Diabetes Technology and Pets: A Market of the Future?

Diabetes is a widespread disease amongst animals; the focus here is on dogs and cats. There are estimates that 900 million dogs and 600 million cats live on the earth (www.kbvresearch.com). For countries like the United States, the estimates are 85 million dogs and 62 million cats, for Europe the numbers are 90 million dogs and 120 cats, and the number of such pet with diabetes is growing. It is assumed that 1.2% of the dogs in Europe will develop diabetes during their lifetime and 0.4% of the cats. In other words, a rough guess is that 1 million dogs in Europe have diabetes and 0.5 million cats. A different question is, if all these animals get a correct diabetes diagnosis and are treated adequately. Most probably, in many cases, this is not the case. Nevertheless, the global pet diabetes care device market is assumed to be $1.9 billion in 2021 and is projected to reach $3.5 billion by 2031, with a Compound annual growth rate (CAGR) of 8.3% from 2022 to 2031. The largest market is North Amerika; however, the fastest growing is Asia-Pacific. With respect to the increase in the number of dogs and cats, this might be driven by overfeeding, insufficient exercise etc, but also by genetic background. Dogs usually get type 1 diabetes and rarely type 2 diabetes, while cats can get either type 1 or type 2 diabetes. Clearly, diabetes is more common in older pets, like in humans.

Dogs and cats with diabetes will be treated most often by a veterinarian and diabetes treatment appears to be a hot topic in animal medicine, one can find numerous respective articles in journals and conferences focusing on animal treatment. Diabetes treatment in dogs and cats is similar to that in humans, ie, insulin administration in pets with type 1 diabetes and treatment with diet/insulin in those with type 2 diabetes. For obvious reasons, some companies that are active in treatment of patients with diabetes, are also active in animal treatment, eg, Sanofi.

Interestingly enough it is more difficult to find information about how the dose of antidiabetic treatment is adjusted to the individual needs of the pet, ie, is it adjusted to the current blood glucose (BG) level of the animal or is a fixed dose given? A literature search (diabetes technology AND animals, with a focus on the last years) provides only 37 hits, many of these do not truly provide relevant information; however, below some publications are presented about glucose monitoring and insulin administration in dogs and cats.

A BG measurement with a conventional BG measurement system requires collecting a drop of blood from an ear vein or a footpad. ¹ This comes along with a certain amount of stress for the animals and their owners.

To avoid this painful procedure and provide more constant information about the glucose profile of the animals, a system for continuous glucose monitoring (CGM) can be used.^2-10 However, fixation of a CGM system to the skin requires shaving a good portion of the fur and good fixation, otherwise, the dog or cat will remove the sensor. Grow of the hairs of the fur can result in losing the sensor within days. Insertion of the glucose sensor can be an undertaking in itself. Depending on the type of CGM system used, additional BG measurements have to be performed for calibration. One option to avoid the handling issues with the glucose sensor of the CGM systems most often used in humans, a CGM system would be used which relies on an implanted glucose sensor. No report about the usage of systems for Automated Insulin Delivery in pets could be found.

It appears as if with horse’s diabetes is not a big topic; however, like in human athletes, the glucose information provided by CGM systems can be used for optimizing the performance of racehorses. CGM systems are also in dairy cows. ¹¹

As antidiabetic treatment dogs and cats get subcutaneous injections of long-acting insulin formulations^12,13; however, also administration of Glucagon-Like Peptides-1 receptor agonists is an option.^14,15 In most animals up to now the therapeutic target is to avoid diabetes ketoacidosis (DKA) and not optimization of glucose control. Animals are known to have high postprandial glucose excursions, usage of CGM should help to detect these and optimize insulin treatment, if one is willing to do such additional efforts. CGM recordings might also help to detect and avoid acute glucose deteriorations, eg, hypoglycemic events. No report about the usage of insulin pumps in dogs or cats could be found.

Apparently, no regulatory approval is needed in Europe for the usage of medical products in animals; however, in the United States, this market is more strictly regulated. The costs for diabetes technology products (ignoring that for the antidiabetic treatment) are covered by the owners, they can sum up to several hundred Euros per year.

The usage of diabetes technology in animals like dogs and cats appears to be no big topic yet, at least not much was published about this topic yet. Nevertheless, one can assume that this will change, probably also driven by the development of glucose monitoring systems and insulin application devices designed especially for this purpose.