Equine Metabolic Syndrome: What the Research Says
Evidence from 80 peer-reviewed studies
1 Systematic Review
3 RCT
31 Cohort Study
13 Case Report
32 Expert Opinion
What Professionals Should Know
- •Diagnosis of insulin dysregulation should investigate both tissue insulin resistance and enteroinsular axis function rather than relying on single tests
- •Account for breed, diet, fasting status, and seasonal variations when interpreting insulin dysregulation test results to avoid false negatives in at-risk horses
- •Focus on identifying horses with insulin dysregulation early to enable preventive laminitis management, as established laminitis remains difficult to treat effectively
- •This supplement combination shows promise for managing metabolic dysfunction in EMS-affected ponies, with measurable improvements in insulin response and weight management over 60 days
- •Consider recommending this evidence-based supplementation approach as part of multimodal EMS management protocols, though results should be monitored individually on each farm
- •Weight loss achieved with supplementation (8.1 kg average) aligns with therapeutic goals for EMS; combine with appropriate diet and exercise management for optimal outcomes
- •Consider oligosaccharide supplementation as a potential dietary intervention for geldings with Equine Metabolic Syndrome and insulin dysregulation, particularly as a laminitis prevention strategy
- •Be aware that treatment response may differ between geldings and mares; this sex-dependent effect warrants further investigation before applying to all horses
- •Recognize that gut microbiota composition and diversity correlate with insulin status and laminitis history, suggesting microbiome assessment may help identify at-risk horses
- •Velagliflozin offers a pharmacological option for managing insulin dysregulation in ponies when dietary management alone is insufficient, with established safety profile over extended use
- •Practitioners should note this SGLT2 inhibitor requires daily oral dosing and response should be monitored via standardized feeding challenges rather than fasting insulin alone
- •Effects appear reversible upon withdrawal, suggesting the drug controls rather than resolves the underlying condition
- •Understanding the role of GIP in fat metabolism may help manage obese ponies and those at risk of laminitis through targeted dietary interventions
- •The strong postprandial response of insulin and GLP-1 to feeding suggests that meal timing and composition are critical factors in managing insulin dysregulation
- •Monitoring triglyceride levels may provide practical insight into GIP-mediated metabolic dysfunction in at-risk horses
- •Monitor older horses and predisposed breeds (particularly native ponies and Quarter Horse types) more closely for colic signs, as they carry substantially higher SLO risk
- •Horses with a history of laminitis warrant aggressive weight management and metabolic syndrome prevention strategies, as they face ~11-fold increased SLO risk
- •Minimize prolonged stabling and maintain optimal body weight through appropriate exercise and nutrition—these modifiable factors significantly reduce SLO risk in high-risk populations
- •Horses with a history of laminitis show exaggerated insulin responses to pasture grazing and oral sugar challenges; monitor these horses more closely during high-NSC seasons and consider restricted grazing or NSC-limiting diets
- •Regional adiposity (cresty neck score) correlates with insulin dysregulation in laminitis-prone horses; weight and condition management should be prioritized year-round to reduce metabolic risk
- •Monthly or seasonal insulin testing via oral sugar test may help identify at-risk horses earlier and guide nutritional interventions before clinical laminitis recurs
- •Activin A should not be relied upon as a screening tool for laminitis risk in pony populations—continue using established insulin testing protocols
- •Basal serum activin A testing does not add clinical value to existing metabolic assessments for laminitis prevention
- •Focus on traditional oral sugar tolerance testing and fasting insulin levels as evidence-based methods for identifying at-risk ponies
- •Advanced clinical signs (hair coat changes, laminitis, supraorbital fat) should prompt ACTH testing; however, absence of these signs does not rule out early PPID—more sensitive diagnostic biomarkers are needed.
- •Equids presenting with metabolic syndrome features alongside elevated ACTH require early intervention; the association suggests these phenotypes share underlying endocrine dysfunction.
- •Clinical assessment should evaluate sign combinations rather than isolated findings, as aggregated clinical patterns better predict high ACTH concentrations than individual observations.
- •Current EMS diagnosis relies on limited tools (basal insulin, OST); new plasma biomarkers may offer more reliable detection in field settings
- •Understanding EMS pathophysiology at the protein level may lead to better preventive strategies and earlier intervention before laminitis develops
- •Consider that multiple factors (diet, age, stress, season, medications) affect insulin testing—new biomarkers could provide more consistent results
- •Don't assume all overweight horses are metabolically abnormal—check insulin and glucose levels; obesity and hyperinsulinemia are independent risk factors requiring separate management strategies
- •Hyperinsulinemia appears to be the primary driver of metabolic dysfunction rather than weight alone; focus diagnostic and management efforts on insulin status regardless of body condition
- •Laminitis cases showed unexpected metabolic patterns (lower glucose, higher IGF-1); consider individual biochemical profiling rather than relying solely on body weight or condition scoring
- •Arthrospira-based feed additive enriched with chromium, magnesium, and manganese may help manage insulin resistance and weight in metabolically affected horses as part of a comprehensive EMS management program
- •This supplement shows promise for reducing inflammatory markers and improving body condition in horses with EMS, potentially reducing reliance on other management interventions
- •Consider this as a complementary strategy alongside diet management and exercise for horses struggling with metabolic syndrome
- •BCI offers a more objective and repeatable alternative to subjective body condition scoring, particularly useful for staff with limited experience in condition assessment
- •BCI appears more sensitive than traditional BCS for tracking weight changes in individual animals over time, supporting early detection of unwanted weight gain or loss
- •Current BCI method may need refinement for Shetland and miniature ponies due to their distinctive body proportions—use caution or seek validation before applying to these breeds
- •Obesity assessment in native-breed ponies should consider adiponectin status as part of metabolic syndrome evaluation, as dysregulation may contribute to laminitis risk independent of insulin alone
- •Weight management and metabolic monitoring are critical preventive strategies, as insulin dysregulation occurs in all affected animals and may be linked to adiponectin abnormalities
- •Veterinarians should consider adiponectin testing alongside traditional insulin and glucose assessments when evaluating obese ponies for metabolic syndrome risk
- •Over 60% of Shetland and Welsh ponies in this Australian cohort had insulin dysregulation; cresty neck and high body condition score are practical visual indicators of metabolic risk in ponies
- •Insulin dysregulation and insulin resistance are significant independent risk factors for laminitis in ponies—metabolic testing should inform preventive lameness management strategies
- •Older ponies and those perceived by owners as overweight warrant metabolic screening; consider PPID testing as PPID status strongly associates with laminitis risk
- •Hyperinsulinemia alone is sufficient to trigger laminitis in previously healthy horses, making insulin management critical for laminitis prevention in EMS cases
- •Digital lamellae appear to be uniquely vulnerable to hyperinsulinemia-induced inflammation, suggesting tissue-specific pathophysiology that may guide future treatment strategies
- •The selective inflammatory response in lamellae but not muscle tissue points to localized mechanisms in laminitis development, potentially opening new avenues for targeted therapeutic intervention
- •Measuring triglyceride and NEFA responses during oral glucose testing may help identify horses with tissue insulin resistance, potentially aiding in earlier detection of Equine Metabolic Syndrome
- •Hyperinsulinemia alone without insulin resistance does not appear to alter lipid metabolism patterns during glucose challenge, suggesting different metabolic pathways may be involved
- •Lipid markers during OGT could complement existing diagnostic protocols for metabolic screening in horses showing signs of metabolic syndrome
- •Do not assume non-obese stock-type horses are safe from insulin dysregulation—approximately 1 in 20 may be affected; consider oral sugar testing regardless of body condition score
- •Morphometric neck measurements alone are poor predictors of insulin response and should not be used as screening tools; formal metabolic testing remains necessary for accurate assessment
- •Sex differences exist in baseline insulin levels; mares warrant particular attention for ID screening given their higher pre-insulin concentrations
- •Request basal and 60-minute post-glucose insulin testing (corn syrup challenge) for nonlaminitic ponies to stratify laminitis risk; high fasting insulin (>45.2 µIU/ml) or stimulated insulin (≥153 µIU/ml) warrants aggressive dietary/management intervention.
