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 25-28 September, 2018 | Singapore
life of albumin. It reflects glucose levels over the 1-2 weeks before sampling. However, several factors, other than plasma glucose concentration, affect fructosamine concentration including hypoproteinemia, hyperlipidemia, and azotemia.3
Glycosylated haemoglobin (HbA1c) is a haemoglobin product with glucose attached to its N-terminal
amino acid valine. Glycosylation is irreversible, and concentration of HbA1c within the circulation is approximately 2–3 months, the lifespan of the red blood cell. Therefore, it may be a consideration for long-term control of stable diabetics, especially when the patient has comorbidities that affect turnover of fructosamine. Renewed interest has been shown in monitoring HbA1c, as unlike fructosamine, is associated with outcomes and therapeutic targets in humans. 4,5
1. iv) Blood glucose curves
A BGC should be performed on the introduction of a new type of insulin; when deciding on a dose change; one to two weeks after a dose change; three monthly
in stable diabetics; when clinical signs of DM recurs; or when hypoglycaemia is suspected. The goals of a BGC are to determine the duration of action of the insulin, the glucose nadir, and the range of BG throughout the day. Ideally, we aim for the duration of insulin effect to be 10– 12 h, BG nadir 100–150 mg/dl for the long-term diabetic pet, and average BG less than 250 mg/dl over that 10–12 h.1,5 However, that while these parameters are ideal, AAHA defines goals of diabetic monitoring to be control of clinical signs while avoiding hypoglycaemia.1 Also, there appears to be a considerable variation in serial BGCs in diabetic dogs, making curve interpretation and decision making difficult.6 Therefore, glycaemic control should not be based solely on these numbers. The AAHA recommends home BGCs where possible, as they are expected to be representative of the patient’s activity, and eliminates stress and associated influences.
BG monitoring should be based on methods
validated for dogs. The AlphaTrak 2 is the glucometer recommended for use in veterinary patients as it has been calibrated in dogs and cats.1,7 The preference is
to use whole blood with this glucometer to improve accuracy, rather than plasma or serum.8 The use of continuous and flash glucose monitoring systems
have also been described.9,10 These devices allow measurement of interstitial glucose and have shown good correlation to blood glucose within specific
ranges. 8,9 These systems provide advantages of allowing more frequent measurements, not requiring patient restraint and phlebotomy, and decreased cost to the client. It also improves the ease at which home glucose curves to be performed.
1. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2018; 54:1–21. DOI 10.5326/JAAHA-MS-6822
2. Briggs CE, Nelson RW, Feldman EC, Elliot DA, Niel LA. Reliability of history and physical examination findings for assessing control of glycemia in dogs with diabetes mellitus: 53 cases (1995-1998). J Am Vet Med Assoc. 2000; 217:48–53.
3. Danese E, Montagnana M, Nouvenne A, Lippi G. Advantages and Pitfalls of Fructosamine and Glycated Albumin in the Diagnosis and Treatment of Diabetes. J Diabetes Sci Technol. 2015;9:169-76. doi: 10.1177/1932296814567227
4. Ramsey A, Goemans AF, Spence SJ. Novel HbA1c Assay for the Monitoring of Canine Diabetes. 2017 ACVIM Forum Proceedings; June 8–9, National Harbor, Maryland. pg 1079-1080.
5. Krecic M. Monitoring of Diabetic Patients: Could We Do Better? 2017 ACVIM Forum Proceedings; June 8–9, National Harbor, Maryland. pg 1172-1173.
6. Fleeman LM, Rand JS. Evaluation of day-to-day variability of serial blood glucose concentration curves in diabetic dogs. J Am Vet Med Assoc. 2003; 222:317–21.
7. Cohen TA, Nelson RW, Kass PH, Christopher MM, Feldman EC. Evaluation of six portable blood glucose meters for measuring blood glucose concentration in dogs. J Am Vet Med Assoc 2009; 235: 276–80.
8. Behrend EN, Suchowersky ND, Carlson EA, Lee HP. Comparison between glucose measurements in canine whole blood, serum, and plasma. J Vet Intern Med 2017;31:1271–1272.
9. Corradini S, Pilosio B, Dondi F, Linari G, Testa S, Brugnoli F, Gianella P, Pietra M, Fracassi F. Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs. J Vet Intern Med 2016; 30: 983–988.
10. Wiedmeyer CE, DeClue AE. Continuous Glucose Monitoring in Dogs and Cats J Vet Intern Med. 2008; 22: 2–8.

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