An ultra-long-acting recombinant insulin for the treatment of diabetes mellitus in cats

Diabetes mellitus (DM) is a common endocrinopathy in cats, and its treatment relies upon the SC injection of insulin once- or twice-daily, along with dietary modification. In the majority of cats this is a life-long treatment.

It is known that in people, increasing frequency of any drug has decreased adherence to treatment protocol. It is anticipated that these problems are also noted in owners having to inject their own pets.

For cat owners, twice daily injections, and the feeding schedules it requires, have a big impact on their quality of life and their pets’. This type of treatment is a major cause of anxiety in owners, including worrying about having their cat cared by others.

Currently, insulin formulations have time-action profiles suitable for use as once- or twice-daily SC injections. In a recent study, it was presented a new form of insulin formulation (AKS-267c) that would only require once-weekly injections. The active molecule in this formulation is a fusion of synthetic insulin and the feline fragment crystallizable (Fc) region of immunoglobulins. Once-weekly injections would likely allow for greater treatment success by improving quality of life for pet and owner, and therefore increasing patient survival.

In this 2021 study, cats with naturally occurring DM were transitioned from the common insulin injections to this novel formulation of fusion insulin. Glycemic control, body weight and clinical signs management were achieved in 7 weeks of treatment, without adverse effects or clinical hypoglycemia, offering the owners and cats considerable benefits.

This ultra-long formula should be considered with caution, especially when nearing euglycemia status and with newly diagnosed cats in which glucolipotoxicity could lead to increased insulin sensitivity, putting them at risk of ketoacidosis.

However, this new formula seems to be beneficial decreasing between-day glycemia variability, making it easier and cheaper to monitor long-term. It will be important to develop feline specific continuous glucose monitoring protocols, in order to maximize its use. It is also important to develop protocols for introduction of this therapy in newly diagnosed cats, and for cats that need to transition from standard insulin to fusion insulin.

Gilor, C, Hulsebosch, SE, Pires, J, Bannasch, MJ, Lancaster, T, Delpero, A, Ragupathy, R, Murikipudi, S, Zion, T, An ultra-long-acting recombinant insulin for the treatment of diabetes mellitus in cats, J Vet Intern Med. 2021;35:2123–2130. DOI: 10.1111/jvim.16150