title: Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes.
abstract: We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors: 1 Pediatric Endocrinology, Oregon Health & Science University, Portland, OR, USA.
authors: Evan A
authors: EA
authors: Los
authors: 2 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
authors: Katrina L
authors: KL
authors: Ramsey
authors: 1 Pediatric Endocrinology, Oregon Health & Science University, Portland, OR, USA.
authors: Ines
authors: I
authors: Guttmann-Bauman
authors: 3 Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA.
authors: Andrew J
authors: AJ
authors: Ahmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D004285:Dogs; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015203:Reproducibility of Results; D055815:Young Adult
keywords: continuous glucose monitor; dog; hypoglycemia; type 1 diabetes