New developments in companion animal endocrinology: impact on 2017 and beyond

This means that we as clinicians need to step out of our busy routines (and comfort zones) to invest some time into familiarising ourselves with these new kids on the block. We also need to satisfy ourselves that we are happy to recommend their usage over possible alternatives to our trusting clients and pets.

New insulin type for diabetic cats

2016 saw the launch of a human recombinant protamine zinc insulin, named ProZinc, licensed for use in diabetic cats.

The Royal Veterinary College’s Diabetic Remission Clinic performed essential clinical trials ahead of the introduction of ProZinc onto the UK and wider European and Asian market. Our judgement on the basis of using it for 4 years in the largest randomised clinical trials ever to be conducted with insulin types in veterinary medicine: we are a fan of its use in diabetic cats.

Traditionally, the main bottleneck in the effectiveness of exogenous insulin types in diabetic cats has been their duration of action. For unknown reasons most insulins in cats have a shorter duration than needed and shorter duration than in most diabetic dogs and humans. This is one of the reasons why human synthetic insulin analogues like glargine and detemir have become increasingly popular in recent years, showing on average, a longer duration of action than the, until recently, only veterinary licensed option porcine lente insulin, Caninsulin.

Glargine: cat insulin of choice?

Early good glycaemic control, for which one needs a decent duration of action, has been associated with increased diabetic remission rates in cats; for this reason, rightly or wrongly, insulin glargine became known as the ‘diabetic cat insulin of choice’ for many across the world. However, a negative consequence has therefore been the increased use of non-veterinary licensed insulin types in our cats.

Apart from the legal issues under the cascade system, any drug marketed solely for use in humans suffers from a lack of an active species-specific pharmacovigilance programme. The latter safeguards the health of the animals under our care through ongoing monitoring for, and communication of, any quality and safety issues of such insulin type relevant to our target species.

Additionally, dynamics in the (non-veterinary) pharmacological market can lead to undesirable effects on availability and prices of human-only licensed drugs for our non-human patients. The recent price hikes of glargine are a good example of this, causing much distress, inconvenience and at times ill-health effects.

A tool in our toolbox

Coming back to the good news: the arrival of ProZinc as a veterinary licensed long-acting insulin type means we now have another official tool in our toolbox when it comes to feline diabetes management and one that has been shown to be comparable to glargine in duration of action and remission rates.

New treatment for Addison’s disease in dogs

It has been a bit of a whirlwind when it comes to developments in the treatment of canine hypoadrenocorticism. The past year saw the discontinuation of fludrocortisone preparation, Florinef, initially leaving only a much more expensive unlicensed and relatively untested alternative preparation.

Fortunately, we also saw the long awaited introduction of veterinary-licensed injectable mineralocorticoid desoxycortone pivalate, Zycortal.

Tailor-made treatment for Addisonian patients

A few important aspects need to be borne in mind when first using this drug in Addisonian patients. For example, a glucocorticoid should always be used alongside Zycortal (which is only a mineralocorticoid) to provide complete supplementation of all lacking endogenous hormones. This is a distinct difference with the fludrocortisone (a mineralocorticoid with some glucocorticoid activity) we previously used in the UK, where quite often the additional glucocorticoid could be discontinued given fludrocortisone’s intrinsic gluco- and mineralocorticoid activity.

However, providing separate gluco- and mineralocorticoid supplementation will now enable us to tailor-make the treatment for each Addisonian patient in terms of exact amounts of needed gluco- and mineralocorticoid. This is especially important when trying to avoid side-effects in patients very sensitive to glucocorticoids (which there are more of than most realise!).

Mobile phone and tablet app to manage pet diabetes

Last year also saw the start of a new movement in companion animal medicine; the integration of technology, often focusing on improving pet owner involvement, in managing pet health. The modern veterinary practice could really separate itself from the rest by seizing these new opportunities.

The Royal Veterinary College (RVC), with the support of the Rumba Foundation, launched a revolutionary Pet Diabetes App. The free app aims to help pet owners control their pet’s diabetes whilst also helping to aid continual research into the condition.

The Pet Diabetes App joins the RVC Epilepsy App in the frontline of a quiet pet health app revolution.

Find out more about companion animal endocrinology

Additional aspects to the use of the above-mentioned new drugs, as well as many other practically relevant novel developments in companion animal endocrinology will be discussed in the upcoming CPD course Endocrine case management in practice – key updates on common scenarios on 16 February 2017. See you there?