Focus on the epidemiology, pathophysiology, diagnosis, and management of insulin dysregulation in horses
Authors: Olumide Odunayo Akinniyi
Journal: Nutrition and Food Processing
Summary
# Editorial Summary: Insulin Dysregulation in Equine Metabolic Syndrome Insulin dysregulation (ID) has become the preferred terminology for describing equine metabolic syndrome, encompassing the spectrum of inter-related insulin metabolic disturbances that culminate in hyperinsulinaemia and pose significant laminitis risk. This 2024 review synthesises current evidence on the epidemiology, pathophysiology, diagnostic protocols, and management strategies for ID, with particular emphasis on sedentary horses where the condition appears more prevalent. Diagnostic assessment should follow a staged approach beginning with basal testing (baseline insulin and glucose values) progressing to dynamic tests that identify tissue insulin resistance and hyperinsulinaemic status. Management priorities centre on dietary restriction to approximately 1.25% of body weight daily combined with individually tailored exercise programmes that improve insulin sensitivity, whilst pharmacological intervention with metformin hydrochloride and levothyroxine sodium may accelerate weight loss in cases refractory to conventional management or where laminitis constrains exercise capacity. Understanding the aetiological, pathophysiological, and diagnostic nuances of insulin dysregulation is essential for equine professionals seeking to prevent clinical laminitis progression and optimise metabolic health across diverse equine populations.
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Practical Takeaways
- •Screen sedentary horses for insulin dysregulation using staged diagnostic approach (basal insulin/glucose followed by dynamic testing) to prevent laminitis development
- •Implement weight management as first-line treatment: restrict feed to ~1.25% body weight daily combined with individualized exercise programs tailored to horse's fitness level and breed
- •Consider pharmacological support (metformin, levothyroxine) for obese horses unable to exercise due to laminitis or those not responding adequately to diet and exercise alone
Key Findings
- •Insulin dysregulation is widespread in horses and appears more prevalent in physically sedentary horses
- •Laminitis and hyperinsulinaemia are directly linked as components of insulin dysregulation
- •Dietary management to 1.25% body weight daily combined with exercise is the primary treatment for EMS-related insulin dysregulation
- •Metformin hydrochloride and levothyroxine sodium can accelerate weight loss and improve insulin sensitivity when exercise and diet alone are insufficient