- •Monitor hoof growth patterns as a clinical predictor—divergent growth is associated with increased laminitis risk independent of metabolic markers.
- •ACTH testing alone is not useful for laminitis risk prediction in nonlaminitic ponies; focus on insulin parameters instead.
- •EMS is highly prevalent in Nigeria affecting 43% of sampled horses; farriers and veterinarians should screen horses for laminitis signs (divergent rings, widened white lines) and conduct insulin testing to identify at-risk individuals
- •Obesity is the primary modifiable risk factor, but not all EMS cases are obese—ensure regular exercise beyond walking only, with frequency at least monthly rather than every 5 months, as infrequent exercise significantly increases EMS risk
- •West African Barb breed and stallions require heightened vigilance for metabolic issues; examine for abnormal neck crest as a clinical indicator and avoid constant tethering management that limits movement
- •Do not rely solely on blood glucose changes during OGT to diagnose insulin dysregulation or PPID; use in combination with serum insulin, ACTH, and clinical signs including cresty neck score
- •Be aware that miniature horses and ponies show disproportionately larger glucose responses than full-sized horses during OGT, which may affect interpretation of results across different equine types
- •Standardize dextrose dosing in OGT protocols, as higher doses produce larger glucose responses and may confound diagnostic interpretation
- •NEFA levels may serve as a practical biomarker for identifying metabolic dysfunction in overweight horses, complementing visual assessment tools like body condition and cresty neck scoring
- •Adipokines (omentin and chemerin) warrant investigation as additional diagnostic markers for equine metabolic syndrome across different breeds to improve early detection
- •Clustering analysis revealed distinct metabolic phenotypes; understanding these relationships could help tailor nutritional and management interventions for individual horses
- •Resting plasma amino acid concentrations, particularly citrulline, GABA, and methionine, differ significantly between obese horses and those with insulin dysregulation and laminitis, potentially offering a new diagnostic tool for laminitis risk assessment
- •These findings suggest amino acid metabolism is altered in hyperinsulinemic states and laminitis, which may warrant investigation of targeted dietary supplementation strategies for at-risk horses
- •Current evidence is preliminary; larger prospective studies are needed before plasma amino acid profiling can be reliably used in clinical practice for laminitis prediction or prevention
- •Repeated oral sugar tests throughout the year may be warranted for horses with variable insulin dysregulation status, as single testing may miss affected animals
- •Exercise appears protective against insulin dysregulation regardless of season; prioritize consistent movement programs for metabolic health
- •Monitor cresty neck score, adiponectin levels, and body composition in older horses as these are linked to insulin response; combine with clinical assessment rather than relying on seasonal patterns alone
- •Overfeeding high-energy diets to ponies produces measurable cardiovascular changes within 1-2 years; monitor body condition and caloric intake carefully to prevent metabolic disease progression
- •Blood pressure and cardiac wall thickness changes appear to develop sequentially in equine metabolic syndrome, suggesting early intervention before structural cardiac changes could be beneficial
- •The absence of arrhythmias despite hypertrophy and hypertension indicates subclinical disease may be present—regular cardiovascular assessment is warranted in obese/overfed horses even without clinical signs
- •Obesity and sedentary lifestyle are modifiable risk factors; increasing exercise and pasture time can reduce EMS risk and laminitis incidence in susceptible ponies
- •Screen female native ponies and cobs aged 3-14 years with a history of laminitis for EMS, as they carry substantially elevated risk
- •Monitor hoof growth rings and supraorbital fat scores as clinical indicators of EMS; these are more frequent in affected animals and warrant further investigation
- •EMS horses have a cellular-level magnesium deficiency that correlates with their degree of insulin dysregulation; this may warrant investigation of magnesium status in EMS management protocols
- •The relationship between intracellular magnesium and insulin suggests that improving insulin sensitivity through diet and exercise may help restore normal magnesium metabolism in affected horses
- •Serum magnesium levels alone may not reflect intracellular status in EMS horses; practitioners should consider functional magnesium assessment in metabolic syndrome cases
- •Overfeeding energy to ponies rapidly causes insulin dysregulation and obesity within weeks; restrict concentrate intake and ensure diet matches maintenance requirements
- •Insulin dysfunction can develop in healthy, non-obese animals on high-energy diets—metabolic health requires dietary control independent of current body condition
- •While insulin abnormalities improve with hay-only feeding, susceptibility to rapid relapse means long-term dietary management is essential for metabolically predisposed animals
- •A synergistic polyphenol-leucine supplement may help reduce hyperinsulinemia and associated laminitis risk in EMS/insulin dysregulated horses at a lower cost than high-dose formulations
- •Monitor baseline adiponectin levels and insulin response to oral challenge as practical markers of supplement efficacy in your EMS cases
- •Weight loss occurred alongside metabolic improvements, suggesting this supplement may support overall metabolic health management in affected horses
- •High protein feeds may exacerbate insulin response in EMS horses and should be avoided or carefully monitored in affected animals
- •When managing insulin-dysregulated horses, evaluate total dietary protein content alongside traditional focus on non-structural carbohydrates
- •Amino acid composition of feed may play a previously underrecognized role in triggering hyperinsulinemic responses in metabolically compromised horses
- •Metabolic traits associated with EMS have substantial genetic components, suggesting selective breeding strategies could reduce disease prevalence in high-risk breeds like Welsh ponies and Morgans
- •Insulin and adiponectin show particularly high heritability, making them potential genetic markers for identifying at-risk animals before clinical signs develop
- •Genetic testing and familial screening may help identify predisposed horses earlier, enabling preventive dietary and management interventions
- •Elevated resting heart rate may be a clinical indicator of EMS in horses and warrants further metabolic screening
- •EMS horses show blunted blood pressure responses to insulin that differ from metabolically normal horses, suggesting underlying cardiovascular dysfunction related to insulin resistance
- •Cardiovascular monitoring during metabolic testing may help identify compensatory mechanisms in EMS horses and could inform management strategies
- •Assess cresty neck appearance as a key screening tool for insulin dysregulation in ponies — it's more reliable than general body condition score alone
- •Ponies with obvious neck crests warrant metabolic testing and management intervention even if overall body condition appears normal, as they have 5-fold increased risk of insulin dysfunction
- •Regional fat distribution (neck crest) matters more than total body fat for identifying metabolic risk in ponies; focus management strategies on reducing regional adiposity
- •Oral prednisolone treatment does not increase laminitis risk in horses—this common concern among practitioners is not supported by this evidence
