Feline diabetes mellitus: Advancements in treatment and the role of the veterinary team

Feline diabetes mellitus (feline DM) has been recognized in veterinary medicine since the 1970s, with a significant increase in prevalence correlated with trends in feline obesity and sedentary lifestyles, particularly noted since the 1990s. While the veterinary field has managed feline diabetes for several decades, it was not until the early 2000s that synthetic long-acting insulin analogs such as glargine (Lantus;Sanofi) and detemir (Levemir;Novo Nordisk) became widely utilized. These formulations have contributed significantly to improved glycemic regulation and quality of life in diabetic feline patients.

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In the last 5 years, further advancements have emerged with the introduction of oral hypoglycemic agents, notably the sodium-glucose cotransporter 2 (SGLT2) inhibitors bexagliflozin (Bexacat;Elanco) and velagliflozin (Senvelgo; Boehringer Ingelheim). However, current guidelines generally recommend that these agents be used only after initial management with injectable insulin, due to the potential for complications such as diabetic ketoacidosis if the patient is misclassified or poorly monitored.

Given the increasing complexity of available treatment options, it is imperative to evaluate each feline diabetic patient holistically, considering not only the pathophysiology of the disease but also the capacity of the caregiver and veterinary team to support ongoing disease management. Historically, feline DM was conceptualized primarily as an insulin-deficiency disorder; however, it is now widely understood to resemble human Type 2 diabetes, characterized by peripheral insulin resistance and progressive pancreatic beta-cell dysfunction.

Client communication and individualized care

Effective diabetes management begins with a thorough and empathetic conversation between the veterinary team and the pet caregiver. Diabetes mellitus is a chronic, multifactorial condition that necessitates sustained client education, regular monitoring, and collaborative decision-making. Many of the clinical signs, such as polyuria, polydipsia, weight loss, and lethargy, are non-specific and may be initially misattributed to other conditions. Thus, clear and early communication is critical for both diagnosis and ongoing care.

Each case must be approached individually, as clients vary widely in their financial capacity, emotional resilience, and physical ability to manage a diabetic cat. Some clients may be comfortable administering injectable medications, while others may have limitations—visual impairment, needle phobia, or handling difficulties with a reactive or fearful cat—that necessitate alternative treatment strategies. Identifying these barriers early can guide the development of realistic, personalized treatment plans.

The role of the veterinary team

Successful management of feline DM requires a coordinated, team-based approach. The client service representatives (CSRs) serve as the initial point of contact, often fielding inquiries from owners who may be unaware of the severity of their pet’s condition. Proper training enables CSRs to triage appropriately and escalate potential emergencies to the veterinary technical or clinical team when needed. Additionally, proactive scheduling of follow-up diagnostics and appointments by CSRs is essential for maintaining continuity of care.

Technicians play a critical role in diagnostics, client education, and treatment implementation. Their responsibilities include collecting comprehensive medical histories, performing initial assessments, obtaining diagnostic samples, and supporting the veterinarian in interpreting results. Importantly, technicians often act as the primary educators for at-home diabetes care, such as demonstrating glucose monitoring, explaining insulin administration, or helping troubleshoot challenges related to in-home care and medication compliance.

Veterinarians are responsible for guiding the clinical decision-making process, which includes identifying comorbidities that may influence insulin sensitivity, such as hyperthyroidism, pancreatitis, acromegaly, formulating diagnostic and treatment plans, and communicating prognosis and treatment goals. Tiered care options—ranging from ideal treatment protocols to financially or logistically constrained alternatives—should be presented without judgment, enabling clients to make informed decisions within their means.

Addressing barriers to compliance

Non-compliance in diabetic management is a common challenge and may stem from financial constraints, emotional stress, physical limitations, or misunderstanding of the disease. Rather than viewing non-compliance as failure, it should be approached as an opportunity for problem-solving and improved communication. Open-ended questioning—such as asking clients what they feel capable of managing—can uncover underlying barriers and lead to more sustainable care plans.

Client education should be iterative and reinforced at each visit. Educational materials, visual aids, and follow-up calls or check-ins can reinforce key concepts and provide ongoing support. Empowering clients to monitor their cat’s clinical signs and glucose levels at home increases their confidence and allows for early intervention if glycemic control deteriorates.

Quality of life and long-term management

An essential aspect of managing feline diabetes is the ongoing evaluation of quality of life—for both the patient and the caregiver. Clients should be counseled that while some cats may enter remission, others will require lifelong management. The emotional investment required should not be underestimated, and periodic reevaluation of the treatment plan may be necessary as the disease progresses or as other comorbid conditions develop.

Clear communication, shared decision-making, and flexibility in treatment approaches are vital. The veterinary team should set realistic expectations and remain responsive to changing circumstances, always centering the conversation on improving the cat’s quality of life and supporting the caregiver’s ability to provide care.

Conclusion

Feline diabetes is a dynamic and increasingly manageable condition, provided that the veterinary team and pet caregiver collaborate effectively. As treatment options evolve, so too must our strategies for communication, education, and client support. By embracing a team-based, client-centered approach, veterinary professionals can improve outcomes for diabetic cats and reduce the burden of care on their owners. Early intervention, continuous education, and a commitment to flexibility are key to successful, long-term management.