Forums » Internal Medicine - Small Animal

Diabetes and Obesity - Future Treatment Options Look Promising

  • August 16, 2016 12:40 PM EDT

    Can daily insulin injections in veterinary patients be replaced by a single, once-a-month injectable option? Could there be an injection that helps to treat obesity? Pilot studies have been done and more are underway. This week we have exciting information to share with you from the 2016 ACVIM Forum.

    If you watch television or browse popular magazines, then you know that insulin alternatives are already an option for human diabetic patients. You can hardly watch television or pick up a periodical without seeing an advertisement for alternative treatment options for type 2 (non-insulin dependent) diabetes mellitus in people.

    These are incretin-based therapies and their evolution as a treatment option for non-insulin dependent diabetes mellitus is an interesting one. Much was learned about incretin hormones through monitoring and studies of human patients that have undergone gastric bypass surgery. After gastric bypass surgery, patients have been shown to have increased levels of incretin hormones post-prandially, improved pancreatic beta-cell activity and increased sensitivity to insulin.  In fact, concurrent type 2 diabetes may resolve in up to 84% of obese patients that undergo gastric bypass surgery. It's been reported that up to one third of patients may be euglycemic within just 3 days of surgery.

    What are incretins? Incretins are hormones that are secreted in response to the presence of nutrients in the GI tract. Specifically, GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide 1) are secreted from cells in the intestines. GIP is secreted from K cells in the duodenum and GLP-1 is secreted from L cells in the ileum. 

    The effects of incretins include:

    • Insulinotropic effects - increase insulin biosynthesis, glucose-dependent insulin secretion, and sensitivity to insulin
    • [GLP-1] Delays gastric emptying and appetite, promotes weight loss, and inhibits glucagon secretion

    In this week's Specialty Update we summarize information that was reported from studies of incretin-based therapies in healthy and diabetic cats. Commercially available incretin-based therapies including drugs like Byetta®, Bydureon®, and Victoza® are discussed including their effects on appetite, body weight, and blood glucose control.

    View this Specialty Update (running time: 8 mins)

    Additional References:

    1)  A Placebo-Controlled Study on the Effects of the Glucagon-Like Peptide-1 Mimetic, Exenatide, on Insulin Secretion, Body Composition and Adipokines in Obese, Client-Owned Cats

    2) Pharmacology of the glucagon-like peptide-1 analog exenatide extended-release in healthy cats

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

    • 148 posts
    August 17, 2016 12:13 PM EDT

    This topic - presented by Dr. Gilor at the 2016 ACVIM Forum - really is fascinating. I knew little to nothing about incretins. It was great to learn about them, how incretin-based therapies came about in humans, and the early studies looking at incretin-based therapies for treating diabetes and obesity in our veterinary patients - at this stage, in cats.  

    Viewers of this Specialty Update are likely to wonder whether or not these therapies have applications in dogs. This question was asked of Dr. Gilor and he indicated that applications of incretin-based therapies for dogs may be investigated in the future, but that the expense of these commercially available products may make these therapies prohibitive for use in dogs. In addition, these drugs are targeted for treating type 2 diabetes mellitus, and therefore, are less likely to be effective in treating diabetes in dogs.