Serum adipokines are useful for predicting hyperinsulinemia secondary to corticosteroid treatment in horses.

Pretreatment leptin-to-adiponectin ratio strongly predicts corticosteroid-induced hyperinsulinemia risk in horses.

This prospective study evaluated pretreatment serum biomarkers capable of predicting the severity of corticosteroid-induced hyperinsulinemia in horses. Twenty-four healthy adult Standardbreds underwent oral glucose testing before (day 1) and after (day 8) a dexamethasone course (0.08 mg/kg every 48 hours). Post-treatment insulin parameters—resting insulin (T0insulin), peak insulin (Cmaxinsulin), and area under the curve (AUCinsulin)—were correlated with pretreatment serum markers including insulin, glucose, adiponectin, leptin, and their ratios. Following dexamethasone treatment, mean resting insulin increased 11.5-fold, peak insulin 6.5-fold, and AUC insulin 6.6-fold compared to baseline values (P < .001), highlighting substantial individual variability in response. Pretreatment adiponectin demonstrated the strongest negative correlation with post-treatment peak and AUC insulin responses (ρ = -0.67 and -0.68, respectively; P < .001). The leptin-to-adiponectin ratio was the strongest overall predictor of post-treatment insulin parameters across all three measures and generalized linear model analyses. Horses with a pretreatment leptin-to-adiponectin ratio greater than 1 were nearly five times more likely to develop resting hyperinsulinemia exceeding 100 µIU/mL after corticosteroid administration. These findings suggest that measuring adipokines prior to corticosteroid therapy could identify horses at elevated risk for hyperinsulinemia and the potentially life-threatening sequela of laminitis, enabling more informed clinical decision-making and risk stratification before initiating corticosteroid treatment in equine patients.

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