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Acta veterinaria Scandinavica2018; 60(1); 4; doi: 10.1186/s13028-018-0358-8

Retrospective analysis of insulin responses to standard dosed oral glucose tests (OGTs) via naso-gastric tubing towards definition of an objective cut-off value.

Abstract: Insulin dysregulation (ID) with basal or postprandial hyperinsulinemia is one of the key findings in horses and ponies suffering from the equine metabolic syndrome (EMS). Assessment of ID can easily be performed in clinical settings by the use of oral glucose challenge tests. Oral glucose test (OGT) performed with 1 g/kg bodyweight (BW) glucose administered via naso-gastric tube allows the exact administration of a defined glucose dosage in a short time. However, reliable cut-off values have not been available so far. Therefore, the aim of the study was to describe variations in insulin response to OGT via naso-gastric tubing and to provide a clinical useful cut-off value for ID when using the insulin quantification performed with an equine-optimized insulin enzyme-linked immunosorbent assay. Results: Data visualization revealed no clear separation in the serum insulin concentration of insulin sensitive and insulin dysregulated horses during OGT. Therefore, a model based clustering method was used to circumvent the use of an arbitrary limit for categorization. This method considered all data-points for the classification, taking into account the individual insulin trajectory during the OGT. With this method two clusters were differentiated, one with low and one with high insulin responses during OGT. The cluster of individuals with low insulin response was consistently detected, independently of the initialization parameters of the algorithm. In this cluster the 97.5% quantile of insulin is 110 µLU/mL at 120 min. We suggest using this insulin concentration of 110 µLU/mL as a cut-off value for samples obtained at 120 min in OGT. Conclusions: OGT performed with 1 g/kg BW glucose and administration via naso-gastric tubing can easily be performed under clinical settings. Application of the cut-off value of 110 µLU/mL at 120 min allows assessment of ID in horses.
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Publication Date: 2018-01-19 PubMed ID: 29351765PubMed Central: PMC5775575DOI: 10.1186/s13028-018-0358-8Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article is mainly about defining a reliable cut-off point for an oral glucose test (OGT) conducted via naso-gastric tubing to diagnose insulin dysregulation (ID) in horses.

Research topic and objective

  • The research is focused on the common issue of Insulin Dysregulation (ID) in horses and ponies, which is typically characterized by basal or post-meal high insulin levels, and is symptomatic of Equine Metabolic Syndrome (EMS).
  • The oral glucose test (OGT) is a method used to assess ID in clinical settings – the test is performed by administering a fixed dosage of glucose (1g per kg of body weight) via a naso-gastric tube.
  • One of the problems with the OGT is that there has been no reliable cut-off point established in the past, which the researchers aim to accomplish in this study.

The study method and results

  • The researchers aimed to detail variations in insulin responses following an OGT conducted via naso-gastric tubing and find a useful clinical cut-off value to determine ID.
  • The test employed an equine-optimized insulin enzyme-linked immunosorbent assay for insulin quantification.
  • Visualization of data revealed no clear distinct separation in the serum insulin concentrations of insulin sensitive and insulin dysregulated horses during the OGT.
  • To overcome the lack of a clear distinction, the researchers used a model-based clustering method – a technique that considered all data points for categorization, and factored in unique insulin trajectories during the OGT.
  • This method identified two clusters of horses: one with low insulin responses and another with high insulin responses.
  • The researchers have proposed an insulin concentration of 110 µLU/mL at 120 minutes as a cut-off point based on consistent results from the cluster of horses exhibiting low insulin response.

Conclusions and applications

  • The study has demonstrated that the OGT performed with a glucose dosage of 1 g per kg body weight via naso-gastric tubing is a feasible method for clinical settings.
  • The defined cut-off value of 110 µLU/mL at 120 minutes provides a useful measure for assessing ID in horses, thereby aiding efficient diagnosis and management of EMS in horses.

Cite This Article

APA
Warnken T, Delarocque J, Schumacher S, Huber K, Feige K. (2018). Retrospective analysis of insulin responses to standard dosed oral glucose tests (OGTs) via naso-gastric tubing towards definition of an objective cut-off value. Acta Vet Scand, 60(1), 4. https://doi.org/10.1186/s13028-018-0358-8

Publication

Acta veterinaria Scandinavica
ISSN: 1751-0147
NlmUniqueID: 0370400
Country: England
Language: English
Volume: 60
Issue: 1
Pages: 4
PII: 4

Researcher Affiliations

Warnken, Tobias
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany. tobias.warnken@tiho-hannover.de.
Delarocque, Julien
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.
Schumacher, Svenja
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.
Huber, Korinna
  • Institute of Animal Science, Faculty of Agricultural Sciences, University of Hohenheim, Fruwirthstraße 35, 70593, Stuttgart, Germany.
Feige, Karsten
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.

MeSH Terms

  • Animals
  • Blood Glucose / analysis
  • Enzyme-Linked Immunosorbent Assay / veterinary
  • Glucose / administration & dosage
  • Glucose Tolerance Test / veterinary
  • Horses
  • Hyperinsulinism / diagnosis
  • Hyperinsulinism / veterinary
  • Insulin / blood
  • Intubation, Gastrointestinal / veterinary
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / veterinary
  • Retrospective Studies

Grant Funding

  • 43055830 / Boehringer Ingelheim Vetmedica GmbH

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Citations

This article has been cited 6 times.
  1. Delarocque J, Feige K, Carslake HB, Durham AE, Fey K, Warnken T. Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses. Animals (Basel) 2023 Aug 24;13(17).
    doi: 10.3390/ani13172704pubmed: 37684968google scholar: lookup
  2. de Tonnerre DJ, Medina Torres CE, Stefanovski D, Robinson MA, Kemp KL, Bertin FR, van Eps AW. Effect of sirolimus on insulin dynamics in horses. J Vet Intern Med 2023 Mar;37(2):703-712.
    doi: 10.1111/jvim.16650pubmed: 36840433google scholar: lookup
  3. Warnken T, Schaub C, Delarocque J, Frers F, Feige K, Sonntag J, Reiche DB. Palatability, glycemic, and insulinemic responses to various carbohydrate formulations: Alternatives for the diagnosis of insulin dysregulation in horses?. J Vet Intern Med 2023 Jan;37(1):282-291.
    doi: 10.1111/jvim.16614pubmed: 36625459google scholar: lookup
  4. de Laat MA, Warnken T, Delarocque J, Reiche DB, Grob AJ, Feige K, Carslake HB, Durham AE, Sillence MN, Thane KE, Frank N, Brojer J, Lindase S, Sonntag J. Carbohydrate pellets to assess insulin dysregulation in horses. J Vet Intern Med 2023 Jan;37(1):302-314.
    doi: 10.1111/jvim.16621pubmed: 36583553google scholar: lookup
  5. Leung YH, Kenéz Á, Grob AJ, Feige K, Warnken T. Associations of plasma sphingolipid profiles with insulin response during oral glucose testing in Icelandic horses. J Vet Intern Med 2021 Jul;35(4):2009-2018.
    doi: 10.1111/jvim.16200pubmed: 34105193google scholar: lookup
  6. Durham AE, Frank N, McGowan CM, Menzies-Gow NJ, Roelfsema E, Vervuert I, Feige K, Fey K. ECEIM consensus statement on equine metabolic syndrome. J Vet Intern Med 2019 Mar;33(2):335-349.
    doi: 10.1111/jvim.15423pubmed: 30724412google scholar: lookup
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