1. ALPHA-385/R1 May 2010 © Abbott Laboratories Striving For Better Patient Outcomes Improving the Diagnosis and Monitoring of Diabetes

2. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 2 Objectives Improve the early detection of diabetes Increase the quality and impact of patient monitoring Understand the benefits of home monitoring

3. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 3 Review of Diabetes What is diabetes? –Diabetes is a disease in which the body doesn't produce or properly use insulin, which results in a poor regulation of glucose metabolism How does insulin work? –It enables glucose to enter cells where it is used for energy. –If your body doesnt make enough or cant use its own insulin, glucose accumulates in the blood, resulting in hyperglycemia. Hyperglycemia –Can lead to various complications that compromise a pets health e.g., Ketoacidosis, Cataracts, Neuropathy, etc What diabetes is NOT? This is important ….. –Diabetes is NOT the outward symptoms, i.e. excessive urination, drinking or hunger etc. A patient can be asymptomatic and still in a diabetic hyperglycemic state that if not managed leads to life threatening diseases. EC Feldman, RW Nelson. Canine and Feline Endocrinology and Reproduction, Elsevier Science, 2004: pages: 486-615. XS Lwcin, Dogs, Diet and Disease, An Owners Guide to Diabetes Mellitus, Pancreatitis, Cushings Disease, & More. Lantern Publications 2001.

4. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 4 Two Types of Diabetes Mellitus EC Feldman, RW Nelson. Canine and Feline Endocrinology and Reproduction, Elsevier Science, 2004: pages: 486-615. XS Lwcin, Dogs, Diet and Disease, An Owners Guide to Diabetes Mellitus, Pancreatitis, Cushings Disease, & More. Lantern Publications 2001. Known as non-insulin dependent diabetes mellitus (NIDDM). Cells fail to use insulin properly, sometimes combined with absolute insulin deficiency. May require oral medications or insulin Cats most commonly suffer from Type 2 –Remission is possible if: Diagnosed early Maintain tight glycemic control Known as insulin dependent diabetes mellitus (IDDM) Caused by destruction of the beta cells –Insufficient functioning beta cells cannot produce the necessary levels of insulin Requires life-long insulin therapy Dogs most commonly suffer from Type 1 Type 1Type 2

5. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 5 Diabetes is usually noticed when pets become symptomatic : Excessive urination, drinking, hunger Weight loss Fatigue and/or weakness Cloudy eyes (dogs) Does not groom (cats) BUT…some of these pets were diabetic long before the signs were noticed Routine, accurate glucose testing would leads earlier diagnosis of diabetes Why Is Early Diagnosis of Diabetes Missed? Diabetes: Persistent Hyperglycemia

6. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 6 Why Is Early Diagnosis Important? Pet Health: –Diabetes can be a contributing factor leading to serious complications: Ketoacidosis Neuropathy (nerve damage) Increased incidence of infections (especially Urinary Tract Infection) Cataracts (dogs) Gastroenteritis –Remission is possible with early detection and tight glycemic control in cats –Possibly increase the life expectancy of the pet Owner Satisfaction: –Reduce costs associated with an undiagnosed pet; such as, ER visits –Healthier pet = happier client

7. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 7 Improved Early Diagnosis Understand and actively look for the Risk Factors Dogs Age –Middle-aged to older dogs are more susceptible Unspayed females Genetics Obesity Breed Type* –Australian Terrier –Fox Terrier –Cairn Terrier –Yorkshire Terrier –Standard Schnauzer –Lhasa Cats Age –Older cats are more susceptible Neutered Males Genetics Obesity Physical inactivity Indoor Lifestyle Other diseases, e.g., chronic pancreatitis or hyperthyroidism - Miniature Schnauzer - Bichon - Frise - Spitz - Miniature & Toy Poodle - Samoyed - Apso *Could your dog or cat be living with diabetes – Common signs and risk factors – Intervet Schering Plough / AAHA Pamphlet.

8. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 8 Diabetes Management - Monitoring Monitoring is the process of tracking the patients glucose level over time –Assesses the effectiveness of the prescribed treatment –Enables changes to be made to optimize treatment –Balances the appropriate level of insulin necessary Monitoring options: –Fructosamine –Urine Glucose –Blood Glucose Effective monitoring gives the practice better quality and more frequent information to assess / optimize treatment

9. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 9 How Do We Improve Treatment? Glucose Monitoring –Improve the accuracy of monitoring –Increase the frequency of monitoring Monitoring Accuracy and Frequency improves the ability to optimize treatment decisions

10. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 10 Current Blood Glucose Testing Attributes AlphaTRAK is the only method that has ALL 4 attributes

11. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 11 Why Are Human Meters Not Accurate? Hand-held Glucose Meters work by: –Reading the whole blood sample –Extrapolating the plasma concentration from the whole blood sample using the ratio of plasma and red blood cells Ratios of glucose in plasma and whole blood is species specific Meters calibrated for humans are not accurate for animals - Plasma and RBC ratios are different

12. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 12 Testing - Accuracy The AlphaTRAK Validation Study

13. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 13 Testing - Accuracy

14. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 14 Testing - Frequency IMPACT CLINIC OWNER PATIENT Late detection of changes in patient status XXX Inability to detect dangerous hypoglycemia XXX Time spent outside normal glucose range XXX Late detection of diabetic remission XXX Late detection of insulin resistance XXX Potential for faster onset of long-term effects XXX Less client involvement/satisfaction XX Lost clinic revenue X What are the negative impacts of infrequent monitoring?

15. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 15 Fact or Fiction: It is technically too difficult for pet owners to generate a blood glucose curve at home. Blood Glucose Monitoring – Pet Owners In this retrospective study, all owners were able to generate a blood glucose curve at home. A previous study conducted in healthy pets showed that 7/7 owners and 3/7 cat owners were able to generate a reliable blood glucose curve (10). Another recent study demonstrated that 10/12 owners of diabetic dogs were able to perform blood glucose curves at home (22). Good owner communication and education were essential in obtaining these results (10,22). Pg. 721 FICTION Reference:Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Centre forCompanion Animal Health Copyright 2010 http://www.uq.edu.au/index.html?page=43392&pid=43392Linda M. Fleeman and Jacquie Rand Pg. 2

16. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 16 AlphaTRAK Blood Glucose Monitoring System Accurate Results Species specific = calibrated for dogs and cats Small Sample Size Capillary sampling … no venous draw Easy-to-Use Simple 3 step operation Fast Results Less than 15 seconds … immediate results Cost Effective Approximately $1 per test

17. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 17 How to Improve Your Diabetic Program Take non-accurate human specific meters out of circulation Make access easy –One AlphaTRAK meter per exam room –Have an AlphaTRAK Home Monitoring Kit on hand for clients Ensure everyone is trained to: –Use the meter successfully –Easily obtain a capillary sample Develop a Diabetic treatment protocol –Helps staff recognize proper treatment and follow-up care –Sets expectations for the client of on-going care scheduling and costs –Staff can uncover client compliance issues Implement a home blood glucose monitoring program

18. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 18 Blood Glucose Home Monitoring Program Clinic Preparation: create a client education/support team –Assign specific staff as the experts in home monitoring –Show confidence in the pet owners ability to monitor at home –Set and communicate proper expectations Understand the learning curve and protocols to help clients be successful Getting the Client Started: make it simple for the pet owner –How-to demonstrations & training: Capillary blood samples, AlphaTRAK meter operation, insulin administration, nutrition, protocols, etc. –Set the clients expectations of early challenges that will improve with experience –Provide a written treatment plan Pet specific instructions for hypo/hyperglycemic scenarios Include: glucose testing, treatment schedules, other medications, dietary changes, and exercise recommendations –Establish an ongoing clinic recheck schedule

19. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 19 Blood Glucose Home Monitoring Program On-Going Support: –Set up a call back system to check in on diabetic pet owners –Share success stories of other clients successfully managing diabetic pets –In-clinic client education programs –Nutrition and exercise consults An Engaged Client = A Compliant Client

20. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 20 Kit Contents Includes what your clients needs to start home monitoring. Training: Accurate Testing Supplies: Ease-of-Use: Engagement: AlphaTRAK Blood Glucose Monitoring System Features and Benefits Accurate Results Species specific = calibrated for dogs & cats Small Sample Size Capillary sampling Easy-to-Use Simple 3 step operation Fast Results Less than 15 seconds … immediate results Cost Effective Approximately $1 per test Instructional DVD AlphaTRAK Meter AlphaTRAK Strips (50)* Lancing Device AlphaTRAK Lancets Quick Users Guide Pet Diary – Track Readings

21. ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories 21 Objectives Check Improve early detection of diabetes Increase the quality of patient monitoring & management Understand the benefits of home monitoring