Evaluation of Commonly Used Field-Testing Protocols to Diagnose Insulin Dysregulation and Investigate the Association with Laminitis in Ponies

Clark, Brianna; Stewart, Allison J.; Kemp, Kate L.; Bamford, N. J.; Bertin, Francois-Rene

doi:10.2139/ssrn.4243385

Cited by 3 publications

(6 citation statements)

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“…6 Dynamic tests for hyperinsulinaemia, such as the OST are considered superior to basal insulin concentration due to increased sensitivity, as they stimulate the enteroinsular axis. 30,31 Obesity was associated with IR, BHI and DHI, with ponies scoring ≥7/9 by their owners using a VAS, almost 10 times more likely to have ID. Interestingly, it was owner assessment of obesity using the VASo, rather than scoring of BCS by the study investigators, that was associated with ID.…”

Section: Discussionmentioning

confidence: 99%

“…Breed differences might explain the higher prevalence among our population of ponies, as ponies exhibit a higher incidence of ID than light‐breed horses 6 . Dynamic tests for hyperinsulinaemia, such as the OST are considered superior to basal insulin concentration due to increased sensitivity, as they stimulate the enteroinsular axis 30,31 …”

Section: Discussionmentioning

confidence: 99%

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Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia

Clark,

Norton,

Bamford

et al. 2024

Equine Veterinary Journal

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BackgroundInsulin dysregulation (ID) is central to equine metabolic syndrome. There are limited epidemiological studies investigating dynamic testing of ID in ponies.ObjectivesTo evaluate prevalence and risk factors for ID through dynamic testing of hyperinsulinaemia (DHI) and insulin resistance (IR).Study designCross‐sectional.MethodsSex, age, breed, height, cresty neck score (CNS), body condition score (BCS), laminitis, HMGA2:c.83G>A genotype and pituitary pars intermedia dysfunction (PPID) status were documented. Dynamic hyperinsulinaemia was diagnosed with an oral sugar test (OST) and IR with an insulin tolerance test (ITT). Owners completed surveys reporting activity, laminitis history and perception of body condition using a (1–9) visual analogue scale (VASo). Ordinal scores were converted to binary outcomes for CNS (≤2/5 or ≥3/5), BCS and VASo (≤6/9 or ≥7/9). Variables associated with insulin concentrations, glucose reduction after the ITT and laminitis were evaluated with mixed effects regression models accounting for random effects of farms.ResultsAmong 167 ponies tested, median (range) age was 9 (4–21) years and BCS was 6 (4–8). Prevalence (95% confidence interval [CI]) of ID was 61 (53–68)%. Factors associated with insulin concentrations (estimate [95% CI]; μIU/mL) 60 min post‐OST were: age (1.07 [1.02–1.11]), CNS (≥3/5, 1.52 [1.04–2.23]) and VASo (≥7/9, 1.75 [1.09–2.79]); and 90 min post‐OST were: age (1.08 [1.03–1.12]), CNS (≥3/5, 1.80 [1.22–2.64]), VASo (≥7/9, 2.49 [1.52–4.08]) and sex (male, 0.64 [0.45–0.91]). Factors associated with glucose reduction after the ITT (estimate [95% CI]; %) were: age (−1.34 [−2.01 to −0.67]), sex (female, −6.21 [−11.68 to −0.74]) and VASo (≥7/9, −1.74 [−18.89 to −4.78]). Factors associated with laminitis (odds ratio [95% CI]) were DHI (4.60 [1.68–12.58]), IR (3.66 [1.26–10.61]) and PPID (11.75 [1.54–89.40]).Main limitationsSingle time‐point sampling, laminitis definition and diet analysis.ConclusionsAgeing, being female and owner‐perceived obesity were associated with ID.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia

Clark,

Norton,

Bamford

et al. 2024

Equine Veterinary Journal

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“…Obesity is a common feature of horses with EMS but not all obese horses demonstrate hyperinsulinaemia (Durham et al., 2019). Conversely, while increases in BCS and cresty neck score are a common feature of hyperinsulinaemia, not all cases with hyperinsulinaemia demonstrate this phenotype (Clark et al., 2023;Knowles, Elliott, et al., 2023; Knowles, Harris, et al., 2023). While some horses do not appear obese on the outside, ultrasonographic evaluation might identify visceral or retroperitoneal fat deposits (Silva et al., 2016).…”

Section: Introductionmentioning

confidence: 99%

“…The choice of test and its diagnostic value depends on the clinical question that is being addressed. There is no single test that will diagnose hyperinsulinaemia in all horses (Clark et al., 2023; Frank & Tadros, 2014). Intravenous tests that assess the pancreatic response and peripheral insulin sensitivity are considered the ‘gold standard’ for the diagnosis of ID (Firshman & Valberg, 2007) but are not routinely performed in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study performed in non‐laminitic ponies demonstrated that measurement of insulin concentration 60 min after administration of corn syrup was an important predictor of future laminitis risk (Knowles, Elliott, et al., 2023; Knowles, Harris, et al., 2023). If time constraints pose a challenge in a field setting and if only one blood sample is possible, measurement of insulin at 60 minutes is recommended as it does not adversely affect the accuracy of the test (Clark et al., 2023). The interpretation of results to an OST is presented in Table 1.…”

Section: Introductionmentioning

confidence: 99%

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A practical approach to hyperinsulinaemia in horses with equine metabolic syndrome

Sundra,

Rossi,

Rendle

et al. 2024

Equine Veterinary Education

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SummaryLaminitis associated with hyperinsulinaemia is a significant cause of morbidity and mortality in horses with equine metabolic syndrome. The diagnosis and management of hyperinsulinaemia are therefore critical to prevent the development of laminitis. This review article aims to help primary care clinicians manage patients with hyperinsulinaemia by providing an overview of diagnostics, management strategies and new therapies that are available.

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Insect Bite Hypersensitivity in Horses: Causes, Diagnosis, Scoring and New Therapies

Cox

Stewart

2023

Animals

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Insect Bite Hypersensitivity (IBH, Queensland itch, sweet itch, equine summer eczema) is the most common pruritic disease of horses. It is most often caused by sensitivity to the saliva of Culicoides spp. of biting midges; however, it can also be caused by hypersensitivity to other insect species. The prevalence of IBH in horses is reported to be as high as 60% in some parts of the world. Due to the severe pruritus and effects of secondary self-trauma, IBH has animal welfare concerns, and there is currently no cure. Management of this condition is life-long, time consuming and costly. New grading systems to document disease severity are being validated, which will allow the comparison of clinical trial results of new and existing therapies. Management involves the minimisation of insect bites by use of stabling, fans, rugs and repellents. Symptomatic therapy involves the administration of systemic or topical corticosteroids, systemic antihistamines, and creams and sprays to promote skin healing and decrease inflammation. New immune-mediated therapeutics including vaccines, in addition to desensitisation procedures, show promise at controlling hypersensitivity reactions. This article will review aetiologic agents, pathophysiology, scoring systems and current and new therapies.

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Evaluation of Commonly Used Field-Testing Protocols to Diagnose Insulin Dysregulation and Investigate the Association with Laminitis in Ponies

Cited by 3 publications

References 0 publications

Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia

Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia

A practical approach to hyperinsulinaemia in horses with equine metabolic syndrome

Insect Bite Hypersensitivity in Horses: Causes, Diagnosis, Scoring and New Therapies

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