Domestic Animal Endocrinology 89 (2024) 106858

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Domestic Animal Endocrinology

journal homepage: www.journals.elsevier.com/domestic-animal-endocrinology

Increased insulin-like growth factor 1 concentrations in a population of

non-diabetic cats with overweight/obesity
D.D. Miceli a, b, *, A. Jaliquias c, M.F. Gallelli d, J.D. García c, C. Vecino c, J.P. Rey Amunategui a, c,
G.A. Pompili c, I.M. Espiñeira c, J. Más e, O.P. Pignataro b
a
Veterinary Science Center, Maimonides University, Buenos Aires, Argentina
b
Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine – CONICET, Buenos Aires, Argentina
c
Private practice, Buenos Aires, Argentina
d
CONICET, Buenos Aires, Argentina
e
Diagnotest Laboratory, Buenos Aires, Argentina

A R T I C L E I N F O A B S T R A C T

Keywords: Feline hypersomatotropism (HST) is typically associated with diabetes mellitus (DM), whereas HST without
Body condition score concurrent DM has only been reported in a few cases. Weight gain may be observed in cats with HST. The aims of
IGF-1 this study were to evaluate circulating insulin-like growth factor-1 (IGF-1) in non-diabetic cats with overweight/
Overweight
obesity, to screen this population for the presence of HST, and to assess whether there is a correlation between
Obesity
Hypersomatotropism
body weight/body condition score (BCS) and serum IGF-1 concentration in overweight/obese cats. In this pro-
Acromegaly spective study, 80 overweight/obese cats from referral centers in Buenos Aires (Argentina) were evaluated.
Serum IGF-1 was measured as part of the routine tests for overweight/obesity. Non-diabetic cats were included in
the study if they had a BCS>6/9. Twenty-nine cats were classified as overweight (BCS 7/9), whereas 51 were
classified as obese (BCS 8-9/9). Median serum IGF-1 concentrations of cats with BCS 7/9, 8/9, and 9/9 were 570
ng/ml (range 123-1456 ng/ml), 634 ng/ml (range 151-1500 ng/ml), and 598 ng/ml (range 284-2450 ng/ml),
respectively. There was a positive linear correlation between serum IGF-1 concentrations and body weight (r=
0.24, 95% CI 0.01-0.44 P=0.03), and between IGF-1 and BCS (r= 0.27, 95% CI 0.08-0.44 P=0.004). In total,
8.75% (95% confidence interval 3.6-17.2%) of the cats with overweight/obesity had IGF-1 concentrations >1000
ng/ml. Pituitary enlargement was detected on computed tomography in 4/7 cases. These seven cats showed
varying degrees of phenotypic changes consistent with acromegaly. A proportion of 8.75 % of overweight/obese
non-diabetic cats from referral centers in Buenos Aires had serum IGF-1 concentration in a range consistent with
HST in diabetic cats. Likewise, 5% of overweight/obese cats were likely to be diagnosed with HST, supported by
evidence of pituitary enlargement. Serum IGF-1 concentrations were positively correlated with body weight and
BCS in this population of cats. This study highlights the relevance of screening different populations of non-
diabetic cats to increase the detection of HST/acromegaly.

1. Introduction
Feline hypersomatotropism (HST) is typically associated with con-
current diabetes mellitus (DM), with prevalence rates ranging from 15 to
25%, depending on the geographical area. The prevalence of HST in the
diabetic cat population is approximately 25% in the UK, 18% in the
Netherlands and Switzerland, and 15% in Buenos Aires, Argentina [1-3].
In human medicine, the prevalence of overt DM in patients with acro-
megaly ranges from 12 to 38% [4].
Feline HST also develop in cats without DM. Few case reports have
been published to date, but the prevalence rate in the general cat pop-
ulation is unknown [5-7]. In a retrospective study, 6.7% of non-diabetic
cats with hypertrophic cardiomyopathy had a serum insulin-like growth
factor-1 (IGF-1) concentration >1000 ng/ml, which is consistent with
HST in diabetic cats [1,8,9]. Most human patients with acromegaly do
not develop overt diabetes [4].
Weight gain and overweight have been previously described in dia-
betic and non-diabetic cats with HST [1,6,10]. Evidence regarding the

* Corresponding author.
E-mail address: dmiceli@fvet.uba.ar (D.D. Miceli).

