AAHA 2018 Guidelines for Managing Diabetes with 2022 update

[Sienne and Gabby (GA)]

Please see this link to the most recent AAHA Guidelines

These guidelines were updated in 2022 to include information on continuous glucose monitors (CGMs) such as the Freestyle Libre. This is a link to information on the specifics of what is included in the update. (Thank you @Chris & China (GA).)

From Jill & Alec's (GA) post:
Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM.

These guidelines were prepared by a Task Force of experts convened by the American Animal Hospital Association. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience.

Practitioners will find several items or topics in the updated DM guidelines to be particularly relevant. These include:

• Quick-reference algorithms on responding to hypoglycemia, DM monitoring, and DM troubleshooting.
• New information on commercially available insulin formulations and recommendations for their use in dogs and cats.
• Recommendations for home monitoring of DM, a disease management approach that can contribute substantially to a favorable treatment response.
• Information on non-insulin therapeutic agents and treatment modalities such as dietary management.
• The implications of identifying patients at risk for developing DM and how to monitor and treat them.

An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.

AAHA Diabetes Management Task Force:
Ellen Behrend, VMD, PhD, DACVIM
Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama

Amy Holford, VMD, DACVIM†
Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee

Patty Lathan, VMD, DACVIM
Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi

Renee Rucinsky, DVM, DABVP†
Mid Atlantic Cat Hospital, Queenstown, Maryland

Rhonda Schulman, DVM, DACVIM
Animal Specialty Group, Los Angeles, California

†A. Holford and R. Rucinsky were cochairs of the Diabetes Management Guidelines Task Force.

Contributing Reviewers:
Audrey Cook, BVM&S, MRCVS, DACVIM, DECVIM-CA, DABVP (Feline)
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, Texas

Lawren Durocher-Babek, DVM, MS, DACVIM
Red Bank Veterinary Hospital, Hillsborough, New Jersey

Correspondence: guidelines@aaha.org

ALP (alkaline phosphatase); BG (blood glucose); BGC (blood glucose curve); BP (blood pressure); CBC (complete blood count); DM (diabetes mellitus); HAC (hyperadrenocorticism); NPH (Neutral Protamine Hagedorn); PD (polydipsia); PP (polyphagia); PU (polyuria); PZI (protamine zinc insulin); T4 (thyroxine); U (units); UG (urine glucose); UPC (urine protein:creatinine ratio)