Journal watch1 April 2026
Author(s): S. Taylor, M. Cannon, D. Church, L. Fleeman, F. Fracassi, C. Gilor, J. Mott and S. Niessen
Published in: Journal of Feline Medicine and Surgery
Date: November 2025
DOI: https://doi.org/10.1177/1098612X251399103
Type of access: Open access (click for full article)
Our summary
The aim of these consensus guidelines is to provide practitioners with easy-to-access practical information regarding the pathogenesis, diagnosis, treatment and monitoring of diabetes mellitus (DM) in cats.
The guidelines are based on the available literature, as well as the opinions and experiences of a panel of experts brought together by the International Cat Care (iCatCare) Veterinary Society. The information featured in them builds on the 2015 ISFM consensus guidelines on DM, with a significant update being the use of the agreed terminology and standardised scoring system for DM diagnosis established by the ‘Agreeing Language in Veterinary Endocrinology’ (ALIVE) project, the inclusion of sodium–glucose cotransporter-2 inhibitor (SGLT2i) and continuous glucose monitoring.
The guidelines start by discussing the pathogenesis and risk factors for feline DM, as well as methods to predict, identify, achieve and prolong remission in diabetic cats. They also provide information on different underlying causes of insulin resistance, highlighting the importance of screening for conditions such as hypersomatotropism (HST) in order to improve patient outcomes.
The following section addresses the clinical signs and diagnosis of DM, delineating the ALIVE criteria for diagnosis of feline diabetes mellitus. The guidelines then cover different methods of managing the condition, starting with the initial assessment of a cat diagnosed with DM, and branching off into guidance for insulin therapy, sodium–glucose cotransporter-2 inhibitor (SGLT2i) therapy as an alternative to insulin, as well as less common options. These sections also provide information on the spectrum of care for feline DM and methods of communicating with caregivers, stressing that each diabetic cat and caregiver will have individual management requirements and will require a flexible, adaptable team approach.
The guidelines feature practical tips on feeding cats with DM, encouraging a slow transition to a low-carbohydrate wet food diet whenever appropriate. They also explore different methods of monitoring glycaemic control in cats, providing information on continuous glucose monitoring (CGM) devices, single blood glucose measurements, home blood glucose monitoring, and monitoring changes in glycated proteins. Guidance on achieving good glycaemic control and avoiding over-regulation when monitoring only using clinical signs using ALIVE Diabetic Clinical Score is also included.
The final sections cover possible complications of DM such as diabetic ketoacidosis (DKA), euglycaemic diabetic ketoacidosis (eDKA), glycaemic variability, and hypoglycaemia. They address possible comorbidities with DM and considerations for performing anaesthesia or sedation for diabetic cats.
Supplementary material provided by the guidelines include the guides ‘Nursing the cat with diabetes mellitus’ and ‘Managing the diabetic cat: a guide for caregivers’, a video demonstrating how to check an ear tip blood glucose measurement in a cat, and a Diabetic Clinical Score chart for caregivers and the veterinary team.
A limitation of the guidelines is the lack of an explicit statement of the methodology used to compile the information, or any explicit grading of the published evidence. The guidelines are also limited by gaps in the research on feline diabetes mellitus, specifically in regard to prediabetes in cats and the use of GLP-1 receptor agonists as a treatment for feline DM.
Take home
These consensus guidelines provide practitioners with an overview of the current knowledge on the diagnosis and management of diabetes mellitus in cats, as well as a range of supplementary materials for both veterinary practitioners and caregivers.
The following may also be of interest
Supplementary information
Diabetic Clinical Score chart for caregivers and the veterinary team. [iCatCare] [Online] Available from: https://journals.sagepub.com/doi/suppl/10.1177/1098612X251399103/suppl_file/sj-pdf-1-jfm-10.1177_1098612x251399103.pdf [Accessed 1 April 2026]
Managing the diabetic cat: a guide for caregivers. [iCatCare] [Online] Available from: https://journals.sagepub.com/doi/suppl/10.1177/1098612X251399103/suppl_file/sj-pdf-2-jfm-10.1177_1098612x251399103.pdf [Accessed 1 April 2026]
Nursing the cat with diabetes mellitus. [iCatCare] [Online] Available from: https://journals.sagepub.com/doi/suppl/10.1177/1098612X251399103/suppl_file/sj-pdf-3-jfm-10.1177_1098612x251399103.pdf [Accessed 1 April 2026]
Links to other resources
Journal watch: Frequency of diabetic remission, predictors of remission and survival in cats using a low-cost, moderate-intensity, home-monitoring protocol and twice-daily glargine. [RCVS Knowledge] [Online] Available from: https://www.rcvsknowledge.org/resource/frequency-of-diabetic-remission-predictors-of-remission-and-survival-in-cats-using-a-low-cost-moderate-intensity-home-monitoring-protocol-and-twice-daily-glargine/ [Accessed 1 April 2026]
Evidence collection: Caregiver burden and the client perspective on veterinary care. [RCVS Knowledge] [Online] Available from: https://www.rcvsknowledge.org/resource/caregiver-burden-and-the-client-perspective-on-veterinary-care/#client-perspective-and-caregiver-burden-in-specific-conditions [Accessed 1 April 2026]
Mejias, Y.G. (2021) Insulin choice in feline diabetes mellitus. Veterinary Evidence, 6 (3). https://doi.org/10.18849/ve.v6i3.407
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