- •Metabolic syndrome and age are more important risk factors to monitor than glucocorticoid use when assessing laminitis risk
- •Practitioners can use prednisolone when clinically indicated without fear of precipitating laminitis as a direct consequence of the drug
- •Know which insulin assay your laboratory uses—results are not interchangeable between assays, and clinical reference ranges must match the specific assay method
- •When diagnosing insulin resistance or dysregulation, ensure your diagnostic criteria (basal values, response to oral glucose tolerance test) align with the assay used by your lab
- •Request species-specific assays when possible, as porcine-specific assays appear more reliable for equine samples than human-specific assays
- •When investigating behavioural changes and anestrus in mares, consider equine metabolic syndrome and insulin dysregulation as differential diagnoses alongside ovarian pathology—appropriate dietary and exercise management may resolve both metabolic and behavioural issues
- •Mild or borderline elevations in AMH and equivocal ovarian ultrasound findings should prompt investigation for concurrent systemic conditions (metabolic syndrome, neoplasia) rather than defaulting to granulosa theca cell tumour diagnosis
- •Monitor thyroid gland size during routine examination of mares with metabolic syndrome, as this case suggests a possible association between EMS and thyroid neoplasia that may impact performance and behaviour
- •Do not rely on owner self-assessment for body condition scoring—veterinary evaluation is essential for identifying obesity and metabolic syndrome risk in working horses
- •Implement owner education programs on proper BCS and cresty neck assessment; visual aids alone are insufficient without hands-on training and palpation instruction
- •Regular professional assessment of body condition is critical for Nigerian horse populations where obesity and EMS are common, particularly for breeding and performance animals
- •Genetic testing for these SNPs may eventually enable early identification of Finnhorses predisposed to insulin dysregulation, allowing preventive nutritional and exercise management before clinical signs develop
- •Results suggest insulin dysregulation has heritable genetic components in addition to environmental factors, supporting the need for selective breeding practices that consider metabolic status
- •Further validation across larger populations and other horse breeds is needed before clinical implementation of genetic screening
- •Use these breed-specific radiological reference values when assessing feet of Straight Egyptian Arabian horses for laminitis, as they differ from general Arabian horse standards.
- •Account for significant anatomical differences between fore and hind feet when interpreting radiographs, particularly hoof angle and wall thickness measurements.
- •Implement routine radiological screening in Arabian horses showing metabolic syndrome signs, as breed carries identified risk locus for laminitis development.
- •MSI-1436 shows promise as a novel therapeutic approach for managing equine metabolic syndrome by addressing multiple pathogenic mechanisms simultaneously
- •Single-dose IV administration improved both metabolic markers and systemic inflammation in affected horses, suggesting potential clinical utility
- •This research provides mechanistic rationale for targeting PTP1B inhibition in EMS management, though further clinical trials are needed before routine practice implementation
- •For horses with suspected metabolic syndrome, request direct LDL measurement rather than Friedewald-calculated values to ensure diagnostic accuracy.
- •The Friedewald formula underestimates LDL in horses and produces more variable results; it should not be used as a substitute for enzymatic testing in clinical decision-making.
- •When evaluating equine lipid profiles, be aware that calculated versus measured LDL values may differ substantially and could affect metabolic disease assessment.
- •Canagliflozin (an SGLT2 inhibitor) may be considered for horses with documented hyperinsulinemia and laminitis that fail to respond to diet control, metformin, levothyroxine, and pergolide
- •This medication requires monitoring of renal function (serum creatinine, blood urea nitrogen) before use and regular urinalysis every 2 weeks to detect glucosuria and screen for complications
- •Canagliflozin should be reserved for refractory cases and must be combined with core therapies: strict dietary control of sugars/starch, exercise when possible, and appropriate PPID treatment if indicated
- •Horses respond to overfeeding with measurable metabolic changes, but timing and magnitude vary individually—monitor each horse's response rather than assuming uniform effects
- •Elevated choline in serum may be an early biomarker for metabolic dysfunction in horses receiving high-carbohydrate diets
- •This metabolomic approach could eventually support early detection of metabolic syndrome risk before clinical signs like laminitis develop
- •Horses with endocrinopathies causing hyperinsulinemia develop laminitis through cellular stress mechanisms involving protein misfolding—aggressive insulin control may help prevent tissue damage progression
- •Understanding that endocrinopathic laminitis involves cellular stress at the ER level supports the importance of metabolic management and early endocrinopathy detection in at-risk horses
- •This cellular mechanism explains why chronically hyperinsulinemic horses are vulnerable to laminitis and emphasizes need for insulin regulation through diet, exercise, and medication where appropriate
- •Pioglitazone shows promise as a pharmacological option for managing insulin dysregulation in horses and ponies, with positive effects on insulin sensitivity markers within 28 days
- •The improvement in HMW adiponectin and reduced insulin response suggests potential benefit for equine metabolic syndrome management, but requires larger clinical trials before routine clinical application
- •Treatment was well-tolerated with only mild hepatic enzyme changes, suggesting reasonable safety profile for short-term use in equids
- •Serum magnesium levels alone are unreliable for assessing a horse's magnesium status; intracellular measurement via mag-fura 2 spectrophotometry is needed for accurate diagnosis
- •This established reference range (0.16-0.42 mmol/L) for healthy horses can now be used to identify magnesium homeostasis alterations in EMS-affected horses
- •Given magnesium's role in insulin sensitivity, this diagnostic tool may help identify metabolic dysfunction earlier in horses at risk for or with EMS
- •Endocrinopathic laminitis involves systemic vascular dysfunction affecting the hoof's blood supply; managing the underlying metabolic syndrome and Cushing's disease is critical for addressing root cause
- •The impaired vasodilation response suggests compromised microvascular perfusion in the laminae, which may explain the severity and recurrent nature of laminitis in metabolically affected horses
- •Screening for equine metabolic syndrome and Cushing's disease in laminitis cases is essential, as vascular dysfunction appears to be a key pathophysiologic mechanism
- •Customized diet and exercise plans can effectively treat EMS in owner-managed settings without specialized facilities, though compliance requires careful owner guidance
- •Weight loss alone correlates with measurable improvements in insulin sensitivity markers, making this a practical first-line intervention for laminitis prevention
- •Regular monitoring of insulin dynamics through dynamic testing helps confirm treatment efficacy and may improve owner compliance by demonstrating objective improvement
- •Screening for insulin dysregulation should be a priority in horses at risk of metabolic syndrome to prevent laminitis development
