June 15, 2016

Mixed Results in a Small Trial on Diabetes Alert Dogs

This is a small trial only using eight dogs and is presented before being published in a peer-reviewed journal. There are several possible biases that are self-evident causing this to be junk science. Either the article was poorly written by an author not understanding the subject, or the authors of the study presented this in a poor manner,

The first statement that I question is this - “the first sign of hypoglycemia was the continuous glucose monitoring, followed by the dog, followed by a patient's symptoms.”

This is the first controlled study of the reliability of diabetes alert dogs to hypoglycemia in their diabetic companions under real-life conditions, Los said. Evan Los, MD, of Oregon Health & Science University in Portland is the lead author. His group examined eight patients (the youngest was 4-years-old) who had both a diabetes alert dog and a blinded CGM. Dog alerts were recorded in a diary and those were compared to capillary blood glucose (CBG) and CGM downloads.

Diabetes alert dogs undergo rigorous training, starting with obedience and socialization, as well as scent training. For the latter, they are trained based on a cotton swab of sweat from a human companion during a hypoglycemic event. The training takes 6-24 months to complete, but there is no universal competence test for dogs.

The first bias is using a 4-year-old child that can do little or no continuous training to the dog. A child this young generally indicates that the parents may have abdicated their responsibility of caring for their child. This is common and occurs more often than it should.

The second bias is the length of training. Six months means the dog is generally unfit for duty as a diabetes service dog. Most excellent trainers would prefer the 24 months or up to 30 months for the dog to be trained and the owner of the service dog to be trained on how to continue the training to reinforce prior training.

While there is no universal competence test for hypoglycemia alert training, there is a test given by the American Kennel Club for a dog to become a good citizen when out in the public and every diabetes service dog needs to have this training and pass this test.

I can concede that there will be some false positives with any dog, but the level in this study does require that the study needs to be redone with properly trained dogs and not include children that have no knowledge in refresher training to prevent the large number of false positives.

Only using eight dogs of unknown training is a serious weakness of this controlled study and makes me doubt that the proper criteria were established before the trial began. No information is given about the original trainers, which can also affect the outcome of the study as some trainers can talk the talk, but not walk the walk.

Study limitations included the small sample size, short duration of the study, and the fact that the dogs were different breeds and different ages, and from different trainers. The most reliable dog in the sample had completed 24 months of dog training, suggesting that dog skills diminish over time and may require re-training. 

The last sentence above shows the ignorance of the person making this statement, as the owner of the diabetes service dog also needs to be trained in how to refresh the dog's training on a continuous basis.  Dogs do get lazy and suffer from poor use.

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