Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit. Agents in the sodium glucose co-transporter-2 inhibitor (SGLT-2) class demonstrate the greatest promise in correcting hyperglycaemia, but there are safety concerns in relation to the risk of diabetic ketoacidosis. Glucagon-like peptide-1 agonists (GLP-1) show a modest effect on glycaemia, if any, but significantly reduce weight, which may make them suitable for use in overweight T1DM patients. Treatment with pramlintide is not widely available worldwide, although there is evidence to indicate that this agent reduces both HbA1c and weight in T1DM. A criticism of adjuvant studies is the heavy reliance on HbA1c as the primary endpoint while generally ignoring other glycaemic parameters. Moreover, vascular risk markers and measures of insulin resistance—important considerations in individuals with a longer T1DM duration—are yet to be fully investigated following adjuvant therapies. Finally, studies to date have made the assumption that T1DM patients are a homogeneous group of individuals who respond similarly to adjuvant therapies, which is unlikely to be the case. Future longer-term adjuvant studies investigating different glycaemic parameters, surrogate vascular markers and harder clinical outcomes will refine our understanding of the roles of such therapies in various subgroups of T1DM patients

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements

Objective-To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements. Design-Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas. Procedures-A telephone survey was administered to dog and cat owners. Results-Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least I dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculoskeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used. Conclusions and Clinical Relevance-Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people