- •Practitioners now have access to improved diagnostic tools and management options beyond traditional approaches for hyperinsulinemic horses
- •Early intervention in insulin dysregulation cases can significantly reduce laminitis morbidity and mortality in your practice
- •Exercise is strongly associated with reduced laminitis and metabolic disease risk, but implementation barriers (yard facilities, time, access) are the main limiting factor—not owner knowledge alone
- •Livery yard management and facilities are critical constraints; if you operate a livery yard, consider whether your facilities enable adequate self-directed exercise as a welfare priority
- •Simply restricting feed through stabling creates welfare problems; exploring how to increase exercise opportunity (both ridden and free movement) should be part of your weight-management strategy
- •If your clinic switches to ADVIA Centaur XPT for insulin testing, you must use new reference ranges adapted from this study—results will be systematically lower than previous Immulite 2000 XPi measurements, but interpretation remains clinically comparable
- •The strong rank-order correlation (0.92) means the new analyzer reliably identifies which horses have dysregulated insulin relative to others, which is the critical clinical decision
- •The 0.82 kappa suggests good agreement for classifying horses into normal vs. abnormal insulin status, supporting use of this newer analyzer for metabolic syndrome screening
- •Senior horses (≥15 years) require consistent routine care: expect to perform farrier work every 5-6 weeks and coordinate with veterinarians and dental specialists on regular schedules, as retired horses show significantly worse compliance with all preventative care
- •Plan for high prevalence of concurrent conditions—64% of senior horses have at least one diagnosed medical condition; osteoarthritis, dental disease, and lameness account for the majority, requiring integrated management strategies
- •Advocate for maintenance therapy in senior horses: the widespread use of firocoxib and joint supplements reflects evidence-based management of degenerative conditions common in this population
- •Screen at-risk horses for insulin dysregulation as part of EMS or PPID workup—early detection and management prevents most cases of endocrinopathic laminitis
- •Coordinate closely with farrier and vet on foot biomechanics and pain management alongside treatment of the underlying metabolic condition for best outcomes
- •Stay current on endocrinopathy diagnostics and therapeutics as this field is rapidly evolving with new testing and treatment options
- •Understand that EMS is a multi-factorial condition affecting obese horses with insulin dysregulation; screening for these components is essential in practice
- •Stay updated on emerging treatment options beyond traditional weight management and dietary restriction
- •Recognize the critical link between metabolic dysfunction and laminitis risk to enable early intervention and prevention strategies
- •SGLT2i treatment shows promising results for managing hyperinsulinaemic horses with laminitis, with strong owner satisfaction and reported pain relief even in cases previously considered for euthanasia
- •Educate owners about common early adverse effects (especially polyuria and polydipsia) as these appear manageable and often temporary; 33% experience some initial side effects but these do not typically lead to treatment discontinuation
- •Current limitations include high medication cost, availability issues, and lack of long-term efficacy data—discuss realistic timelines and set management expectations around diet, exercise and monitoring alongside pharmacological intervention
- •Educate owners that maintaining moderate body weight is critical prevention for laminitis and metabolic disease, even when horses are 'easy keepers'
- •Monitor fasting insulin levels and body condition in middle-aged horses, as insulin resistance often precedes clinical laminitis
- •Address overfeeding of concentrates and hay as the primary modifiable risk factor; feeding behavior change is essential for management
- •Screen horses for signs of metabolic syndrome and obesity as part of routine preventive care, as early intervention can prevent severe laminitis
- •Understand the relationship between insulin dysregulation and laminitis risk to better counsel clients on management and dietary modifications
- •Familiarise yourself with current diagnostic tests and clinical recognition criteria for metabolic syndrome to enable prompt identification and treatment initiation
- •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
- •Veterinarians should tailor client education on condition severity and management to address knowledge gaps, particularly for metabolic and respiratory conditions where owner understanding is lowest
- •Recognize that owners' emotional responses to equine illness directly correlate with their perception of disease impact; counseling should address both horse welfare and owner wellbeing
- •Discussions about quality of life, pain management, and end-of-life care are critical touch points for owners making health decisions—prioritize these conversations in clinical practice
- •Experience alone does not drive preventative weight management—target intervention messaging toward owners of metabolically-affected ponies, as they demonstrate higher adoption of feeding and exercise protocols
- •Simply building owner confidence through education may not be sufficient to change behaviour; focus instead on demonstrating practical benefits and disease-risk pathways specific to individual operations
- •Consider developing preventative care packages or protocols for native pony owners that address the gap between knowing best practice and acting on it before clinical disease develops
- •Don't treat a single cut-off value as definitive—use both reference intervals and clinical decision limits appropriately to distinguish healthy horses from those with endocrine disease
- •Recognize that some test results fall in a 'grey zone' where the test cannot clearly distinguish disease state; these uncertain results require clinical correlation and possible retesting rather than immediate diagnostic or treatment decisions
- •Understand that RIs tell you if a horse is 'normal' compared to a healthy population, while CDLs tell you if a horse has or is at risk for a specific disease—these serve fundamentally different diagnostic purposes
- •Maintain mares at optimal body condition score before breeding—obesity-related metabolic dysfunction impairs fertility and compromises pregnancy outcomes, affecting both mare and foal health
- •Monitor insulin status in overweight or insulin-dysregulated mares, as hyperinsulinemia during pregnancy increases foal susceptibility to developmental orthopedic disease and metabolic problems later in life
- •Consider weight management and metabolic assessment as essential preventative strategies for reproductive success and long-term foal welfare, not just a cosmetic or general health issue
- •When discussing endocrine disease diagnosis with veterinarians, understand that research case definitions may differ from clinical diagnostic standards used in practice
- •Be aware that diagnostic recommendations for PPID, EMS, and insulin dysregulation are evolving, so clinical protocols should be reviewed regularly
- •Request clarification on which diagnostic methods and decision limits your veterinarian is using, as this affects consistency in monitoring and management of endocrine cases
- •Oral carbohydrate testing that includes gastrointestinal assessment is important for diagnosing insulin dysregulation and identifying laminitis risk in horses, particularly measuring post-prandial insulin responses.