https://doi.org/10.1016/j.domaniend.2024.106858
Received 23 February 2024; Received in revised form 16 May 2024; Accepted 17 May 2024
Available online 19 May 2024
0739-7240/© 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
D.D. Miceli et al.
effects of body weight change on serum IGF-1 concentrations is
controversial. A lack of correlation between IGF-1 and body weight has
been reported in healthy and diabetic cats [11,12], whereas other
studies have reported a positive correlation in healthy cats and cats with
various diseases [13-15].
Considering that studies evaluating the prevalence of HST in non-
diabetic cats are lacking and that overweight may be observed in cats
with HST, it is necessary to evaluate the presence of HST in a population
of non-diabetic cats with overweight or obesity. Therefore, the aims of
this study were to evaluate circulating IGF-1 concentration in non-
diabetic cats with overweight or obesity and to screen this population
for the presence of HST. Likewise, to assess whether there is a correlation
between body weight/BCS and serum IGF-1 concentration in overweight
or obese cats.
2. Materials and methods
2.1. Study population
This study was approved (protocol number 2022/66) by the Ethics
Committee of the School of Veterinary Science of the University of
Buenos Aires (Institutional Committee on the Care and Use of Labora-
tory Animals [CICUAL]), in accordance with the laws on animal testing
in Argentina and the recommendations of the World Health Organiza-
tion (WHO). Informed written consent was obtained from all study cat
owners before enrollment. Client-owned cats with overweight/obesity
admitted to 6 referral centers in Buenos Aires, Argentina, were pro-
spectively included in this study between March 2021 and December
2023.
Inclusion criteria were non-diabetic cats with a BCS >6/9 and cats
without any relevant concurrent disease. On the day of admission, all
cats underwent a physical examination, routine blood tests (complete
blood count and serum biochemistry), fructosamine, total thyroxine,
and urinalysis with urinary protein/creatinine ratio. Body condition
score (BCS) was defined by two investigators from each referral clinic
using a scale from 1 to 9, where 1 was emaciated, 5 was ideal, and 9 was
extremely fat [16]. All cats received the same commercial diet (Royal
Canin, “Weight control” adult dry cat food). All cats without DM were
included, based on the absence of clinical signs of DM, absence of
hyperglycemia/glycosuria, and fructosamine within the reference
range, according to the ALIVE criteria for the diagnosis of DM [17].
Exclusion criteria were diabetic cats or cats with a history of overt DM,
cats with BCS <7/9, cats with any relevant concurrent disease that could
be diagnosed by the history, physical examination and laboratory tests
mentioned above (e.g., hyperthyroidism, chronic kidney disease, ma-
lignant neoplasia, liver disease, heart failure), and cats treated with any
formulation of corticosteroids 60 days before enrollment. Overweight
cats with BCS 6/9 were also excluded to obtain a more accurate selection
of the overweight population.
A group of apparently healthy control cats with BCS 5/9 were also
recruited at the Veterinary Science Center (VSC), Maimonides Univer-
sity, during the study period. These cats came to the clinic for annual
vaccinations/controls and had no relevant medical history and were not
receiving any medication. None of the cats in this group had clinical
signs of DM, neither fasting hyperglycemia nor glycosuria.
2.2. Serum IGF-1 measurement
Serum IGF-1 concentration was evaluated as part of routine tests for
overweight/obesity. Total IGF-1 was measured by a commercially
available radioimmunoassay system (RIA, Immuno-Biological Labora-
tories, Inc., Mediagnost, IBL-America). All components were supplied
with the kit. Serially diluted cat plasma samples produced curves par-
allel to the standard curve. The standard was recombinant human IGF-1
calibrated against WHO reference material 02/254, and was equivalent
to 33, 81, 229, 640 and 1529 ng/ml. The assay was performed according
2
Domestic Animal Endocrinology 89 (2024) 106858
to the manufacturer’s instructions; including a pre-treatment step that
involved the extraction of IGF-1 binding proteins (IGFBPs) by using an
acidic buffer solution (pH <3.1). A first anti-rabbit IGF-1 polyclonal
antibody with an excess of IGF-2 was diluted in a buffer capable of
neutralizing the acidic sample (pH 7). The sample was then further
processed using RIA and a second anti-rabbit polyclonal antibody for
IGF-1. The sensitivity of the kit was 3.4 ng/ml and no cross reactivity
with IGF-2 was documented (<0.1%). The laboratory reported an
average of intra- and inter-assay coefficient of variability for IGF-1 of
4.2% and 5.8%, respectively. In the present study, free IGF-1 and IGFBPs
were not evaluated. A cut-off of total IGF-1 >1000 ng/ml has previously
shown to result in a 95% positive predictive value for HST in a popu-
