Diabetes alert dogs: Objective behaviours shown during periods of owner glucose fluctuation and stability (original) (raw)
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An Owner-Independent Investigation of Diabetes Alert Dog Performance
Frontiers in Veterinary Science
Objective: To quantify Diabetes Alert Dog (DAD) performance by using owner-independent measures. Research Design and Methods: Eight owners of accredited DADs used a FreeStyle Libre Flash Glucose Monitoring System (FGMS). Concurrent Closed Circuit Television (CCTV) footage was collected for between 5 and 14 days in each owner's home or workplace. The footage was blind-coded for dogs' alerting behaviors. The sensitivity, False Positive Rate and Positive Predictive Values (PPV) of dogs' alerts to out-of-range (OOR) episodes were calculated. Ratings for 11 attributes describing participant's lifestyle and compliance (taken from each dog's instructor) and the percentage of DAD alerts responded to by the owner as per training protocol (taken from CCTV footage) were assessed for association with dog performance. Results: Dogs alerted more often when their owners' glucose levels were outside vs. inside target range (hypoglycaemic 2.80-fold, p = 0.001; hyperglycaemic 2.29-fold, p = 0.005). Sensitivity to hypoglycaemic episodes ranged from 33.3 to 91.7%, the mean was 55.9%. Mean PPV for OOR episodes was 69.7%. Sensitivity and PPV were associated with aspects of the dog and owner's behavior, and the owner's adherence to training protocol. Conclusions: Owner-independent methods support that some dogs alert to hypo-and hyperglycaemic events accurately, but performance varies between dogs. We find that DAD performance is affected by traits and behaviors of both the dog and owner. Combined with existing research showing the perceived psychosocial value and reduced critical health care needs of DAD users, this study supports the value of a DAD as part of a diabetes care plan. It also highlights the importance of ongoing training and continued monitoring to ensure optimal performance.
Canine responses to hypoglycemia in patients with type 1 diabetes
The Journal of Alternative …, 2008
Objective: Anecdotal evidence suggests that domestic dogs may be able to detect hypoglycemia in their human caregivers; scientific investigation of this phenomenon, however, is sorely lacking. This study thus aimed to investigate how pet dogs respond to the hypoglycemic episodes of their owners with type 1 diabetes. Methods: Two hundred and twelve dog owners (64.2% female) with medically diagnosed type 1 diabetes participated in the study. All participants owned at least 1 dog. Each person completed a purpose-designed questionnaire developed to collect information on their dogs' responses (if any) to their hypoglycemic episodes. Results: One hundred and thirty-eight (65.1%) respondents indicated that their dog had shown a behavioral reaction to at least one of their hypoglycemic episodes, with 31.9% of animals reacting to 11 or more events. Canine sex, age, breed status, and length of pet ownership were unrelated to hypoglycemia-response likelihood. Thirty-six percent of the sample believed that their dogs reacted most of the times they went "low"; 33.6% indicated that their pets reacted before they themselves were aware they were hypoglycemic. Dogs' behavioral responses to their owners' hypoglycemic episodes varied. Most animals behaved in a manner suggestive of attracting their owners' attention, for example, vocalizing (61.5%), licking them (49.2%), nuzzling them (40.6%), jumping on top of them (30.4%), and/or staring intently at their faces (41.3%). A smaller proportion showed behavioral responses suggestive of fear, including trembling (7.2%), running away from the owner (5.1%), and/or hyperventilating (2.2%).
PLOS ONE
Aims Domestic dogs are trained to a wide variety of roles including an increasing number of medical assistance tasks. Glycaemia alert dogs are reported to greatly improve the quality of life of owners living with Type 1 diabetes. Research into their value is currently sparse, on small numbers of dogs and provides conflicting results. In this study we assess the reliability of a large number of trained glycaemic alert dogs at responding to hypo-and hyper-glycaemic (referred to as out-of-range, OOR) episodes, and explore factors associated with variations in their performance. Methods Routine owner records were used to assess the sensitivity and specificity of each of 27 dogs, trained by a single UK charity during almost 4000 out-of-range episodes. Sensitivity and positive predictive values are compared to demographic factors and instructors' ratings of the dog, owner and partnership. Results Dogs varied in their performance, with median sensitivity to out-of-range episodes at 70% (25 th percentile = 50, 75 th percentile = 95). To hypoglycaemic episodes the median sensitivity was 83% (66-94%) while to hyperglyaemic episodes it was 67% (17-91%). The median positive predictive value (PPV) was 81% (68-94%), i.e. on average 81% of alerts occurred when glucose levels were out of target range. For four dogs, PPV was 100%. Individual characteristics of the dog, the partnership and the household were significantly associated with performance (e.g., whether the dog was previously a pet, when it was trained, whether its partner was an adult or child).