- •Understanding how the gastrointestinal tract enhances insulin secretion through the enteroinsular axis can help inform dietary management strategies to reduce hyperinsulinaemia and laminitis risk.
- •Current knowledge gaps remain regarding several gut peptides in horses; ongoing research into enteroinsular axis function may reveal new diagnostic or therapeutic targets for managing insulin dysregulation.
- •Endocrine testing for insulin dysfunction should be a standard part of your laminitis diagnostic protocol, as this is now recognized as the most common cause of field laminitis
- •Stay updated on evolving understanding of insulin's role in laminitis pathogenesis, as treatment approaches continue to change based on recent research
- •Consider regional best practices when developing your laminitis management protocols, as approaches vary between North America and other regions
- •Obesity alone may not directly cause lamellar failure in draft horses, but all horses in this study showed some lamellar pathology warranting preventive hoof management
- •Morphological differences in secondary lamellae structure exist between obese and lean horses; tapered SELs in obese horses may have different weight-bearing implications than club-shaped SELs
- •Hoof lamellae length correlates with overall hoof size rather than metabolic status; farriers should consider individual hoof dimensions when evaluating lamellar architecture
- •MSC therapy is emerging as a potential treatment for multiple equine conditions beyond joint and tendon injuries, but clinical protocols are not yet standardized for routine use
- •The horse serves as a valuable translational model for human diseases due to similarities in disease pathogenesis, particularly for wound healing, laminitis, and metabolic disorders
- •Current evidence supports further research but practitioners should await robust clinical trials before adopting MSC therapies for non-musculoskeletal conditions in their practice
- •Screen horses for insulin dysregulation through appropriate laboratory tests; this is your main lever for preventing laminitis in metabolically predisposed horses
- •Combine diet (calorie and sugar restriction) with consistent exercise as the foundation of EMS management—these address the root problem, not just symptoms
- •Partner with your veterinarian on long-term monitoring; EMS control requires sustained owner discipline and professional guidance to succeed
- •Obesity management is critical in horses with EMS, as adipose tissue dysfunction may underlie insulin dysregulation and metabolic complications
- •Veterinarians should recognize that pathological changes in adipose tissue similar to those in other species may occur in obese horses, requiring investigation and intervention
- •Weight loss and metabolic management strategies may help restore normal adipose tissue function and improve insulin sensitivity in affected horses
- •Obesity management in horses should be prioritized as a preventive strategy against insulin dysregulation and laminitis risk
- •Practitioners should recognize that insulin dysregulation is a key mechanism linking metabolic dysfunction to laminitis, requiring targeted dietary and management interventions
- •Understanding inflammatory pathways related to adiposity and oxidative stress may inform future therapeutic approaches for laminitis prevention and management
- •This in vitro research suggests nortropane alkaloids may have therapeutic potential for horses with metabolic syndrome, though clinical application requires further development and testing in living animals
- •The findings support exploring natural compounds with antioxidant and antidiabetic properties as adjunctive treatments for managing equine metabolic syndrome
- •Results are preliminary laboratory work; translation to clinical practice for EMS management remains years away and requires in vivo validation
- •Identify high-risk horses (those showing signs of equine metabolic syndrome or insulin resistance) and prioritize metabolic management alongside pasture control as primary laminitis prevention strategies.
- •Monitor and manage pasture nonstructural carbohydrate content—particularly simple sugars, starches, and fructans—through grazing management and forage testing to reduce laminitis risk in susceptible animals.
- •Implement combined nutritional and management protocols addressing both the horse's metabolic status and environmental carbohydrate exposure rather than relying on single-factor interventions.
- •Soaked hay diets do promote weight loss in obese horses (0.98% BM/week), but the mechanism is partly due to unintended severe energy restriction caused by nutrient leaching during soaking
- •Always correct the amount of soaked hay fed using the validated ADF-based method to avoid accidentally restricting energy by >20% beyond your target, which may cause welfare concerns or unexpected rapid weight loss
- •Monitor individual animals closely as weight loss sensitivity varies considerably (range ~0.5-2% BM/week); the most sensitive animals may lose weight too rapidly on this protocol
- •AICAR shows promise as a potential pharmacological intervention for equine metabolic syndrome and insulin resistance, though further investigation is needed before clinical application
- •The novel glucose transporter GLUT8 appears to be a key player in equine muscle glucose uptake and may be a target for managing metabolic disease in horses
- •AMPK activation via AICAR enhances both muscle glucose uptake and pancreatic insulin secretion, suggesting multi-system metabolic benefits
- •Managing EMS in horses requires attention to diet composition and meal structure to modulate postprandial insulin responses, not just caloric restriction
- •Hyperinsulinaemia should be monitored and controlled as both a consequence and driver of metabolic dysfunction, as it perpetuates insulin resistance independent of initial causation
- •Understanding how different tissues handle glucose helps explain why some horses remain insulin resistant despite weight loss, guiding more targeted nutritional and management strategies
- •Horses with Cushing's disease or metabolic syndrome may have altered vascular reactivity in the laminae, increasing laminitis risk through cortisol-mediated changes in vein contraction
- •Insulin resistance may compound laminitis risk by reducing the natural protective effects of insulin on laminar blood vessel contraction
- •Management strategies targeting cortisol control and insulin sensitivity may help mitigate vascular mechanisms underlying laminitis in predisposed horses
- •Screen horses at risk of laminitis for insulin dysregulation using oral sugar or glucose tolerance tests to enable early intervention
- •Manage hyperinsulinaemia through dietary modification and weight control, as insulin dysregulation significantly increases laminitis risk
- •Consider insulin dysregulation in foals presenting with prematurity or systemic illness, as it can accompany these conditions
- •Assess pasture forage quality and carbohydrate content in horses with metabolic risk factors; consider strip grazing, hay nets, or dry lot management during high fructan periods (spring, autumn)
