Section 9: Diabetic Remission

Diabetic remission (i.e, euglycemia maintained for >4 wk without exogenous insulin or oral hypoglycemic agents) routinely occurs in diabetic cats. This transition reflects recovery of beta-cell function and relies on the reversal of IR and glucose toxicity.¹ However, diabetic cats undergoing remission are not cured, because pancreatic insulin reserve is permanently limited and relapse is common.²

Approximately 25% of cats achieving remission did so in the 2-3 months following diagnosis, while a majority of cats achieved remission within 6 months.^3,4 Reported incidences vary and appear to be influenced by patient characteristics and management strategies; however, the task force supports using an average remission rate of approximately 30% in the United States. ⁵ Cats with reversible causes of IR, such as obesity or recent glucocorticoid administration, are more likely to undergo remission, assuming that adiposity is addressed or insulin-antagonizing medications are withdrawn or both.⁶ Promptly address other causes of IR such as dental disease, rather than postponing treatment until BG is adequately regulated. Canned high protein diets may also support remission by mitigating sarcopenia and boosting secretion of GLP-1, an incretin with a trophic effect on beta cells.^7,8 Cats with a history of DKA⁹ and/or peripheral neuropathy may undergo remission, with a 2024 study reporting similar rates of remission between cats with historic DKA (9.8%) and those with neuropathy (8.5%) at diagnosis.¹⁰ Cats with hypersomatotropism (acromegaly) are not expected to undergo remission without definitive treatment for the underlying condition.¹¹

For cats receiving insulin, diabetic remission is supported by effective glycemic control and indicated by a progressive decrease in insulin requirements or evidence of hypoglycemia.¹² Although some studies suggest that insulin type plays a key role, carefully monitoring and adjusting the treatment protocol to achieve good glycemic control within 6 months of DM diagnosis is probably more impactful than the product administered.

Remission onset is readily apparent if BG is routinely monitored, but remission may be overlooked in unmonitored cats until there are obvious signs of hypoglycemia. Urine glucose monitoring is less sensitive, but zero glucosuria for >48 hr suggests either excellent glycemic control or sustained hypoglycemia. Similarly, consider remission if serum fructosamine concentrations are within or below the reference range.

The incidence of remission for cats receiving an SGLT2 inhibitor has not been evaluated at this time. As these drugs cause persistent glucosuria irrespective of BG concentration and insulin secretion, the drug must be withheld to identify remission. If clients have cost concerns or want to assess if the SGLT2 drug is required long term, it is reasonable to check for remission after at least 90 days of therapy. Closely monitor BG with a CGM or 1–2 glucometer checks per day for at least a week; values >250 mg/dL with concurrent ongoing clinical signs indicate the need for continued treatment.¹³ Alternatively, clients can monitor urine at home, bearing in mind that it may take several days for the glucosuric effects of the drug to wear off and even short periods of hyperglycemia impact beta cell viability and drive apoptosis.^14,15 Cats that undergo remission but subsequently relapse often lose enough beta cells to ultimately require exogenous insulin permanently. Achieving a second remission is less common, with reported rates ranging between 0-22%.^16,17

Although further studies are needed to evaluate strategies for maintaining diabetic remission, diligent weight management and continued use of a canned low-carbohydrate diet are recommended for all cats.¹⁸ Additionally, relapses in cats previously treated with insulin may possibly be prevented by long-term use of an SGLT2 inhibitor (an extra-label use), although more research is needed. Physical examination with continued monitoring of clinical signs, weight, and appropriate laboratory evaluation every 6 mo may allow early detection of possible diabetic relapse.

The 2026 AAHA Diabetes Management Guidelines for Cats are generously supported by Adapet Medical, Boehringer Ingelheim, Dechra, and Merck Animal Health.