Investigation into the Value of Trained Glycaemia Alert Dogs to Clients with Type I Diabetes
PLoS ONE, 2013
Previous studies have suggested that some pet dogs respond to their owners' hypoglycaemic state. Here, we show that trained glycaemia alert dogs placed with clients living with diabetes afford significant improvements to owner well-being. We investigated whether trained dogs reliably respond to their owners' hypoglycaemic state, and whether owners experience facilitated tightened glycaemic control, and wider psychosocial benefits. Since obtaining their dog, all seventeen clients studied reported positive effects including reduced paramedic call outs, decreased unconscious episodes and improved independence. Owner-recorded data showed that dogs alerted their owners, with significant, though variable, accuracy at times of low and high blood sugar. Eight out of the ten dogs (for which owners provided adequate records) responded consistently more often when their owner's blood sugars were reported to be outside, than within, target range. Comparison of nine clients' routine records showed significant overall change after obtaining their dogs, with seven clients recording a significantly higher proportion of routine tests within target range after obtaining a dog. HbA1C showed a small, non significant reduction after dog allocation. Based on owner-reported data we have shown, for the first time, that trained detection dogs perform above chance level. This study points to the potential value of alert dogs, for increasing glycaemic control, client independence and consequent quality of life and even reducing the costs of long-term health care.
Variability of Diabetes Alert Dog Accuracy in a Real-World Setting
Journal of diabetes science and technology, 2017
Diabetes alert dogs (DADs) are growing in popularity as an alternative method of glucose monitoring for individuals with type 1 diabetes (T1D). Only a few empirical studies have assessed DAD accuracy, with inconsistent results. The present study examined DAD accuracy and variability in performance in real-world conditions using a convenience sample of owner-report diaries. Eighteen DAD owners (44.4% female; 77.8% youth) with T1D completed diaries of DAD alerts during the first year after placement. Diary entries included daily BG readings and DAD alerts. For each DAD, percentage hits (alert with BG ≤ 5.0 or ≥ 11.1 mmol/L; ≤90 or ≥200 mg/dl), percentage misses (no alert with BG out of range), and percentage false alarms (alert with BG in range) were computed. Sensitivity, specificity, positive likelihood ratio (PLR), and true positive rates were also calculated. Overall comparison of DAD Hits to Misses yielded significantly more Hits for both low and high BG. Total sensitivity was 57...
