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& Elliott, 2007 ; Katz & Bailey, 2012 ). Dexamethasone administered orally at 0.08 mg/kg in horses once daily for 7 days worsened ID in healthy light- breed horses (Timko et al., 2022 ). For equids with hyperinsulinaemia and asthma, the use of inhaled corticosteroids is preferred over enteral or other parenteral routes as they are less systemically available (Rush et al., 1998 ). Given the potential welfare implications if HAL were to develop following corticosteroid use, it would seem prudent to assess the insulin status of previously lami- nitic horses or those at high risk for ID prior to initiating treatment (Knowles, 2018 ).
CONCLUSION
Laminitis associated with high insulin concentrations poses a daily challenge in clinical practice. Measurement of serum insulin concen- tration is not only critical in the diagnosis of hyperinsulinaemia but also in monitoring response to diet, management and medication. The OST offers clinicians a simple dynamic test to assess hyperinsu- linaemia, which can be easily performed in the field. Low- sugar feeds and forages which reduce the post- prandial insulinaemic response and exercise to improve tissue insulin sensitivity are the foundations of managing horses with EMS. Increasingly, pharmaceuticals are used as an adjunct to reduce insulin concentrations more rapidly and improve the welfare of horses suffering from HAL but there remains a lack of clinical data on their use, particularly in the longer term.
AUTHOR CONTRIBUTIONS Tania Sundra: Conceptualization; writing – original draft; writing – review and editing. Gabriele Rossi: Writing – review and editing. David Rendle: Writing – original draft; writing – review and editing. Guy Lester: Writing – original draft; writing – review and editing.
ACKNO WLE DGE MENTS Open access publishing facilitated by Murdoch University, as part of the Wiley - Murdoch University agreement via the Council of Australian University Librarians.
FUNDING INFORMATION No funding was received.
CONFLICT OF INTEREST STATEMENT D. Rendle provides consultancy services to BOVA who produce an extemporaneous ertugliflozin paste specifically for horses. T. Sundra has received subsidised travel expenses to CPD events organised by BOVA.
ETHICS STATEMENT Not applicable to this review article.
ORCID Tania Sundra
https://orcid.org/0000-0003-0556-4406 David Rendle
https://orcid.org/0000-0001-6943-6425
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