Veterinary Medicine - May 2008 - (Page c14) Strategies for monitoring in dogs Assistant Professor of Small xxxx Animal Medicine College of Veterinary Medicine Kansas State University Manhattan, Kan. diabetes mellitus Thomas Schermerhorn, VMD, DACVIM (SAIM) Monitoring the e ectiveness of therapy is an important part of managing canine diabetes mellitus. The success of treatment for this disorder greatly depends on the complete cooperation of the pet owner, as the majority of day-to-day patient care is done at home. The pet owner must be trained to carefully observe and even interpret signs of possible illness. Monitoring must be frequent enough to be e ective, but not so frequent as to discourage client compliance. It is also essential to foster a strong veterinarian-client relationship at the time of diagnosis and maintain that relationship throughout the pet’s lifetime. The time and e ort the veterinarian devotes to client education will improve the client’s ability to accurately relate what is observed at home and to monitor the dog according to the veterinarian’s instructions—both of which facilitate the veterinarian’s ability to assess the long-term e cacy of treatment. Variables in choosing a monitoring program The goals of a monitoring program are improvement and maintenance of patient health through optimization of antidiabetic therapy and minimization of diabetic complications. Several published clinical reviews outline the various clinical and laboratory measures available to veterinarians for monitoring diabetic dogs.1,2 Unfortunately, few published studies are available to guide clinicians’ recommendations as to the best monitoring strategy to achieve these goals. An e ective monitoring strategy should provide su cient information and room for adjustments until the dog is free of clinical signs for the majority of each day. For example, a moderate monitoring program, the strategy veterinarians most commonly recommend, might have as its endpoint the suppression of clinical signs of diabetes. An intensive monitoring program, on the other hand, might gather the detailed physiologic and metabolic information needed to achieve speci c endpoints associated with excellent diabetic control. Evidence from human medicine indicates that intensive diabetic monitoring is associated with improved long-term results in clinical variables and reduced rates of diabetic complications. Unfortunately, intensive diabetic monitoring is also associated with a higher frequency of severe hypoglycemic episodes in people.3 A relationship between the optimization of clinical endpoints via intensive monitoring and improved clinical results has not been shown in veterinary medicine. Given the increased morbidity and diminished quality of life that might result from chronic or recurrent hypoglycemia, 14
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