Introduction and Abbreviations and Acronyms
A substantial number of cats develop diabetes mellitus (DM), a serious endocrine disorder that can lead to other physiologic complications. While DM management can be complex, successful control that alleviates the patient’s clinical signs and avoids hypoglycemia is achievable in most cats. Diabetic remission is also possible. The 2026 AAHA Diabetes Management Guidelines for Cats retain clinically relevant information from the 2018 AAHA Diabetes Management Guidelines and present new findings and expert opinions. Subjects such as pathophysiology, diagnosis, how to treat and monitor cats receiving SGLT2 inhibitors, various insulin options for cats, how to monitor cats receiving insulin, diet and physical activity recommendations, advantages and disadvantages of at-home glucose monitoring devices, diagnosing and treating diabetic ketoacidosis, and client education are all discussed. The guidelines also cover how to identify patients who are at risk of developing DM and how to differentiate DM from transient or mild hyperglycemia.
Introduction
Diabetes mellitus (DM) can be successfully managed in cats but requires an up-to-date understanding of feline diabetes pathophysiology and a thorough grasp of how to incorporate new treatments into therapeutic approaches. Staying informed about emerging treatment options is crucial. Diabetic feline patients need diligent clinical, observational, and diagnostic assessments and individualized treatment and monitoring plans. Rewarding diabetes management is intertwined with committed client education and communication.
These guidelines retain clinically relevant information from the 2018 AAHA Diabetes Management Guidelines 1 and present new findings and expert opinion on diagnosing, treating, and monitoring diabetes mellitus in cats, recognizing at-risk patients, and identifying patients with hyperglycemia who do not require diabetic treatment. The refreshed reorganization of these guidelines separates the feline and canine content into two distinct publications to provide veterinarians with an easier reference to managing the disease in each species.
These guidelines cover SGLT2 (sodium-glucose cotransporter 2) inhibitor drugs, a newly approved drug class for use with newly diagnosed diabetic cats, as well as traditional and new insulin formulations for cats and when and how to use each. Easy-to-use at-home monitoring tools such as continuous glucose monitors (CGMs) and glucometers and methods to help detect abnormalities in urine are highlighted. The guidelines also feature new or updated algorithms, tables, and boxes for quick reference on a variety of topics including managing hypoglycemia, addressing diabetic ketoacidosis, and troubleshooting suboptimal responses to therapy. Dietary management is also discussed, and key points in client education on treatment and monitoring, including the financial and time commitments and lifestyle changes, are emphasized.
Abbreviations
ALP, alkaline phosphatase; BG, blood glucose; BGC, blood glucose curve; BHB, beta-hydroxybutyrate; BP, blood pressure; CBC, complete blood count; CGM, continuous glucose monitor; DKA, diabetic ketoacidosis; DM, diabetes mellitus; EDKA, euglycemic diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HAC, hyperadrenocorticism; HbA1C, hemoglobin A1C; HC, hypercortisolism; IM, intramuscular; IGF-1, insulin-like growth factor 1; IR, insulin resistance; ME, metabolizable energy; NPH, neutral protamine Hagedorn; PD, polydipsia; PBGM, portable blood glucose monitor; PP, polyphagia; PU, polyuria; PZI, protamine zinc recombinant human insulin; SGLT2, sodium-glucose cotransporter 2; SQ, subcutaneous; TT4, total thyroxine; U, units; UG, urine glucose
The 2026 AAHA Diabetes Management Guidelines for Cats are generously supported by Adapet Medical, Boehringer Ingelheim, Dechra, and Merck Animal Health.
Citations
- Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2018;54(1):1–21.