Dogs Can Be Successfully Trained to Alert to Hypoglycemia Samples from Patients with Type 1 Diabetes
Diabetes Therapy, 2015
Introduction: Hypoglycemia (Hypo) is the most common side effect of insulin therapy in people with type 1 diabetes (T1D). Over time, patients with T1D become unaware of signs and symptoms of Hypo. Hypo unawareness leads to morbidity and mortality. Diabetes alert dogs (DADs) represent a unique way to help patients with Hypo unawareness. Our group has previously presented data in abstract form which demonstrates the sensitivity and specificity of DADS. The purpose of our current study is to expand evaluation of DAD sensitivity and specificity using a method that reduces the possibility of trainer bias. Methods: We evaluated 6 dogs aging 1-10 years old who had received an average of 6 months of training for Hypo alert using positive training methods. Perspiration samples were collected from patients during Hypo (BG 46-65 mg/dL) and normoglycemia (BG 85-136 mg/dl) and were used in training. These samples were placed in glass vials which were then placed into 7 steel cans (1 Hypo, 2 normal, 4 blank) randomly placed by roll of a dice. The dogs alerted by either sitting in front of, or pushing, the can containing the Hypo sample. Dogs were rewarded for appropriate recognition of the Hypo samples using a food treat via a remote control dispenser. The results were videotaped and statistically evaluated for sensitivity (proportion of lows correctly alerted, ''true positive rate'') and specificity (proportion of blanks ? normal samples not alerted, ''true negative rate'') calculated after pooling data across all trials for all dogs. Results: All DADs displayed statistically significant (p value \0.05) greater sensitivity (min 50.0%-max 87.5%) to detect the Hypo sample than the expected random correct alert of 14%. Specificity ranged from a min of 89.6% to a max of 97.9% (expected rate is not defined in this scenario). Conclusions: Our results suggest that properly trained DADs can successfully recognize and Electronic supplementary material The online version of this article (
Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes
Journal of Diabetes Science and Technology, 2016
Background: We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes. Methods: Patients with type 1 diabetes who currently used diabetes alert dogs participated in this exploratory study. Subjects reported satisfaction, perceived dog glucose sensing ability and reasons for obtaining a trained dog. Reliability of dog alerts was assessed using capillary blood glucose (CBG) and blinded continuous glucose monitoring (CGM) as comparators in 8 subjects (age 4-48). Hypoglycemia was defined as CBG or CGM <70 mg/dL. Results: Dog users were very satisfied (8.9/10 on a Likert-type scale) and largely confident (7.9/10) in their dog's ability to detect hypoglycemia. Detection of hypoglycemia was the primary reason for obtaining a trained dog. During hypoglycemia, spontaneous dog alerts occurred at a rate 3.2 (2.0-5.2, 95% CI) times higher than during euglycemia (70-179 mg/dL). Dogs provided timely alerts in 36% (sensitivity) of all hypoglycemia events (n = 45). Due to inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. When there was concurrence of a hypoglycemic event between the dog alert and CGM (n = 30), CGM would have alerted prior to the dog in 73% of events (median 22-minute difference). Conclusions: This is the first study evaluating reliability of trained dogs to alert to hypoglycemia under real-life conditions. Trained dogs often alert a human companion to otherwise unknown hypoglycemia; however due to high false-positive rate, a dog alert alone is unlikely to be helpful in differentiating hypo-/hyper-/euglycemia. CGM often detects hypoglycemia before a trained dog by a clinically significant margin.
Anthrozoos: A Multidisciplinary Journal of The Interactions of People & Animals, 2011
The aim of this exploratory study was to determine heart rate and the levels of oxytocin, cortisol, and insulin in dogs and their owners in response to a short-term interaction. In addition, the dogs' behavior was studied. The owners' responses were compared with those obtained from a control group. Ten female volunteers and their own male Labrador dogs participated in an experiment during which the owner stroked, petted, and talked with her dog during the first 3 minutes. Blood samples were collected from both dog and owner before (0) and at 1, 3, 5, 15, 30, and 60 minutes after the start of the interaction. Blood samples were analyzed by EIA. Heart rate was monitored telemetrically. The data were analyzed using linear mixed models and paired t-tests. The dogs' oxytocin levels were significantly increased 3 minutes after the start of the interaction (p = 0.027). Cortisol levels were significantly increased after 15 and 30 minutes (p = 0.004 and p = 0.022, respectively), and heart rate was significantly decreased after 55 minutes (p = 0.008). The dogs displayed normal behaviors during the experiment. The owners' oxytocin levels peaked between 1 and 5 minutes after interaction (p = 0.026). No such effect was seen in the controls. Cortisol levels displayed a significant decrease at 15 or 30 minutes in both owners and controls, and insulin levels did so at 60 minutes (p = 0.030, p = 0.002 and p = 0.002, 301 Anthrozoös Anthrozoös Short-Term Interaction between Dogs and Their Owners… p < 0.0001, respectively). Heart rate decreased significantly in the owners at 55 and 60 minutes (p = 0.0008) but not in the controls. In conclusion, short-term sensory interaction between dogs and their owners influences hormonal levels and heart rate. However, further studies need to be performed in order to better understand the effects of interaction between dogs and their owners.