AVA Conference Brisbane 2018

Equine metabolic syndrome (EMS) is a collection of metabolic and endocrine abnormalities associated with a high risk of laminitis. Although many horses with EMS have general or regional obesity, not all obese horses and ponies have EMS and EMS can occur in the absence of visibly increased adiposity. Previously, a diagnosis of EMS was most commonly investigated after the onset of laminitis. The focus now is increasingly on early detection of horses with EMS before the onset of laminitis, allowing preventive strategies to be implemented. The key feature of EMS and laminitis risk is insulin dysregulation (ID). This term was first introduced by Frank and Tadros in 2014, and refers to any combination of 3 abnormalities: 1. Tissue insulin resistance (the inability of tissues to respond appropriately to insulin) 2. Basal hyperinsulinaemia 3. Postprandial (post “carbs”) hyperinsulinaemia. The aims of this presentation are to: 1. Discuss how best to diagnose insulin dysregulation, including consideration of whether the test is measuring insulin resistance or hyperinsulinaemia. This will include basal and dynamic testing, taking into account practical considerations and whether testing for diagnosis versus monitoring of the syndrome. 2. Discuss the use of ancillary tests such as adipokines can support the diagnosis of EMS. 3. Discuss interpretation of diagnostic tests including assessment of the accuracy and repeatability of the tests, and how to manage the differences between laboratory assays and the reference ranges produced by them versus published in the literature.