated with insulin resistance and affects glycemic control in diabetic patients. Hypothesis/Objectives: Assess the impact of 12-week caloric restriction on remission and glycemic control in overweight diabetic cats using a prospective, randomized controlled trial. Animals: Seventy-two overweight (body condition score ≥ 6/9) client-owned insulin-treated diabetic cats, randomized either to caloric restriction (intervention, 32; target approximately 2% weekly weight loss) or body weight maintenance (control, 40). Methods: All cats received a novel therapeutic diabetic diet, suitable for weight reduction, for 12 weeks (%metabolizable energy [protein/fat/nitrogen-free extract]: dry [49.4/24/26.6]; wet [63.2/25.3/11.5]). Physical examination, serum biochemistry, home blood glucose curves (BGC), diabetic clinical score, and quality of life questionnaires were performed on weeks: −1, 4, 8, and 12. Insulin dose was recorded and glycemic variability (SD of BGC) was calculated. Induction of diabetic remission was the primary outcome measure. Data were analyzed using regression and linear mixed models. Results: By week 12, intervention had 2.1 times higher probability of remission (16/32) compared with controls (12/40, P = .04). Weight loss was 7.2% (95% confidence interval [CI], 5.7-8.7) for the intervention versus 2.7% (95% CI, 1.3-4.1, P < .001) for controls. For cats not achieving remission, glycemic variability decreased 45% (95% CI, 26-65) and 7% (95% CI, 16-21) for intervention and control cats, respectively (P = .01), insulin-dose decreased by 36% (95% CI, 2-70) for intervention and increased 28% (95% CI, 3-53, P = .004) for controls. Conclusions and clinical importance: Caloric restriction, using a therapeutic diabetic diet suitable for weight reduction increased the probability of remission and improved glycemic control in overweight diabetic cats.

The management of diabetes mellitus (DM) in cats can benefit from an integration of medical and nutritional strategies, based on an understanding of the dynamic nature of the disease, together with an appreciation of the interrelationships between nutritional status and clinical status. In this context, a new classification system for feline DM is proposed, comprising three clinical status categories: those at risk of developing DM, those with clinical DM and those in diabetic remission. The influence of individual dietary components (carbohydrate, protein, fat and water fractions) on clinical outcomes is discussed, followed by overarching principles for the dietary management of diabetic cats, based on both the limited scientific evidence and the clinical experience of the authors. Key aspects of nutritional assessment, the principles of therapeutic weight reduction and feeding practices are covered. Using the classification framework, recommendations for nutritional management are proposed for cats at risk of development of DM, cats with clinical DM and those in clinical remission. Successful implementation of these recommendations can be achieved by using a relationship-centred approach, where owner concerns are addressed and goals for management are agreed in partnership. It is hoped that these perspectives will help guide veterinary professionals in their clinical management decisions, thereby improving health outcomes in cats in all three categories of DM.