Dr. Dog & Dr. Jenny Join the Diabetes Care Team

Whether you realize it or not, your diabetes care efforts may be getting support from some unlikely ancillary staff: the Jenny Craig weight loss programs and a growing number of specially trained Diabetes Alert Dogs.

AlertDog1According to a recent report on ConsultantLive.com, by Veronica Hackenthal, MD, Diabetic Alert Dogs (DADs) trained to alert their human companions about excessive glucose swings are becoming more widely accepted as part of disease management programs.

The idea is to utilize the dogs’ acute sense of smell—which is roughly 1,000 times more sensitive than a human’s—to detect metabolic changes via volatile organic compounds in urine, sweat, saliva, and pulmonary exhalations. These changes show up 15-30 minutes before they appear in blood, and are detectable by dogs well before they would register on a home glucose meter.

DADs are especially helpful to older “brittle” diabetics living alone. At night, they can be life-savers, rousing their owners from sleep and enabling them to avert seizures, brain damage, and death.

Nature’s Finest Sniff-Testers

The initial work with alert dogs was in the context of Type 1 insulin-dependent diabetes. Several studies have shown that dogs are quite good clinicians. In one survey of 212 Type 1 dog owners, 65% said their dogs had shown a behavioral action to at least one confirmed hypoglycemic episode, and 32% say their canine friends reacted to 11 or more such events.

The dogs alert their companions to impending hypoglycemic crises by barking or vocalizing, licking intensely, nuzzling, jumping or staring intently at their owners’ faces (Wells DL, et al. J Altern Complement Med. 2008; 14(10): 1235-41).

A more recent 2013 survey in Diabetes Care, indicated that Type 1 diabetics who owned trained DADs had less frequent and less severe hypoglycemia, and improvements in HbA1c in the months following placement of the dogs. They also reported decreased worry about hypo and hyperglycemia, improved quality of life, and greater ability to participate in physical activities (Gonder-Frederick L, et al. Diabetes Care. 2013; 36 (4)).

Over 90% of the doggie alerts occurred at blood glucose levels in the range of 3.3 to 3.9 mmol/L. While none of the owners reported that their canine companions had perfect accuracy, the authors are quick to point out that most blood glucose monitors lose accuracy below 4.2 mmol/L.

A British survey by University of Bristol’s Nicola Rooney, of 17 patients with Medical Detection Dogs found that all respondents reported decreased frequency of hypoglycemia, episodes of unconsciousness, or paramedic home visits. Blood tests showed significantly improved glycemic control (p<0.001).

In recent years, some people have begun experimenting with detection dogs in Type 2 Diabetes, says Dr. Hackenthal in her review. They may be somewhat less helpful in this setting because drug therapies for Type 2 diabetes typically take a long period of time to normalize glucose levels.

During these periods, a detection dog’s olfactory equipment may become over-saturated with the scents of hyperglycemia, and their accuracy may be thrown off. That said, type 2 diabetics who are insulin-dependent may be helped by a well-trained canine friend.

Long Term Investment

A wide variety of dog breeds have been trained for work in diabetes care. According to Lily Grace, founder of the National Institute for Diabetic Alert Dogs AlertDog2(NIDAD), specific breed is less important than temperament, trainability, and ability to bond with humans. Ms. Grace, a registered nurse who has trained more than 400 DAD puppies, says her institute tends to train Labrador and Golden Retrievers, Poodles and mixed sporting dogs.

Professional trainers tend to prefer training puppies—like humans, dogs are most imprintable in their first years—but organizations dedicated to DADs note that some people are able to train their pets to become alert dogs.

Detection dogs are a significant investment: a fully trained, ready-for-work adult typically costs between $18,000 and $30,000. Puppies are roughly half that price. Training can take up to two years, and some trainers go beyond the basics and train their dogs to do things like retrieving glucose monitors or grabbing cordless phones.

Though not yet covered by health insurance plans, there are a number of national and local charities focused on making DADs available to diabetic patients in need. There are also several groups that help people find and purcase well-trained alert dogs. These include:

Alert dog advocates stress that these animal friends are adjuncts to home glucose monitors and good clinical care; they are not replacements. But they represent a new approach to home care that patients are sure to…ahem…embrace.

Dr Jenny Gets Results

On the therapeutic end of the diabetes care continuum, the Jenny Craig programs appear to outperform conventional clinical care, delivering not just weight loss but also good glucose control without medication in overweight diabetic adults.

Cheryl Rock, PhD, RD, and colleagues at the University of California, San Diego compared 76 obese/overweight diabetic adults receiving usual clinical care (consisting of two weight loss counseling sessions and monthly checkups), with 74 similar patients on a low-fat Jenny Craig weight loss program, and 77 on the Jenny Craig low carb diet.

JennyCraigLogoThe Jenny Craig programs provided the patients with complete packaged meals designed for glycemic control, as well as a menu plan and frequent one-on-one counseling sessions, all provided free of charge by the Jenny Craig company, the study’s sponsor. Patients were also encouraged to increase their physical activity.

The UCSD team found that after one year, 38% of the Jenny Craig patients lost at least 10% body weight compared with only 9% of those in usual care. Further, 72% of Jenny Craig patients were able to discontinue pre-meal insulin shots or cut back on dose, versus just 8% of those in usual care. Average fasting glucose levels for the Jenny patients was 141 mg/dl at one year, versus 159 ng/dl in the customary care cohort. This translated into average HbA1cs of 6.9% versus 7.5%.

The lower-carb version of the meal plan group gave better blood sugar control during the last three months of the study, compared to the low-fat version. On a cohort basis, the low-carb plan also gave greater weight loss (9% of total body weight versus 7.4% for the low-fat version, and 2.5% in the usual care cohort). The data were published in late April in Diabetes Care.

“Dr Jenny” also scored impressively on the cardiovascular risk front, with triglycerides down around 148 mg/dL versus 204 mg/dL in the control group.

The Jenny Craig company funded the study but was not involved in analysis of the data.

This is not the first study to show that a commercial weight loss program has value in diabetes care. US-based Weight Watchers and the Scandinavian ITrim programs have also been shown effective.

Still, the new findings should provide "a huge ray of hope for people that lifestyle changes are possible and there are some things that don't cost an arm and a leg," Dr. Rock said in an interview with Andrew Seaman of Reuters Health.

That said, the new Jenny Craig for Type 2 program ain’t exactly cheap. The plan costs approximately $689 per month, plus the cost of shipping the prepacked meals.