2018 AAHA Diabetes Management Guidelines for Dogs and Cats
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Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM.
Practitioners will find several items or topics in the updated DM guidelines to be particularly relevant. These include:
- Quick-reference algorithms on responding to hypoglycemia, DM monitoring, and DM troubleshooting.
- New information on commercially available insulin formulations and recommendations for their use in dogs and cats.
- Recommendations for home monitoring of DM, a disease management approach that can contribute substantially to a favorable treatment response.
- Information on non-insulin therapeutic agents and treatment modalities such as dietary management.
- The implications of identifying patients at risk for developing DM and how to monitor and treat them.
An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.
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ALP (alkaline phosphatase); BG (blood glucose); BGC (blood glucose curve); BP (blood pressure); CBC (complete blood count); DM (diabetes mellitus); HAC (hyperadrenocorticism); NPH (Neutral Protamine Hagedorn); PD (polydipsia); PP(polyphagia); PU (polyuria); PZI (protamine zinc insulin); T4 (thyroxine); U (units); UG (urine glucose); UPC (urine protein:creatinine ratio)
These guidelines were prepared by a task force of experts convened by AAHA. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience.
Note: When selecting products, veterinarians have a choice among those formulated for humans and those developed and approved by veterinary use. Manufacturers of veterinary-specific products spend resources to have their products reviewed and approved by the FDA for canine or feline use. These products are specifically designed and formulated for dogs and cats and have benefits for their use; they are not human generic products. AAHA suggests that veterinary professionals make every effort to use veterinary FDA-approved products and base their inventory-purchasing decisions on what product is most beneficial to the patient.