Received: 20 September 2023 DOI: 10.1111/eve.13938
R E V I EW A R T I C L E
A practical approach to hyperinsulinaemia in horses with equine metabolic syndrome
Tania Sundra 1,2 | Gabriele Rossi 2 | David Rendle 3
1 Avon Ridge Equine Veterinary Services , Brigadoon , Western Australia , Australia 2 School of Veterinary Medicine , Murdoch University , Murdoch , Western Australia , Australia 3 EMT Consulting Tiverton , Devon , UK 4 Equiimed , Perth , Western Australia , Australia
Correspondence: Tania Sundra Email:
info@avonridgeequine.com.au
| Guy Lester 4
Summary Laminitis associated with hyperinsulinaemia is a significant cause of morbidity and mor- tality in horses with equine metabolic syndrome. The diagnosis and management of hy- perinsulinaemia are therefore critical to prevent the development of laminitis. This review article aims to help primary care clinicians manage patients with hyperinsulinaemia by providing an overview of diagnostics, management strategies and new therapies that are available.
K E YWORDS iaminitis , insulin , sglt2 inhibitor
| Accepted: 3 December 2023
INTRODUCTION
Laminitis associated with insulin dysregulation (ID) is commonly en- countered in equine practice and poses a significant threat to equine welfare (Ireland et al., 2011 ). ID is defined as either basal hyperinsu- linaemia, post- prandial hyperinsulinaemia, tissue insulin resistance or a combination thereof (Frank & Tadros, 2014 ). Hyperinsulinaemia is defined as the circulation of inappropriately high concentrations of insulin, whereas tissue insulin resistance refers to the inability of tissues to adequately respond to insulin (Lebovitz, 2001 ; Suagee et al., 2011 ). Horses with post- prandial hyperinsulinaemia demon- strate an exaggerated insulin response to ingested carbohydrates, which may or may not be present with tissue insulin resistance (de Laat, Hampson, et al., 2016 ; de Laat, McGree, & Sillence, 2016 ). The exact mechanism by which hyperinsulinaemia causes lami-
nitis remains unclear. However, experimental studies have demon- strated that exogenous administration of insulin induces laminitis in normal horses (Asplin et al., 2007 ; de Laat et al., 2010 ). Recent reports indicate that hyperinsulinaemia is not only a reliable predic- tor of future risk of laminitis but is also central to the development of hyperinsulinaemia- associated laminitis (HAL) in horses and ponies with EMS (Knowles, Elliott, et al., 2023 ; Knowles, Harris, et al., 2023 ). The diagnosis of hyperinsulinaemia is pivotal in identifying horses
with EMS, and strategies to reduce serum insulin concentration are fundamental in preventing and managing cases of HAL (de Laat & Sillence, 2020 ; Durham et al., 2019 ). Dietary modification to reduce the insulinaemic response and exercise to improve insulin sensitiv- ity form the cornerstone of managing horses with EMS (Durham et al., 2019 ). However, in severely affected animals, management alone may not be effective in aiding recovery or preventing future episodes of HAL, and medications might be warranted to reduce suf- fering from laminitis (Sundra, Kelty, & Rendle, 2023 ; Sundra, Lester, et al., 2023 ).
Diagnosis
Measurement of serum insulin concentration is important in the diagnosis, management and prevention of HAL (EEG, 2022 ). While experimental studies have demonstrated that insulin concentrations exceeding 200 μU/mL were associated with the development of laminitis (Asplin et al., 2007 ; de Laat et al., 2010 ), the exact threshold concentration of insulin required to cause laminitis in a clinical set- ting is yet to be determined. It is likely that the insulin threshold at which lamellar damage occurs varies between horses, and individual factors such as previous episodes of laminitis, genetics, age and
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. Equine Veterinary Education published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Equine Vet Educ. 2024;36:325–336.
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