lation of diabetic cats from the UK [1]. Although the cats in this present
study were non-diabetic, serum IGF-1 concentrations above this cut-off
were considered to be increased. In cases where IGF-1 was above 1000
ng/ml, additional studies were performed (intracranial imaging with
computed tomography [CT], abdominal ultrasonography, and echo-
cardiography). Pituitary imaging was performed using
contrast-enhanced CT on a 128-slice multidetector unit (Siemens,
SOMATOM Perspective, 128 slice). Pituitary dimensions were measured
in millimeter using commercial DICOM viewer software (RadiAnt,
Medixant). Pituitary height was measured on transverse images showing
the largest cross section of the hypophysis. Pituitary enlargement was
defined as a dorsoventral height >4 mm [18-20], with a range reference
of 1.8-4 mm (mean 2.9 mm) [19]. CT images were evaluated by the
veterinary radiologist of VSC.
2.3. Statistical analysis
Statistical analysis was performed with commercial software
(GraphPad Prism 6, San Diego, California). Data were analyzed for
normal distribution (Shapiro–Wilk tests). Values were expressed as
median and range, with a significance level set at P <0.05. The Man-
n–Whitney U-test was used to compare serum IGF-1 concentration be-
tween groups. The proportion of cats with an IGF-1 >1000 ng/ml and
confidence interval (CI) were calculated in both overweight/obese and
control groups (http://www.sample-size.net/confidence-interval-pro
portion/). Correlations between IGF-1 and body weight and between
IGF-1 and BCS were assessed using Spearman correlation coefficients.
3. Results
3.1. Population characteristics
In this prospective study, 80 non-diabetic cats (n = 80) with over-
weight/obesity were evaluated. Seventy-three cats were Domestic
Short-Hair, three were Siamese, two were Domestic Long-Hair, one was
Persian, and one was Abbysinian. Fifty-six cats were neutered males and
24 were spayed females; median age was 8 years (range 2-16 years);
median body weight was 7.4 kg (range 5.2-11 kg). Thirty apparently
healthy control cats (n = 30) with BCS 5/9 were recruited. Twenty-eight
cats were Domestic Short-Hair, one Siamese, and one Domestic Long-
Hair. Eighteen cats were neutered male and twelve cats were spayed
female; median age was 9 years (range 6-14 years); median body weight
was 3.9 kg (range 3.2-4.6 kg). No significant differences were observed
in relation to age or sex between the group of overweight/obese cats and
the group of control cats. Age comparisons were made by subgroups of
2-6 years, 7-11 years, and 12-16 years.
3.2. BCS
Thirty-six percent of non-diabetic cats had a BCS of 7/9 (n = 29), and
were considered overweight; 37.5% of cases had a BCS of 8/9 (n = 30),
and the remaining 26% of cases had a BCS of 9/9 (n = 21); both groups
were considered obese. The median body weights of cats with BCS 7/9,
8/9 and 9/9 were 6.7 kg (range 5.2-8.2 kg), 7.6 kg (range 5.8-10.9 kg)
D.D. Miceli et al.
and 9 kg (range 6-11 kg), respectively.
3.3. Serum IGF-1 concentration
Median serum IGF-1 concentration in the 80 overweight and obese
cats was 599 ng/ml (range 123-2450 ng/ml). Median IGF-1 concentra-
tions of cats with BCS 7/9, 8/9, and 9/9 were 570 ng/ml (range 123-
1456 ng/ml), 634 ng/ml (range 151-1500 ng/ml), and 598 ng/ml
(range 284-2450 ng/ml), respectively. Median IGF-1 concentration in
healthy cats with BCS 5/9 was 505 ng/ml (range 114-720 ng/ml). The
distribution of circulating IGF-1 concentrations in the population of
overweight/obese cats and control cats is shown in Fig. 1. No significant
differences were observed in IGF-1 between cats with BCS 7/9, 8/9, and
9/9, but there were significant differences when comparing IGF-1 be-
tween the control group and the overweight/obese group (P=0.01).
Significant differences were observed when comparing the control
group to obese cats with BCS of 8/9 and 9/9 (P=0.014 and P=0.013,
respectively).
In total, 8.75% (95% CI 3.6-17.2%) of non-diabetic cats with over-
weight/obesity (n = 7) had IGF-1 concentrations >1000 ng/ml, and
13.7% of cats (n = 11) had IGF-1 concentrations between 800 and 1000
ng/ml. The remaining 77.5% of non-diabetic cats with overweight/
obesity (n = 62) had IGF-1 <800 ng/ml. All healthy cats in the control
group had IGF-1 <800 ng/ml.
3.4. Cats with serum IGF-1 concentration >1000 ng/ml
Of the 80 non-diabetic cats with overweight/obesity, seven (n = 7)
had circulating IGF-1 concentrations >1000 ng/ml. Information on age,
sex, breed, body weight, BCS, and IGF-1 concentration is summarized in
Table 1. The reason for referral was overweight or obesity, and in three
cases, there was a strong suspicion of acromegaly. All cats with IGF-1
>1000 ng/ml had varying degrees of phenotypic changes consistent
with acromegaly: prognathia inferior (5/7), abdominal enlargement (5/
7), broad facial features (4/7), weight gain (4/7), polyphagia (3/7),
broadening of paws (2/7), respiratory stridor (2/7) and degenerative
arthropathy (1/7). The most relevant clinicopathological findings were
hyperproteinemia in four cases (n = 4), mild azotemia in three cases (n
