Chetoacidosi diabetica nel cane e nel gatto: nuove prospettive terapeutiche e strumenti di monitoraggio

Complications induced by treatment of diabetic ketoacidosis (DKA) usually result from overly aggressive therapy, inadequate animal monitoring, and failure to reevaluate biochemical parameters in a timely manner. The thesis is divided into 6 studies focusing on new therapeutic and monitoring approaches during DKA treatment. Chapter 2 is an introduction to the topic and summarizes the current state of the art on DKA. Chapter 3 reports a study aimed at investigating the efficacy and safety of intravenous infusion of Lispro insulin in cats demonstrating that its use is associated with few side effects and the same effectiveness compared to regular insulin. Next up, two studies investigated the accuracy and precision of a glucometer (Gluco Calea, WellioVet) and a glucose-ketones meter (Belua, WellioVet) in dogs (Chapter 4) and cats (Chapter 5). Neither device is sufficiently accurate for use in dogs, while the superior performance of Belua glucometer support its clinical use in cats. In recent years, there has been great interest in devices measuring interstitial glucose. The aims of the study in Chapter 6 were to assess the performance of the FreeStyle Libre in dogs with DKA, and to determine the effect of body condition score (BCS), lactate concentration, severity of ketosis and acidosis on its accuracy. Although the ISO 15197:2013 criteria being only partially fulfilled, the clinical accuracy of the FreeStyle, unaffected by metabolic variables, supports its use. The effect of BCS requires further investigation. Finally, the thesis reports a study whose objective was to investigate which parameter between urinary acetoacetate (AcAc) and blood 3-beta-hydroxybutyrate (3-HB) was more suitable to define the end-point for insulin therapy during the treatment of DKA in dogs. The use of blood 3-HB does not reduce the time of insulin infusion and the time of hospitalization (Chapter 7).