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Pioglitazone Treatment for Fat Cats

Clinician's Brief (Capsule)

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Diabetes mellitus in cats is often compared with human type 2 diabetes. Pioglitazone, a thiazolidinedione oral insulin sensitizer used in human type 2 diabetics, up-regulates the nuclear transcription factor PPAR-γ, which increases whole body insulin sensitivity and promotes adipocyte uptake and storage of circulating lipids.

This prospective, placebo-controlled 3-way crossover study investigated the effects of pioglitazone on insulin sensitivity and lipid metabolism in obese cats. Obese cats (n = 12) received 7 weeks of each treatment: oral placebo, 1 mg/kg pioglitazone, and 3 mg/kg pioglitazone. Each treatment was followed by a 7-week washout, and each cat received 3 treatments. IV glucose tolerance testing (IVGTT) was performed and serum insulin, nonesterified fatty acids (NEFAs), adiponectin, and leptin measured. Results showed that pioglitazone at 3 mg/kg, as compared with 1 mg/kg and the placebo, significantly increased insulin sensitivity and adiponectin levels and lowered plasma triglycerides and cholesterol. Both pioglitazone doses enhanced NEFA suppression during IVGTT as compared with controls. No adverse effects were noted on physical, laboratory, or echocardiographic examination of study cats. The authors concluded that pioglitazone at 3 mg/kg q24h improves insulin sensitivity and lipid metabolism in obese cats. 

Commentary

For cats with absolute insulin deficiency, pioglitazone is not likely effective, as it requires the presence of insulin to work. However, even in insulin-dependent cats, it may lower the dose requirement. Of particular interest is potential pioglitazone use in cats with hepatic lipidosis. The alterations in lipid metabolism documented in healthy but obese study cats with this disease may prove helpful in reducing illness severity. It will be interesting to see how pioglitazone works in patients with diabetes mellitus and hepatic lipidosis. However, it is important to stress the importance of maintaining a healthy weight in cats, as no drug can replace the benefit of eliminating feline obesity.—Jennifer Ginn, DVM, DACVIM

Source

Effects of pioglitazone on insulin sensitivity and serum lipids in obese cats. Clark M, Thomaset K, Dirikolu L, et al. JVIM 28:166-174, 2014.

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