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27 NOVEMBER/DECEMBER 2017 ■ TVPJOURNAL.COM NUTRITION NOTES • One approach owners may find on the internet is to use "any kitten diet," which wrongly assumes that all canned diets made for growing kittens are low in carbohydrates. This is not always the case, and, again, flavors and consistency can be concerns in over-the-counter diets that are not formulated and produced to be exactly the same from batch to batch. PREVENTION Although multiple studies show obesity is strongly associated with diabetes, the other risk factors for diabetes (and, thus, possible strategies for prevention) are less clear and have been considered controversial. Of the epidemiologic studies available, it appears risk factors for diabetes include obesity, male sex, physical inactivity, and indoor confinement, but not dry-food feeding or carbohydrate content. 11–13 Veterinary Therapeutic Versus Over-the-Counter Diets Some veterinary therapeutic diets require a prescription because they are outside the Association of American Feed Control Officials guidelines for a healthy pet, but high–insoluble-fiber or low–carbohydrate-diet nutrient profiles can also be found in over-the-counter foods. Of consideration, however, is the consistency and strict processing protocols in veterinary diets that may not be found in over-the-counter diets, which may have more batch-to-batch variability. This variability may be fine for a healthy pet, but the consistency a veterinary therapeutic diet has for diabetic regulation may be beneficial. More peer-reviewed studies are warranted to further support this notion. Regardless of prescription diet status, all clients should be warned about the risks of substituting flavors, textures, or even dry and canned versions of the same food ( Box 2 ). Each product may have a drastically different nutrient profile and should be evaluated before switching. Additionally, a study has shown that semi-moist foods, especially those with sucrose, fructose, or other simple carbohydrates, resulted in higher postprandial blood glucose and insulin responses and should be avoided in pets with diabetes. 14 MORE TIPS FOR CLINICAL MANAGEMENT OF DIABETES • For clients who really want to provide treats, encourage the same treat at the same time each day or use a portion of the daily kibble as treats. • Setting expectations is crucial, and it is helpful to discuss with clients that dietary management alone may not be successful. • Clients sometimes seek home-cooked diets. Consistency can vary because diets are made daily or weekly by owners and will have mild variability with each batch. As a result, such diets may not be ideal. Recommend a consultation with a board-certified veterinary nutritionist ( acvn.org ) to ensure the diet is formulated properly without any deficiencies. 15 References 1. Schachter S, Nelson RW, Kirk CA. Oral chromium picolinate and control of glycemia in insulin-treated diabetic dogs. J Vet Intern Med 2001;15(4):379-384. 2. Fleeman LM, Rand JS, Markwell PJ. Lack of advantage of high-fibre, moderate-carbohydrate diets in dogs with stabilised diabetes. J Small Anim Pract 2009;50(11):604-614. 3. Nelson RW, Duesberg CA, Ford SL, et al. Effect of dietary insoluble fiber on control of glycemia in dogs with naturally acquired diabetes mellitus. JAVMA 1998;212(3):380-386. 4. Kimmel SE, Michel KE, Hess RS, Ward CR. Effects of insoluble and soluble dietary fiber on glycemic control in dogs with naturally occurring insulin-dependent diabetes mellitus. JAVMA 2000;216(7):1076-1081. 5. Freeman L, Becvarova I, Cave N, et al. WSAVA nutritional assessment guidelines. Compend Contin Educ Vet 2011;33(8):E1-E9. BOX 2. Client Communication Tip 5 What determines a high-quality pet food company? The World Small Animal Veterinary Association has created guidelines for pet owners and veterinarians to help determine companies producing high-quality products. One example is employing board-certified veterinary nutritionists and PhD-level animal nutrition scientists to properly formulate and test foods using their training in animal nutrition, physiology, and biochemistry. A full list of the guidelines can be found at wsava.org/nutrition-toolkit . Deborah E. Linder Deborah E. Linder, DVM, MS, DACVN, is a research assistant professor in clinical nutrition at Tufts Cummings School of Veterinary Medicine and head of the Tufts Obesity Clinic for Animals. Her interests include obesity management and effective client education, and she has focused her research on safe and effective weight loss strategies for pets as well as the effect of obesity on pet and human well-being. Dr. Linder received her DVM from Tufts Cummings School of Veterinary Medicine.