= 3), and increased liver enzymes in one case (n= 1). The most
important ultrasonographic findings were bilateral chronic nephropathy
in three cases (n = 3), bilateral adrenomegaly in two cases (n = 2),
hepatomegaly in two cases (n = 2), splenomegaly, nephrolithiasis, and
thyroid cysts in one case (n = 1). Left ventricular hypertrophy was
identified in four cases (n = 4). Intracranial imaging was performed in
seven cats with IGF-1 >1000 ng/ml, and pituitary enlargement was
detected in four cats (n = 4) (Table 1).
Fig. 1. Scatter plot of serum IGF-1 concentrations in a population of over-
weight/obese cats (circles) and healthy control cats (squares).
3
Domestic Animal Endocrinology 89 (2024) 106858
3.5. Correlation between serum IGF-1 concentration and body weight
There was a positive linear correlation between serum IGF-1 con-
centrations and body weight (r= 0.24, 95% CI 0.01-0.44 P=0.03). In
addition, there was a positive linear correlation between serum IGF-1
concentrations and BCS (r= 0.27, 95% CI 0.08-0.44 P=0.0042).
4. Discussion
In this population of cats from referral centers in Buenos Aires
classified as overweight or obese, 8.75 % of cases had a serum IGF-1
concentration >1000 ng/ml (95% Cl 3.6-17.2%); none of the cats in
the apparently healthy group had IGF-1 >800 ng/ml. This study pro-
vides evidence that a proportion of non-diabetic cats with overweight or
obesity had serum IGF-1 concentration in a range that is associated with
HST in diabetic cats. This is the first study to date to screen for HST in a
population of cats with overweight or obesity.
In domestic cats (Felis catus), HST is caused by a functioning ade-
noma or hyperplasia of the pars distalis of the pituitary gland [1,21]. HST
implies excess GH production, whereas “acromegaly” is a syndrome that
results from this state of excess GH production [22]. Feline HST has
previously been characterized by the presence of concurrent DM, with
prevalence rates depending on geographical area [1-3]. Feline HST can
also develop in non-diabetic cats; however, the prevalence rate in the
general cat population is unknown. To date, only five cases of feline HST
without concurrent DM have been reported [5-7]. In the present study,
seven cats (8.75%, 7/80) with overweight/obesity had IGF-1 >1000
ng/ml and phenotypic changes consistent with acromegaly. Of these
cats, four (5%, 4/80) had pituitary enlargement on CT. Although there is
no cut-off value for IGF-1 to diagnose HST in the non-diabetic cat pop-
ulation, it is likely that the four cases with IGF-1 >1000 ng/ml, acro-
megalic features, and pituitary enlargement were compatible with HST.
While incidental pituitary enlargement may occur in healthy cats, it is
important to highlight that this percentage is reduced to a small pro-
portion: 1.6% according to Niessen et al. (2015) [1]. In addition,
morphological characteristics of the pituitary gland were assessed by
magnetic resonance imaging (MRI) in cats, with no significant differ-
ences in relation to body weight [23]. The potential presence of HST in
the remaining cats (3.75%, 3/80) with IGF-1 >1000 ng/ml and acro-
megalic features, but without pituitary enlargement, warrants addi-
tional tests with MRI, octreotide suppression test, GH measurement, or
examination of the pituitary gland (post--
hypophysectomy/post-mortem) to support the diagnosis of HST. How-
ever, not all cats with HST and DM have been described to have pituitary
enlargement on CT [1,24]. It could be hypothesized that some cats with
increased IGF-1 and without pituitary enlargement are in an early stage
of the disease, or with mild HST caused by pituitary hyperplasia or
microadenoma (difficult to identify on CT), or that the quality of the CT
equipment used in this study does not allow for the identification of
subtle pituitary alterations. Likewise, it is essential to emphasize the
relevance of clinical suspicion in the diagnosis of HST/acromegaly. In
diabetic cats, acromegalic features are present in 24-61% of cases [1,3].
In this study, all cats with IGF-1 >1000 ng/ml showed phenotypic
changes consistent with acromegaly. It would be interesting to consider
in the diagnostic criteria for feline HST/acromegaly without DM, the
presence of clinical signs compatible with GH excess, especially when
hormonal tests and imaging are not conclusive.
The current diagnostic criteria for HST in diabetic cats may be
controversial in some cases because the cut-off for IGF-1 may be high to
detect milder/early stages of HST and the difficulty in identifying a
small tumor/hyperplasia on CT. Measurement of serum IGF-1 concen-
trations >1000 ng/ml by RIA has a good sensitivity for HST [8] and has
been associated with a 95% positive predictive value for HST in diabetic
cats [9]. This cut-off is probably too high, leading to an underestimation
of HST. In the present study, 11 cats (13.7%) had IGF-1 between 800 and
1000 ng/ml. All these cases require further investigation. Unfortunately,
D.D. Miceli et al. Domestic Animal Endocrinology 89 (2024) 106858

