Can Diabetic Alert Dogs Improve Patient Outcomes?


Dogs for Diabetics provides alert dogs for patients of all ages with diabetes.

Living with diabetes can be a difficult journey for patients who have to overcome the challenge of controlling blood glucose levels with lifelong medication, in addition to diet and exercise. Patients who continually experience high or low blood glucose levels may experience adverse events and high healthcare costs later in life.

While diabetic or glycemic alert dogs are not a “cure all” approach to treating diabetes, they can provide patients with the support and motivation to adhere to treatments and improve quality of life, according to Ralph Hendrix, vice president and executive director at Dogs for Diabetics (D4D), which provides medical-alert dogs to patients with insulin-dependent diabetes at no cost.

The organization was founded by D4D President Mark Ruefenacht—who is also a researcher with the National Institute of Standards and Technology—after a guide dog-in-training alerted him to a hypoglycemic event while he was sleeping. Rufenacht and his dog, Armstrong, received notoriety from the Guinness Book of World Records as the first scientifically trained diabetic alert dog team, Hendrix told The American Journal of Pharmacy Benefits. D4D is also the first program in the world to be accredited by Assistance Dogs International (ADI) for this work.

The dogs undergo an arduous training process specific to each person. The dogs are trained to alert their handler when their blood sugar is too high or too low, and must be correct more than 80% of the time before they graduate the program, according to D4D. The highly structured training for every dog is monitored and measured as a means to prove the dog’s capabilities. On average, each dog performs over 1400 scent-training runs over a 3 to 5 month training cycle, to achieve D4D’s rigorous accuracy requirement. While the training is strenuous, the dogs view the blood sugar alerts as an engaging game with their handler, according to Hendrix.

While many breeds of dog can become glycemic-alert dogs, D4D typically trains Labrador retrievers and golden retrievers to alert for low and/or high blood sugar. The trainers work to match patients with a dog who meets their individualized needs and physical capabilities.

Importantly, clients need to keep up with the training of their dog to ensure that they are receiving the necessary alerts and mitigating potential harms from high or low blood sugar, Hendrix said.

“Our clients can come into our training center for follow-up training. We have support groups and monthly meetings for our clients to attend for on-going support. We'll also do 1-on-1 remedial training with our dogs, if necessary, all at no charge,” he told AJPB. “So, we've taken out the financial issues associated with obtaining a medical-alert dog, but we do require significant time and commitment on the part of the person to learn to handle the dog properly.”

D4D’s clients range in age from 5 to 85 years. Hendrix said that a majority of their dogs are placed with patients who have type-1 diabetes, as they have limited treatment options. D4D has also placed dogs with high-risk, insulin-dependent patients with type-2 diabetes.

Although clients receive support to improve blood glucose control from their glycemic-alert dog, they must be committed to their health and remain adherent to treatments prescribed by their healthcare professionals.

“Clients need to be motivated to take action to improve their insulin-therapy. They [diabetic-alert dogs] will not change an unmotivated or irresponsible person,” Hendrix said. “They do support the difficult and frustrating times that all diabetics have. Besides the positive impact on their insulin-therapy, they provide real emotional support. We have found that they are particularly helpful with youth seeking independence and going through the difficult changes in their teens, leaving home for college, etc.”

When placing these dogs, the hope is that patients succeed in improved disease control, which will prevent adverse events, especially for younger patients. Hendrix said that a majority of patients will normalize their blood glucose levels resulting from work with the dogs.

“It is very common to hear our clients initially understand that as the dog is successful in alerting on lows, their A1C will actually rise, due to the elimination of the extreme lows in the 3 month-average. Then, they are able to enhance their use of insulin to stay in better control of the overall range of blood sugars,” Hendrix told AJPB. “This will reduce the range of lows and highs over time, which is the overall objective.”

This will result in mitigated hospitalizations, comorbidities, and additional drug therapies, which may save patients and the healthcare system thousands per year.

“Sustaining great insulin-therapy over 5 years will have a lifetime impact on a client,” Hendrix told AJPB. “These dogs have a working life of up to 8 or more years and help that occur.”

Despite a cost of $25,000 to train the dogs, the generosity of donors and volunteers allows patients of all ages with diabetes to benefit from a companion that supports them emotionally, improves disease control, and reduces overall healthcare costs.

As someone who has volunteered his time and service to D4D for the last 11 years, Hendrix has the same hope for all D4D clients—to have a better life with diabetes.

To learn more about D4D, visit

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