- •Screen at-risk horses (overweight, insulin-resistant, or with abnormal insulin dynamics) before turnout to identify those requiring modified grazing management to prevent laminitis
- •Understanding the inflammatory cascade from carbohydrate overload helps frame prevention and early intervention strategies focused on limiting fermentable carbohydrate intake rather than treating advanced lamellar damage
- •Work with your veterinarian to identify and treat underlying PPID or metabolic syndrome as a primary laminitis prevention strategy
- •Pharmacologic management of endocrine disease can reduce laminitis risk before clinical signs develop
- •Coordinate care across your veterinary, farrier, and nutrition team for best outcomes in metabolically at-risk horses
- •Insulin resistance should be considered as a potential underlying factor in cases of laminitis, metabolic syndrome, and endotoxaemia; clinicians need better diagnostic tools to reliably assess insulin status
- •Body condition, nutritional management, and breeding/lactation status all significantly affect insulin sensitivity and should be evaluated when assessing metabolic health in individual horses
- •Current insulin testing has limitations; practitioners should be aware that tolerance testing and clamping techniques each have practical constraints and diagnostic accuracy considerations when selecting assessment methods
Key Research Findings
Insulin dysregulation encompasses both tissue insulin resistance and dysfunction of the enteroinsular axis in horses
The equine enteroinsular axis plays a major role in insulin secretion and hyperinsulinaemia development
Multiple factors including breed, diet, fasting state, and season significantly influence diagnostic test results and must be considered during interpretation
Early detection of insulin dysregulation is critical for laminitis prophylaxis as treatment options for established laminitis remain inadequate
Supplement group showed significant reduction in maximum insulin post-oral sugar test between timepoints 1-2 and 3-4
Supplement group lost average 8.1 kg bodyweight by day 60-61 while placebo group gained 2.6 kg (p=0.006)
More ponies in supplement group reduced maximum post-prandial insulin by ≥40% compared to placebo (p=0.01)
Leucine, pyridoxine and resveratrol combination may support weight loss and reduce insulin dysregulation in EMS
Oligosaccharide supplementation significantly reduced plasma insulin in geldings (p = 0.02) but not mares, suggesting sex-dependent response
Horses with insulin concentrations >60 mIU/L showed significantly greater within-sample bacterial diversity compared to those <60 mIU/L
Horses with previous laminitis and high insulin concentrations demonstrated significantly greater beta diversity in gut microbiota
Oligosaccharide supplementation showed a tendency to reduce obesity-associated bacteria, though dominant bacterial populations did not change significantly
Velagliflozin at 0.3 mg/kg BW daily reduced post-prandial hyperinsulinemia in insulin dysregulated ponies over 16 weeks of treatment
The drug was well-tolerated with no safety concerns identified during daily monitoring, veterinary examination, or haematological/biochemical assessment
Treatment effects were assessed using standardized diet challenge tests (7.5 g NSC/kg BW/day) every 8 weeks with 4 weeks of post-withdrawal monitoring
Evidence Base
The diagnosis of equine insulin dysregulation.
Bertin F R, de Laat M A (2017) — Equine veterinary journal
Systematic Review
Leucine, pyridoxine and resveratrol supplementation alter metabolic parameters in ponies with equine metabolic syndrome.
Norton Elaine M, Plumb Sydney, Shane Douglas et al. (2025) — Equine veterinary journal
RCT
Oligosaccharide feed supplementation reduces plasma insulin in geldings with Equine Metabolic Syndrome
Alexandra Von Münchow, Sarah Torp Yttergren, R. R. Jakobsen et al. (2023) — Frontiers in Microbiomes
RCT
The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies.
Meier A, de Laat M, Reiche D et al. (2019) — BMC veterinary research
RCT
Temporal variation in incretin and insulin secretion in ponies in association with dietary macronutrients.
Andrews K E, Sibthorpe P E M, Fitzgerald D M et al. (2026) — Veterinary journal (London, England : 1997)
Cohort Study
Risk factors for equine strangulating lipoma colic: An international, case-control study.
Gillen Alexandra, Hassel Diana, Gonzalez Sam et al. (2025) — Equine veterinary journal
Cohort Study
Horses with previous episodes of laminitis have altered insulin responses to seasonal oral sugar testing and grazing compared to horses with no known history of laminitis.
Kaufman K L, Suagee-Bedore J K, Johnson S E et al. (2025) — Journal of equine veterinary science
Cohort Study
Plasma Activin A concentrations are not a useful biomarker for detecting insulin dysregulation and predicting laminitis risk in ponies.
McGuire C J, Knowles E J, Harris P A et al. (2025) — Journal of equine veterinary science
Cohort Study
Association Between Adrenocorticotropic Hormone Concentration and Clinical Signs of Pituitary Pars Intermedia Dysfunction in Swiss and Austrian Equids.
Fouché Nathalie, Doras Camille, Schüpbach-Regula Gertraud et al. (2025) — Journal of veterinary internal medicine
Cohort Study
Quantitative proteomics unveils potential plasma biomarkers and provides insights into the pathophysiological mechanisms underlying equine metabolic syndrome.
Espinosa-López E M, Ortiz-Guisado B, Diez de Castro E et al. (2025) — BMC veterinary research
Cohort Study
Investigations on metabolic diseases of horses in Egypt.
Aboelmaaty Amal M, Ahdy Ahmed M, El-Khodery Sabry et al. (2025) — Frontiers in veterinary science
Cohort Study
Arthrospira platensis enriched with Cr(III), Mg(II), and Mn(II) ions improves insulin sensitivity and reduces systemic inflammation in equine metabolic affected horses.
Artur Tomal, Jolanta Szłapka-Kosarzewska, Małgorzata Mironiuk et al. (2024) — Frontiers in endocrinology
Cohort Study
Development of a body condition index to estimate adiposity in ponies and horses from morphometric measurements.
Potter Samantha J, Erdody Madison L, Bamford Nicholas J et al. (2024) — Equine veterinary journal
Cohort Study
Relationships between total adiponectin concentrations and obesity in native-breed ponies in England.
Barnabé Marine A, Elliott Jonathan, Harris Patricia A et al. (2024) — Equine veterinary journal
Cohort Study
Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia.
Clark Brianna L, Norton Elaine M, Bamford Nicholas J et al. (2024) — Equine veterinary journal
Cohort Study
Prolonged hyperinsulinemia increases the production of inflammatory cytokines in equine digital lamellae but not in striated muscle.
Jayathilake W M N K, de Laat M A, Furr M et al. (2024) — Veterinary journal (London, England : 1997)
Cohort Study
Value of measuring markers of lipid metabolism in horses during an oral glucose test.
Zemek Claire H K, Kemp Kate L, Bertin François-René (2024) — Journal of veterinary internal medicine
Cohort Study
Prevalence of insulin dysregulation in the non-obese stock-type horse and relationship with morphometric neck measurements.
Heaton C P, Cavinder C A, McClure E N et al. (2024) — Journal of equine veterinary science
Cohort Study
Predictors of laminitis development in a cohort of nonlaminitic ponies.