Table 1
Population characteristics of overweight/obese cats with serum IGF-1 concentration >1000 ng/ml.
Age (years) Sex Breed Body weight (kg) BCS [IGF-1] (ng/ml) Clinical Signs Pituitary height on CT (mm)

Case 1 7 Neutered male DSH 6.2 8/9 1500 - prognathia inferior 3.1
- abdominal enlargement
Case 2 12 Neutered male DSH 7.1 8/9 1293 - prognathia inferior 4.2
- broad facial features
- respiratory stridor
Case 3 7 Neutered male DSH 7.2 9/9 1047 - abdominal enlargement 4.1
- broadening of paws
Case 4 10 Neutered male DSH 8.1 7/9 1456 - broad facial features 3.7
- broadening of paws
Case 5 9 Neutered male DSH 9.8 9/9 1170 - prognathia inferior 3.3
- abdominal enlargement
- polyphagia
Case 6 11 Neutered male DSH 10 8/9 1210 - prognathia inferior 4.8
- abdominal enlargement
- broad facial features
- polyphagia
Case 7 10 Neutered male DSH 10.5 9/9 2450 - prognathia inferior 7.9
- abdominal enlargement
- broad facial features
- polyphagia
- respiratory stridor

Abbreviation: DSH, Domestic Short Hair; BCS, body condition score; IGF-1, insulin-like growth factor 1; CT, computed tomography.

