Ambulatory Glucose Monitoring in Canine Diabetes: Using Technology to Inform Clinical Decisions

Monitoring glycaemic control is fundamental to managing canine diabetes mellitus, yet traditional methods such as single blood glucose measurements or in-clinic glucose curves provide only limited insight into day-to-day glucose behaviour. These approaches capture isolated time points and may not reflect fluctuations associated with feeding patterns, physical activity, insulin pharmacodynamics, or home-environment variables. As a result, clinicians frequently encounter situations where clinical signs and measured glucose values appear discordant. Recent open-access research has therefore focused on ambulatory glucose monitoring as a tool to better characterise real-world glycaemic patterns in diabetic dogs. 

Technology Overview: Continuous and Flash Glucose Monitoring 

Modern continuous glucose monitoring systems (CGMS) and flash glucose monitoring devices measure interstitial glucose concentrations repeatedly over several days, generating longitudinal glucose profiles under normal living conditions. In a 2025 open-access study, Xi et al. evaluated a real-time CGMS with intelligent tracking in diabetic dogs and demonstrated strong correlation between interstitial glucose values and portable blood glucose meter measurements, particularly after system calibration. The study also showed improved data acquisition and stability when intelligent tracking was applied, supporting the feasibility of ambulatory glucose monitoring in canine patients¹. 

Complementary evidence comes from a 2025 open-access study by Salerno et al., which analysed flash glucose monitoring–derived ambulatory glucose profiles in diabetic dogs.² This study confirmed that flash monitoring can consistently generate interpretable glucose datasets over extended monitoring periods in clinical settings². Together, these studies establish the technical validity and reliability of ambulatory glucose monitoring technologies in dogs. 

What Ambulatory Metrics Objectively Show 

Both studies demonstrate that ambulatory monitoring enables calculation of quantitative glycaemic metrics, including mean glucose concentration, coefficient of variation (CV), time in range (TIR), and time above range (TAR^)1,2. Xi et al. reported substantial glycaemic variability and prolonged hyperglycaemic exposure in monitored dogs despite ongoing insulin therapy, highlighting the dynamic nature of glucose control in routine conditions¹. These findings indicate that isolated glucose readings may underestimate daily variability. 

Importantly, Salerno et al. showed that ambulatory glucose metrics derived from flash monitoring were associated with established clinical glycaemic control assessment scores used in canine diabetes management. This provides evidence that ambulatory metrics reflect clinically meaningful aspects of glycaemic status rather than random fluctuation². 

Clinical Interpretation: How This Helps in Practice 

Current evidence does not demonstrate that ambulatory glucose monitoring directly improves outcomes or dictates insulin dose adjustments. However, the available data support its role as a clinical interpretation tool^1,2. By visualising glucose patterns over time, veterinarians can better contextualise inconsistent glucose curves, unexplained hyperglycaemia, or apparent instability in dogs receiving insulin. 

For example, identification of sustained hyperglycaemia or high glucose variability on ambulatory profiles may prompt clinicians to reassess insulin timing, feeding schedules, owner adherence, or the presence of concurrent disease rather than escalating insulin doses based solely on single readings.¹² Similarly, correlation of ambulatory metrics with clinical assessment scores supports their use alongside traditional evaluation methods, rather than as replacements². 

Relevance in Referral and Advanced Practice Settings 

In referral or advanced practice environments, ambulatory glucose monitoring offers a practical means of assessing glycaemic behaviour when standard monitoring fails to explain clinical observations. Continuous datasets provide insight into glucose exposure across the full daily cycle, including periods not captured during hospital visits^1,2. While interpretation must remain cautious, the evidence supports use of ambulatory monitoring to enhance understanding of complex or unstable cases without overstating its therapeutic impact. 

Clinical Takeaways 

Open-access evidence confirms that both real-time and flash glucose monitoring systems can reliably capture ambulatory glucose profiles in diabetic dogs. These technologies objectively demonstrate glycaemic variability and prolonged hyperglycaemia that may not be evident with intermittent testing. Although outcome benefits are not yet established, ambulatory glucose metrics can meaningfully support clinical interpretation and comprehensive assessment in canine diabetes management. 

References 

1. Xi J, Yang H, Zhang Q, Yang S, Ping F, Fang X. Glucose monitoring intelligent tracking system for remote glycaemic assessment in diabetic dogs: a novel approach. BMC Vet Res. 2025;21:354. Available from: https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-025-04809-6 

2. Salerno TC, Corradini S, Parisi G, Coradini M, Veronesi MC, Zini E, et al. FreeStyle Libre-derived ambulatory glucose metrics correlate with clinical assessment of glycaemic control in diabetic dogs. J Vet Intern Med. 2025;39(4):e70151. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12175195/