Knowles Edward J, Elliott Jonathan, Harris Patricia A et al. (2023) — Equine veterinary journal
Cohort Study
Occurrence of equine metabolic syndrome, clinical manifestations, and associated risk factors in Nigeria
O. Akinniyi, A. Sackey, G. E. Ochube et al. (2023) — Journal of Equine Science
Cohort Study
Show 60 more references
Diagnosis of equine endocrinopathies: The value of measuring blood glucose during an oral glucose test.
de Laat M A, Sillence M N (2023) — Veterinary journal (London, England : 1997)
Cohort Study
Clustering and Correlations amongst NEFA, Selected Adipokines and Morphological Traits-New Insights into Equine Metabolic Syndrome.
Daradics Zsofia, Niculae Mihaela, Crecan Cristian Mihăiță et al. (2022) — Animals : an open access journal from MDPI
Cohort Study
Plasma Amino Acid Concentration in Obese Horses with/without Insulin Dysregulation and Laminitis.
Stoeckle Sabita Diana, Timmermann Detlef, Merle Roswitha et al. (2022) — Animals : an open access journal from MDPI
Cohort Study
Variation in insulin response to oral sugar test in a cohort of horses throughout the year and evaluation of risk factors for insulin dysregulation.
Karikoski Ninja P, Box Justin R, Mykkänen Anna K et al. (2022) — Equine veterinary journal
Cohort Study
Effect of a long-term high-energy diet on cardiovascular parameters in Shetland pony mares.
D' Fonseca Nicky M M, Beukers Martjin, Wijnberg Inge D et al. (2021) — Journal of veterinary internal medicine
Cohort Study
Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors.
Carslake Harry B, Pinchbeck Gina L, McGowan Catherine M (2021) — Equine veterinary journal
Cohort Study
Relationship between intracellular free magnesium concentration and the degree of insulin resistance in horses with equine metabolic syndrome
J. Winter, E. Müller, G. Sponder et al. (2020) — Pferdeheilkunde Equine Medicine
Cohort Study
Effect of long-term overfeeding of a high-energy diet on glucose tolerance in Shetland pony mares.
d' Fonseca Nicky M M, Gibson Charlotte M E, van Doorn David A et al. (2020) — Journal of veterinary internal medicine
Cohort Study
Investigation of the Effects of a Dietary Supplement on Insulin and Adipokine Concentrations in Equine Metabolic Syndrome/Insulin Dysregulation.
J. Manfredi, E. Stapley, J. Nadeau et al. (2020) — Journal of equine veterinary science
Cohort Study
A high protein meal affects plasma insulin concentrations and amino acid metabolism in horses with equine metabolic syndrome.
Loos C M M, Dorsch S C, Elzinga S E et al. (2019) — Veterinary journal (London, England : 1997)
Cohort Study
Heritability of metabolic traits associated with equine metabolic syndrome in Welsh ponies and Morgan horses.
Norton E M, Schultz N E, Rendahl A K et al. (2019) — Equine veterinary journal
Cohort Study
The effect of insulin infusion on heart rate and systemic blood pressure in horses with equine metabolic syndrome.
Nostell K, Lindåse S, Edberg H et al. (2019) — Equine veterinary journal
Cohort Study
The cresty neck score is an independent predictor of insulin dysregulation in ponies.
Fitzgerald Danielle M, Anderson Stephen T, Sillence Martin N et al. (2019) — PloS one
Cohort Study
Does oral prednisolone treatment increase the incidence of acute laminitis?
Jordan V J, Ireland J L, Rendle D I (2017) — Equine veterinary journal
Cohort Study
Comparison of three different methods for the quantification of equine insulin.
Warnken T, Huber K, Feige K (2016) — BMC veterinary research
Cohort Study
Hyperandrogenemia and behavioural changes in a mare with equine metabolic syndrome
K. Shell, A. Rijkenhuizen, I. Vervuert (2026) — Equine Veterinary Education
Case Report
Can Nigerian horse owners effectively estimate body condition and cresty neck scores?
AKINNIYI Olumide Odunayo, MSHELIA Philip Wayuta, EDEH Richard Emmanuel (2024) — Journal of Equine Science
Case Report
Genome-wide association study suggests genetic candidate loci of insulin dysregulation in Finnhorses.
Weckman M J, Karikoski N P, Raekallio M R et al. (2024) — Veterinary journal (London, England : 1997)
Case Report
Radiological measurements of the feet of normal Straight Egyptian Arabian horses in Qatar.
Jacquinet Gautier, Rowan Conor, Ryan Jackie et al. (2024) — Journal of equine veterinary science
Case Report
The PTP1B inhibitor MSI-1436 ameliorates liver insulin sensitivity by modulating autophagy, ER stress and systemic inflammation in Equine metabolic syndrome affected horses
Lynda Bourebaba, Anna Serwotka-Suszczak, Ariadna Pielok et al. (2023) — Frontiers in Endocrinology
Case Report
Comparison Between the Direct Method and Friedewald's Formula for the Determination of Low-Density Lipoprotein Cholesterol Serum Levels in Horses.
Ribeiro Rodrigo M, Ribeiro Debora da Silva Freitas, Cota Leticia Oliveira et al. (2023) — Journal of equine veterinary science
Case Report
Use of the SGLT2 inhibitor canagliflozin for control of refractory equine hyperinsulinemia and laminitis
E. Kellon, K. Gustafson (2022) — Open Veterinary Journal
Case Report
Metabolic Profile Changes in Mangalarga Marchador Horses Subjected to A Hypercaloric Diet Evaluated by Proton NMR Spectroscopy.
Duarte Patricia de Castro, Ribeiro Rodrigo Martins, Machado Alan Rodrigues Teixeira et al. (2021) — Journal of equine veterinary science
Case Report
Detection of endoplasmic reticulum stress and the unfolded protein response in naturally-occurring endocrinopathic equine laminitis.
Cassimeris Lynne, Engiles Julie B, Galantino-Homer Hannah (2019) — BMC veterinary research
Case Report
Pharmacodynamic Effects of Pioglitazone on High Molecular Weight Adiponectin Concentrations and Insulin Response After Oral Sugar in Equids.
Legere Rebecca M, Taylor Debra R, Davis Jennifer L et al. (2019) — Journal of equine veterinary science
Case Report
Intracellular free magnesium concentration in healthy horses.
Winter J C, Sponder G, Merle R et al. (2018) — Journal of animal physiology and animal nutrition
Case Report
Vascular Dysfunction in Horses with Endocrinopathic Laminitis.
Morgan Ruth A, Keen John A, Walker Brian R et al. (2016) — PloS one
Case Report
Treatment of equine metabolic syndrome: A clinical case series.
