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OBSERVATIONS
Diabetic Alert Dogs:
A Preliminary Survey
of Current Users
Methods for monitoring blood glu-
cose (BG) levels play many essen-
tial roles in diabetes management,
and one of the most important is alerting
individuals to the occurrence of hypogly-
cemia. A growing number of individuals
with diabetes are turning to the use of
Diabetic Alert Dogs (DADs) for hypogly-
cemia detection, despite their high cost.
Testimonials from DAD owners and train-
ers have reported in the media that the
accuracy of trained canine alerts matches
that of BG monitoring technology (1,2)
and described other benefits attributed
to DADs, including improvements in
glycemic control and quality of life (QoL).
However, with the exception of one ab-
stract from a case study (3) there is no
scientific evidence that confirms the abil-
ity of DADs to detect hypoglycemia accu-
rately or to improve clinical outcomes and
QoL. We have recently conducted an ex-
ploratory study based on a survey of DAD
owners from a Virginia-based nonprofit
organization, Service Dogs by Warren Re-
trievers, Inc. (SDWR).
To gain information about their clients’
experiences, SDWR conducted an online
survey, which was completed by 36 DAD
owners—23 parents of children and 13
adults with type 1 diabetes (means/standard
deviations of child/adult age 8.4/3.1 and
36.4/14.1, respectively). Data were deiden-
tified by SDWR then sent to the University
of Virginia for analysis, and the study was
approved as exempt by the University of
Virginia Institutional Review Board. Survey
items inquired about the accuracy of DAD
alerts, as well as frequency of hypoglyce-
mia, diabetes control, and QoL prior to
and since DAD placement.
DAD accuracy—Respondents were
asked how frequently they experienced
hypoglycemia with no corresponding
DAD alert in the past month. Over one-
third (36.1%) reported no occurrences
without a DAD alert in this time period,
27.8% reported fewer than one event per
week, and 36.1% reported more than one
per week. Nearly all respondents (91.7%)
reported that DAD alerts occurred at BG
levels between 3.3–3.9 mmol/L.
Clinical outcomes —Respondents
reported significant decreases in the fre-
quency of severe (P50.039) and mod-
erate (P50.02) hypoglycemia since DAD
placement, as well as glycosylated hemo-
globin levels (P50.001).
Psychosocial outcomes—The
majority of respondents reported de-
creased worry about hypoglycemia
(61.1%) and hyperglycemia (61.1%), im-
proved QoL (75%), and the ability to
participate in physical activities (75%).
A number of significant methodolog-
ical limitations should be considered
when interpreting these findings, includ-
ing the small number of respondents, as
well as the subjective and retrospective
nature of the survey data. Obviously, pro-
spective studies of larger numbers of DAD
owners, with objective measures to assess
DAD accuracy and clinical outcomes are
needed. Nonetheless, these preliminary
findings provide some encouraging evi-
dence about the potential benefits of DAD
use. Although DAD owners did not all
report perfect accuracy, this is not sur-
prising given that BG monitoring tech-
nology is also not perfectly accurate at BG
levels ,75 mg/dL or 4.2 mmol/L (4). On
the basis of these positive exploratory
findings, more research into the use of
DADs in diabetes management appears
warranted, including scientifically rigor-
ous studies comparing the accuracy of
DADalertstothatofBGmonitoring
devices (5).
LINDA GONDER-FREDERICK,PHD
1
PAM RICE,BA
2
DAN WARREN
2
KAREN VAJDA,BA
1
JACLYN SHEPARD,PSYD
1
From the
1
Behavioral Medicine Center, University of
Virginia, Charlottesville, Virginia; and
2
Service Dogs
by Warren Retrievers, Inc., Culpeper, Virginia.
Corresponding author: Linda Gonder-Frederick,
lag3g@virginia.edu.
DOI: 10.2337/dc12-1998
© 2013 by the American Diabetes Association.
Readers may use this article as long as the work is
properly cited, the use is educational and not for
profit, and the work is not altered. See http://
creativecommons.org/licenses/by-nc-nd/3.0/ for
details.
Acknowledgments—D.W. is the CEO of
Service Dogs by Warren Retrievers, Inc.
(SDWR). P.R. is a client of SDWR. No other
potential conflicts of interest relevant to this
article were reported.
L.G.-F. supervised data analysis and in-
terpretation and manuscript preparation and
editing. P.R. and D.W. researched data and
edited the manuscript. K.V. analyzed data,
contributed to data interpretation, and edited
the manuscript. J.S. contributed to data inter-
pretation and edited the manuscript. L.G.-F. is
the guarantor of this work and, as such, had
full access to all the data in the study and takes
responsibility for the integrity of the data and
the accuracy of the data analysis.
The authors thank Dallas Ducar and Jean Pak,
University of Virginia, for editorial assistance.
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