Longitudinal Evaluation of Serum Pancreatic Enzymes and Ultrasonographic Findings in Diabetic Cats Without Clinically Relevant Pancreatitis at Diagnosis

Abstract

BackgroundCats with diabetes mellitus can have subclinical pancreatitis but prospective studies to confirm this are lacking. Metabolic control of diabetic cats with pancreatitis is difficult.HypothesisSubclinical pancreatitis occurs in diabetic cats at the time diabetes is diagnosed or might develop during the follow‐up period, hampering diabetic remission.AnimalsThirty cats with newly diagnosed diabetes without clinical signs of pancreatitis on admission.MethodsProspective study. On admission and 2 and 6 months later, serum Spec fPL and DGGR‐lipase were measured and the pancreas underwent ultrasonographic examination. Pancreatitis was suspected if serum markers were increased or ≥2 ultrasonographic abnormalities were detected. Cats were treated with insulin glargine and diabetic remission was defined as euglycemia ≥4 weeks after discontinuation of insulin. Nonparametric statistical tests were used for analysis.ResultsSubclinical pancreatitis at the time of diagnosis was suspected in 33, 50, and 31% of cats based on Spec fPL, DGGR‐lipase and ultrasonography, respectively; and in 60% when diagnostic criteria were combined. During the follow‐up period, suspected pancreatitis developed in additional 17–30% cats. Only 1 cat had transient clinical signs compatible with pancreatitis. Seventeen of the 30 cats (57%) achieved remission. Frequency of abnormal Spec fPL and DGGR‐lipase and abnormal ultrasonographic findings did not differ in cats achieving remission and those who did not. Cats achieving remission had significantly lower Spec fPL at 2 months (P < .001).Conclusions and Clinical ImportanceBased on laboratory and ultrasonographic measurements, many cats with diabetes might have pancreatitis, although without clinical signs. Cats with high Spec fPL might have a reduced chance of diabetic remission; however, this topic needs further studies in large cohorts of diabetic cats.

Effect of the Glucagon‐like Peptide‐1 Analogue Exenatide Extended Release in Cats with Newly Diagnosed Diabetes Mellitus

“…To our knowledge, a possible association between incretin‐based treatment and pancreatitis in cats has not been investigated. Previous investigations showed that many cats with DM may have subclinical pancreatitis . In our study, some cats treated with exenatide ER had clinical signs compatible with pancreatitis that included decreased appetite and vomiting, but only 1 (8.3%) cat with normal baseline Spec fPL and DGGR‐lipase concentrations had an increase in Spec fPL concentration during treatment.…”

What's in a Name? Classification of Diabetes Mellitus in Veterinary Medicine and Why It Matters

“…Diabetes mellitus in cats often is associated with abnormalities in serum markers of exocrine pancreatic disease . A weak positive correlation between feline pancreatic lipase activity (fPLI) and serum fructosamine was reported in cats with DM, suggesting that subclinical pancreatitis might cause inadequate glycemic control .…”

“…Alternatively, inadequate glycemic control (reflected by increased serum fructosamine) might cause ongoing damage to the exocrine pancreas (reflected by increased fPLI), as suggested by an experimental study in which pancreatic neutrophils increased in healthy cats with experimentally induced hyperglycemia . The fact that most diabetic cats with increased fPLI do not have gastrointestinal signs and are not less likely to achieve remission further argues in favor of inadequate glycemic control as the cause of increased fPLI . Similarly, T2DM in people is considered a risk factor for pancreatitis .…”

Exocrine Pancreas in Cats With Diabetes Mellitus

“…The morphologic scoring system 5 used in the present investigation led to diagnose acute or chronic pancreatitis in more than half of the diabetic and control cats, suggesting that pancreatic inflammation is very common in this species. However, identification of pancreatitis is often difficult in living cats, 18 and its clinical diagnosis was achieved in only 1 diabetic cat. Therefore, in light of the large discrepancy observed between the frequency of histopathologic and clinical diagnosis of pancreatitis, the significance of the adopted scoring system 5 remains uncertain, and the term pancreatitis might have been misleading for some cases.…”

“…One of our studies revealed that about 60% of diabetic cats (18 of 30) had suspected pancreatitis at the time of initial diagnosis, based on increased activity of serum 1,2-o-dilauryl-rac-glycero-3-glutaric-acid-6 0 -methylresorufin ester lipase, increased feline pancreas-specific lipase activity, or the presence of ultrasonographic abnormalities of the pancreas. 18 In addition, diabetic cats with increased feline pancreas-specific lipase values were less likely to achieve clinical remission of DM, which suggests that glycemic control may be more difficult when pancreatitis is present, despite appropriate therapy. Histopathologic evaluation of the pancreas was not carried out in any of those clinical studies.…”