neither CT/MRI nor additional studies have been performed in these
cats.
Another controversial aspect of the biochemical diagnosis of HST
and an alternative explanation for the results of this study, is that IGF-1
is not necessarily a reliable marker for the detection of feline HST, at
least in relation to the cut-off of 1000 ng/ml. Strage et al. (2015) re-
ported a wide reference interval for IGF-1 (90-1207 ng/ml) in 55 healthy
cats using enzyme-linked immunosorbent assay (ELISA), and showed an
association between body weight and IGF-1 [15]. Thus, two of the seven
cats (2/7) in the present study with IGF-1 >1000 ng/ml were <1207
ng/ml and could be considered within the reference interval and normal
for their weights (Table 1). Similarly, a recent study validated the use of
chemiluminescence (CLIA) for serum IGF-1 measurement and estab-
lished a comparatively lower cut-off of IGF-1 (746 ng/ml) in diabetic
cats [25]. In the present study, however, RIA was used to measure IGF-1,
not ELISA or CLIA. In addition, all seven cats with IGF-1 >1000 ng/ml
showed phenotypic changes consistent with acromegaly and 4/7 cats
had pituitary enlargement on CT, thus increasing the likelihood that
these cats could potentially have HST.
Several studies have investigated the relationship between serum
IGF-1 concentration and body weight, with conflicting results. On the
one hand, Reusch et al. (2006) reported a lack of correlation in healthy
and diabetic cats [11], and Zini et al. (2021) reported that IGF-1 may not
be affected by changes in body weight in healthy cats, although the
sample size in this study was too small (n = 10) [12]. In contrast, Strage
et al. (2015) reported that IGF-1 increased by 38% for each kg of body
weight gain [15]; Maxwell et al. (1999) [13] and Tvarijonaviciute et al.
(2012) [14] reported that after a 42% reduction in daily energy intake,
IGF-1 increased in obese cats after weight loss. According to the present
study, IGF-1 was positively correlated with body weight and BCS in this
population of overweight or obese cats.
The underlying mechanism of the association between feline obesity
and HST is unknown. The GH/IGF-1 axis and its multiple interactions is
complex. GH has anabolic effects on most tissues, but adipose tissue is an
exception: GH, but not IGF-1, has a dramatic catabolic effect on adipose
tissue [26]. However, since GH excess blocks insulin action, humans
with acromegaly are prone to insulin resistance. Obese patients, both
humans and cats, develop hyperinsulinemia [26,27]. Given that insulin
regulates hepatic IGF-1 production, it is possible that an increase in
insulin levels would lead to an increase in IGF1 concentrations, as has
been reported in humans [28,29]. This hypothesis remains to be eluci-
dated in cats. Serum IGF-1 consists of free IGF-1 and IGF-1 bound to
IGFBPs [30]. In humans, obese patients have lower levels of IGFBPs,
leading to increased availability of free IGF-1, which causes negative
feedback on GH secretion [31]. Thus, a decrease in GH results in a
decrease in the release of IGF-1 into the circulation. However, some
authors have observed increased or decreased IGF-1 in obese patients
[32,33]. Hence, the relationship between obesity and IGF-1 in humans is
unclear.
The present study had several limitations. First, there was a lack of
IGF-1 cut-off values for the diagnosis of feline HST in the non-diabetic
population. To date, all studies have been performed in diabetic cats.
Therefore, the association with a possible diagnosis of HST/acromegaly
could only be considered in these four cats with IGF-1 >1000 ng/ml,
phenotypic changes consistent with acromegaly, and pituitary enlarge-
ment. It would have been appropriate to perform intracranial imaging in
cats with IGF-1 concentrations between 800 and 1000 ng/ml to identify
possible pituitary abnormalities. Unfortunately, neither CT nor MRI was
performed in these cases. Another limitation of the study was that in-
sulin concentrations and IGFBPs were not measured. In addition, it
would be ideal to measure IGF-1 in a group of larger cat breeds (e.g.,
Maine Coon) that have higher body mass (and BCS = 5/5) than the
healthy control group used in this study, but it was not possible to
include these types of cats/breeds since are not common in the
geographical area where the study was conducted.
5. Conclusion
A proportion of 8.75 % of non-diabetic cats with overweight/obesity
from referral centers in Buenos Aires (Argentina) had serum IGF-1
concentrations consistent with HST in diabetic cats. Likewise, 5% of
overweight/obese cats were likely to be diagnosed with HST, supported
by evidence of pituitary enlargement and clinical signs compatible with
acromegaly. Serum IGF-1 concentrations were positively correlated with
body weight and BCS in cats with overweight/obesity. This study
highlights that HST/acromegaly should not be suspected only in diabetic
cats, and emphasizes the relevance of screening different populations of
non-diabetic cats to potentially increase the detection of HST.
Author note
Preliminary data from the study were presented as an oral research
communication at the 33rd ECVIM-CA Congress, 2023 (Barcelona,
Spain).

4
D.D. Miceli et al.
CRediT authorship contribution statement
D.D. Miceli: Writing – review & editing, Writing – original draft,
Visualization, Validation, Supervision, Project administration, Method-
ology, Investigation, Formal analysis, Data curation, Conceptualization.
A. Jaliquias: Methodology, Investigation. M.F. Gallelli: Writing – re-
view & editing, Supervision, Methodology, Investigation, Formal anal-
ysis, Data curation, Conceptualization. J.D. García: Methodology,
Investigation. C. Vecino: Methodology, Investigation. J.P. Rey Amu-
nategui: Methodology, Investigation. G.A. Pompili: Methodology,
Investigation. I.M. Espiñeira: Methodology, Investigation. J. Más:
Validation, Software, Resources, Methodology, Investigation. O.P.
Pignataro: Writing – review & editing, Supervision, Methodology,
Investigation.
Declaration of competing interest
There are no conflicts of interest for any of the authors.
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