Study links older age to early mortality and treatment gaps in feline diabetes

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A study presented at the 2025 American College of Veterinary Internal Medicine (ACVIM) Forum in Louisville, Kentucky, on 375 cats with a first lifetime diagnosis of diabetes in the United Kingdom found that age 15 years or greater was a risk factor for failure to receive antihyperglycemic therapy and early mortality (less than or equal to 30 days).¹ The research was presented by Oliver Waite, BVSc, MVetMed, DACVIM (SAIM), MRCVS, senior lecturer in small animal medicine at The Animal Hospital of Murdoch University in Western Australia, Australia.

Approximately 1 in 100 to 1 in 500 cats will be diagnosed with diabetes in their lifetime.² During his presentation, Waite shared that up to 10% of cats on high-dose prednisone may develop diabetes, with more than 85% of these patients developing the disease within 3 months of therapy.¹ He also noted that neutering males acts as a risk factor for developing diabetes.

Twenty percent of feline patients diagnosed with diabetes do not receive antihyperglycemic therapy.¹ “There's limited information describing these events, so there doesn't appear to be a lot of information pertaining patient signalment, presenting clinical signs, [or] laboratory tests performed at or around the time of diagnosis,” said Waite, speaking of the statistics of feline patients with diabetes who do not receive antihyperglycemic therapy.¹

Additionally, up to 20% of cats will die within 30 days following their first lifetime diagnosis of diabetes, although for this, there is also limited information explaining why, according to Waite. “It's even more...alarming when we look at how many cats are euthanized,” he said during his presentation. “Euthanasia is the overwhelming cause of mortality, and I suppose it would be the case that these cats are euthanized either because of their diabetes or because diabetes is part of their concurrent problem. But again, it's a little bit hard to kind of tease apart these cats—were they actually treated with antihyperglycemic therapy [and] died and or were [they] euthanized within [the treatment] period?”

The study, an anonymized retrospective cohort study, used electronic health records from VetCompass, a UK-based program that extracts and analyzes clinical data from veterinary practices in the country. Using this program, electronic health records from cats seeing UK veterinary primary care practices between January 1, 2019, and December 31, 2019, were identified and reviewed. Multivariable logistic regression and Cox proportional hazard models were then performed, including risk factors (p<0.2) associated with cats who were not receiving antihyperglycemic therapy and a ≤30 mortality (p>0.05).

According to Waite, the most common presenting clinical signs reported in the primary care practice electronic health records were polydipsia, weight loss, and polyuria. Signs associated with diabetic neuropathy or diabetic ketoacidosis were infrequently reported in the health records. Still, presenting clinical signs, comorbidities, and laboratory tests were not found to be associated with less than or equal to 30-day mortality.

More than 80% (n=310) of the cats in the study received antihyperglycemic therapy. Yet, approximately 10% of treated cats still suffered mortality within 30 days of diagnosis. Sixty-five did not receive antihyperglycemic therapy.

Being aged 15 years or older was identified as the only factor significantly associated with increased odds of not receiving antihyperglycemic therapy as well as increased mortality within 30 days after starting therapy in both analyses.

“We know that age is not a disease—it's something that we're all told...But here it's really hard to ignore [since] it appears to drastically influence decisions and outcomes to these patients,” said Waite.

Waite explained that this baseline information will be necessary to benchmark future outcomes, especially as new therapies like SGLT-2 inhibitors emerge. “We're going to need this baseline information to fall back on to decide how significant the use of SGLT2 inhibitors is in terms of improving patient quality of life [and] compliance, reducing morbidity and/or mortality,” he said.

References

1. Waite O. Risk Factors Against Treating Cats with Diabetes Mellitus and ≤30-day Survival After Starting Anti-Hyperglycaemic Therapy. Presented at: American College of Veterinary Internal Medicine (ACVIM) Forum; June 18-21, 2025. Louisville, KY.
2. Feline diabetes. Cornell University College of Veterinary Medicine. Accessed June 20, 2025. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-diabetes