Outcomes & Quality of Life in Cats With Diabetes Mellitus

Andrew Sparkes, BVetMed, PhD, DECVIM, MANZCVS, MRCVS, Simply Feline Veterinary Consultancy, Dorset, United Kingdom

ArticleLast Updated September 20233 min read
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In the Literature

Rothlin-Zachrisson N, Öhlund M, Röcklinsberg H, Ström Holst B. Survival, remission, and quality of life in diabetic cats. J Vet Intern Med. 2023;37(1):58-69. doi:10.1111/jvim.16625

The Research …

This study explored factors associated with survival time, remission, and quality of life in 477 cats diagnosed with diabetes mellitus (DM) between 2009 and 2013, as well as impact on pet owners. Owners were retrospectively identified from a Swedish insurance database and asked to complete an online questionnaire. A 35% response rate yielded 477 analyzable questionnaires.

Mean patient age at diagnosis was 10.7 years, with 71% males and 29% females. Most (77%) cats were nonpedigree. Treatments included dietary changes (93%), insulin (89%), and/or oral hypoglycemics (7%). Of cats receiving insulin, 56% of owners practiced home blood glucose monitoring, and 31% did not practice blood or urine glucose monitoring.

Of the 477 cats, 15% were euthanized within 4 weeks of diagnosis, and 85% survived ≥4 weeks; 63% of all cats survived >1 year, and 25% survived >3 years. Factors significantly and positively associated with survival beyond 4 weeks were a lack of negative impact on cat quality of life, owner lifestyle limitations, and owner concerns about complications. Factors significantly associated with overall survival times were insulin therapy, cat quality of life, and owner concerns about medication.

Twenty-nine percent of cats surviving >4 weeks went into remission; however, 38% experienced relapse. Factors significantly associated with remission included breed (Norwegian forest cats versus domestic cats), maintenance or improvement of cat quality of life, and feeding of a commercial low-carbohydrate wet diet rather than a therapeutic DM diet. Diet and quality of life were also significantly associated with cats that did not relapse.

Of the 144 cats still alive at the time of the questionnaire, 97% were assessed as having excellent or good quality of life, with quality of life being better than before DM diagnosis in 16% and worse in 10%. Of the 333 cats that died, 44% were assessed as having worse quality of life after diagnosis of DM, compared with 4% having better quality of life following diagnosis. Factors significantly associated with maintained or improved quality of life were treatment with insulin and achieving remission without relapse.

… The Takeaways

Key pearls to put into practice:

  • Considerable caution should be used when interpreting the results of this study, as many confounding factors existed, including a strong possibility of selection bias and recall bias (most cats were deceased at the time of the study); lack of information on concomitant disease, glycemic control, and other important details; sole reliance on owner-supplied information and interpretation; and lack of established tools to measure quality of life.

  • Confounding factors may help explain some of the surprising or unexpected findings, indicate caution in putting too much reliance on the results, and suggest that further, more detailed research in this area is needed.

  • Despite a 15% euthanasia rate reported within the first 4 weeks after DM diagnosis, 63% of cats survived >1 year, and 25% survived >3 years. Many owners also subjectively considered their cats to have good quality of life during treatment.

  • Careful discussions with owners are warranted after a cat is diagnosed with DM. Prognosis, treatment options, effects of the disease on both cat and owner lifestyle and quality of life, and possible complications from the disease and treatments should be acknowledged.