Morgan R A, Keen J A, McGowan C M (2016) — Equine veterinary journal
Case Report
Practical management of insulin dysregulation and hyperinsulinaemia-associated laminitis
Sundra Tania, Rossi Gabriele, Rendle David et al.
Expert Opinion
Exercise as a welfare strategy? Insights from horse (Equus caballus) owners in the UK
C. J. Naydani, Tamsin Coombs (2025) — Animal Welfare
Expert Opinion
Clinical evaluation of the ADVIA Centaur XPT chemiluminescent immunoassay for equine insulin measurement.
Rey-Conejo R, Toribio R E, Möller S et al. (2025) — Journal of equine veterinary science
Expert Opinion
Owner-reported health and disease in U.S. senior horses.
Herbst Alisa C, Coleman Michelle C, Macon Erica L et al. (2025) — Equine veterinary journal
Expert Opinion
Understanding, diagnosing and managing endocrinopathic laminitis
Grenager Nora (2024) — UK-Vet Equine
Expert Opinion
Equine metabolic syndrome: part 2
Philip J Johnson (2024) — UK-Vet Equine
Expert Opinion
Horse owner experiences and observations with the use of SGLT2i for the management of equine metabolic syndrome and hyperinsulinaemia‐associated laminitis
T. Sundra, E. Kelty, Gabriele Rossi et al. (2024) — Equine Veterinary Education
Expert Opinion
Equine metabolic syndrome
A. Cristian, A. Dutulescu, M. Codreanu (2024) — Practica Veterinara.ro
Expert Opinion
Equine metabolic syndrome: part 1
Philip J Johnson (2024) — UK-Vet Equine
Expert Opinion
Focus on the epidemiology, pathophysiology, diagnosis, and management of insulin dysregulation in horses
Olumide Odunayo Akinniyi (2024) — Nutrition and Food Processing
Expert Opinion
Survey of the knowledge and perceptions of horse owners in Ireland of common clinical conditions and their impact.
Golding Emma, Neavyn Neita Aoife, Walshe Nicola et al. (2023) — Equine veterinary journal
Expert Opinion
Confidence does not mediate a relationship between owner experience and likelihood of using weight management approaches for native ponies.
Ward Ashley B, Harris Patricia A, Argo Caroline McG et al. (2023) — PloS one
Expert Opinion
Deciphering reference intervals and clinical decision limits in equine endocrine diagnostic testing.
Ireland Joanne, McGowan Catherine (2023) — Veterinary journal (London, England : 1997)
Expert Opinion
The effects of obesity and insulin dysregulation on mare reproduction, pregnancy, and foal health: a review.
Hallman Isa, Karikoski Ninja, Kareskoski Maria (2023) — Frontiers in veterinary science
Expert Opinion
Equine Endocrine Disease: Challenges With Case Definition for Research.
McGowan Catherine M, Ireland Joanne L (2023) — Journal of equine veterinary science
Expert Opinion
Equine metabolic syndrome: Role of the enteroinsular axis in the insulin response to oral carbohydrate.
de Laat Melody A, Fitzgerald Danielle M (2023) — Veterinary journal (London, England : 1997)
Expert Opinion
Approaches to endocrinopathic laminitis in the field: Results of a survey of veterinary practitioners in North America.
Rumfola Elizabeth, Banse Heidi E, Atkins Megan et al. (2022) — Journal of equine veterinary science
Expert Opinion
The Differences in Histoarchitecture of Hoof Lamellae between Obese and Lean Draft Horses.
Senderska-Płonowska Magdalena, Siwińska Natalia, Zak-Bochenek Agnieszka et al. (2022) — Animals : an open access journal from MDPI
Expert Opinion
The Usefulness of Mesenchymal Stem Cells beyond the Musculoskeletal System in Horses.
Cequier Alina, Sanz Carmen, Rodellar Clementina et al. (2021) — Animals : an open access journal from MDPI
Expert Opinion
ECEIM consensus statement on equine metabolic syndrome
A. Durham, N. Frank, C. McGowan et al. (2019) — Journal of Veterinary Internal Medicine
Expert Opinion
Adipose tissue dysfunction in obese horses with equine metabolic syndrome.
Reynolds A, Keen J A, Fordham T et al. (2019) — Equine veterinary journal
Expert Opinion
From Table to Stable: A Comparative Review of Selected Aspects of Human and Equine Metabolic Syndrome.
Ragno Valentina M, Zello Gordon A, Klein Colby D et al. (2019) — Journal of equine veterinary science
Expert Opinion
Nortropane alkaloids as pharmacological chaperones in the rescue of equine adipose-derived mesenchymal stromal stem cells affected by metabolic syndrome through mitochondrial potentiation, endoplasmic reticulum stress mitigation and insulin resistance alleviation
Lynda Bourebaba, F. Bedjou, M. Röcken et al. (2019) — Stem Cell Research & Therapy
Expert Opinion
Nutritional Management for Avoidance of Pasture‐Associated Laminitis
Harris Pat (2017) — Equine Laminitis
Expert Opinion
Considerations for the use of restricted, soaked grass hay diets to promote weight loss in the management of equine metabolic syndrome and obesity.
Argo Caroline McG, Dugdale Alexandra H A, McGowan Catherine M (2015) — Veterinary journal (London, England : 1997)
Expert Opinion
AICAR administration affects glucose metabolism by upregulating the novel glucose transporter, GLUT8, in equine skeletal muscle.
de Laat M A, Robinson M A, Gruntmeir K J et al. (2015) — Veterinary journal (London, England : 1997)
Expert Opinion
Glucose homeostasis and the enteroinsular axis in the horse: a possible role in equine metabolic syndrome.
de Graaf-Roelfsema Ellen (2014) — Veterinary journal (London, England : 1997)
Expert Opinion
Short-term incubation of equine laminar veins with cortisol and insulin alters contractility in vitro: possible implications for the pathogenesis of equine laminitis.
Keen, McGorum, Hillier et al. (2014) — Journal of veterinary pharmacology and therapeutics
Expert Opinion
Insulin dysregulation.
Frank N, Tadros E M (2014) — Equine veterinary journal
Expert Opinion
Current concepts on the pathophysiology of pasture-associated laminitis.
Geor (2010) — The Veterinary clinics of North America. Equine practice
Expert Opinion
The Pharmacologic Basis for the Treatment of Endocrinopathic Laminitis
Durham Andy (2010) — Veterinary Clinics of North America: Equine Practice
Expert Opinion
Factors affecting clinical assessment of insulin sensitivity in horses.
Firshman A M, Valberg S J (2007) — Equine veterinary journal
Expert Opinion