Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival
Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival
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DOI：
10.1186/s40575-020-00087-7
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发表时间：
2020-06-10
影响因子：
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通讯作者：
Brodbelt DC
中科院分区：
文献类型：
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作者：
Heeley AM;O’Neill DG;Davison LJ;Church DB;Corless EK;Brodbelt DC
糖尿病（Diabetes mellitus，DM）是犬的一种重要内分泌疾病。本研究的目的是估计糖尿病的患病率和发病率在狗，并探讨糖尿病的危险因素和糖尿病病例的生存在英国的初级保健诊所。在430家VetCompass诊所就诊的≥3岁犬队列（n = 480，469）中进行了一项病例对照研究，采用多变量logistic回归确定DM的风险因素。2016年共确定了409例新发和863例既存DM病例（共计1272例），得出≥3岁犬的表观年患病率为0.26%（95%置信区间（CI）：0.25-0.28%），年发病率风险为0.09%（95% CI：0.08-0.09%）。与糖尿病诊断几率增加相关的因素是所有年龄组> 8岁，雌性整只犬（比值比（OR）：3.03，95% CI 1.69-5.44，p < 0.001）和雄性绝育犬（OR：1.99，95% CI 1.18-3.34，p = 0.010）与雄性完整犬相比，边境梗（OR：3.37，95% CI 1.04-10.98，p = 0.043）和西部高地白色梗（WHWT）（OR：2.88，95% CI 1.49-5.56，p = 0.002）相比，杂交品种。既往接受糖皮质激素治疗的犬（OR：2.19，95% CI 1.02-4.70，p = 0.044）和伴有并发症（记录的肥胖、胰腺炎、肾上腺皮质功能亢进）的犬也增加了DM诊断的几率。使用考克斯回归模型评估了2016年409例糖尿病病例中与生存相关的因素。在≥ 10岁的犬、可卡犬中，诊断为DM后的死亡风险增加（HR：2.06，95% CI 1.06-4.01，p = 0.034）与杂交种相比，诊断时血糖（BG）水平> 40 mmol/L（HR：2.73，95% CI 1.35-5.55，p = 0.005），与诊断时< 20 mmol/L或既往接受过糖皮质激素治疗（HR：1.86，95% CI 1.21-2.86，p = 0.005）相比。死亡风险降低的犬包括绝育犬（HR：0.58，95% CI 0.42-0.79，p = 0.001）、边境牧羊犬（HR：0.39，95% CI 0.17-0.87，p = 0.022）和开始胰岛素治疗的犬（HR：0.08，95% CI 0.05-0.12，p < 0.001）。某些品种和并发的健康状况与糖尿病风险增加有关。除了某些显著因素外，诊断时高血糖水平和既往糖皮质激素治疗与DM犬的生存率存在不良相关性。
Diabetes mellitus (DM) is an important endocrine disorder of dogs. The objectives of this study were to estimate prevalence and incidence of DM in dogs, and to explore risk factors for DM and the survival of DM cases in primary-care clinics in the UK. A case-control study nested in the cohort of dogs (n = 480,469) aged ≥3 years presenting at 430 VetCompass clinics was used to identify risk factors for DM, using multivariable logistic regression. Overall 409 new and 863 pre-existing DM cases (total 1272) were identified in 2016, giving an apparent annual prevalence of 0.26% (95% confidence interval (CI): 0.25–0.28%), and an annual incidence risk of 0.09% (95%CI: 0.08–0.09%) in dogs aged ≥3 years. Factors associated with increased odds for DM diagnosis were all age categories > 8 years, female entire dogs (odds ratio (OR): 3.03, 95% CI 1.69–5.44, p < 0.001) and male neutered dogs (OR: 1.99, 95% CI 1.18–3.34, p = 0.010) compared to male entire dogs, Border Terriers (OR: 3.37, 95% CI 1.04–10.98, p = 0.043) and West Highland White Terriers (WHWT) (OR: 2.88, 95% CI 1.49–5.56, p = 0.002) compared to crossbreeds. Dogs that had received previous glucocorticoid treatment (OR: 2.19, 95% CI 1.02–4.70, p = 0.044) and those with concurrent conditions (documented obese, pancreatitis, hyperadrenocorticism) also had increased odds for DM diagnosis. Cox regression modelling was used to evaluate factors associated with survival in the 409 incident DM cases in 2016. Increased hazard of death following diagnosis of DM was shown in dogs that were ≥ 10 years age, Cocker Spaniels (HR: 2.06, 95% CI 1.06–4.01, p = 0.034) compared to crossbreeds, had a blood glucose (BG) level at diagnosis > 40 mmol/L (HR: 2.73, 95% CI 1.35–5.55, p = 0.005) compared to < 20 mmol/L at diagnosis, or had received previous glucocorticoid treatment (HR: 1.86, 95% CI 1.21–2.86, p = 0.005). Dogs at reduced hazard of death included neutered dogs (HR: 0.58, 95% CI 0.42–0.79, p = 0.001), Border Collies (HR: 0.39, 95% CI 0.17–0.87, p = 0.022) and those starting insulin treatment (HR: 0.08 95% CI 0.05–0.12, p < 0.001). Certain breeds and concurrent health conditions are associated with an increased risk of DM. In addition to certain signalment factors, a high BG level at diagnosis and prior glucocorticoid treatment were adversely associated with survival of dogs with DM.