Diabetic Monitoring: Dogs Versus Sensors

In National Geographic Channel's “The Science of Dogs,” presenters examined how dogs can be trained to warn their owners of low blood sugar levels.

Several organizations train medical alert dogs. In the United Kingdom, there’s a charity-NHS-research partnership group, Bark Britain. In the United States, Can Do Canines has trained 28 dogs from 2003 – 2013. Demand is strong: 21 individuals are on the waiting list. Two other groups are Pawsitive Perspectives Assistance Dogs and Scent Angles. [For 2013 clinical study results, visit: http://care.diabetesjournals.org/content/36/4/e47.full#sec-3.]

Alert Detection Data Gathering:

Researchers continue to analyze how well dogs perform. A U.K. investigation published in March 2013 used owner-reported data and found that detection rates are “above chance.” The first-ever study ended with the following observation and recommendation:
“Although based mainly on owner-recorded data, multiple findings point consistently to the potential value of trained alert dogs, but for conclusive proof, longitudinal studies are now required, examining matched clients pre- and post-dog allocation.” [1]

Self-Monitoring Blood Glucose Devices:

Low cost glucose diabetic monitoring has traditionally relied upon finger stick sampling and meter analysis. Even though companies and researchers have explored various methodologies and technologies since the 1980s, new and improved alternatives to self-monitoring blood glucose devices have not changed the market.

Sensors may eventually provide good continuous glucose diabetic monitoring. One of the prominent technologies uses Complementary Metal Oxide Semiconductor (CMOS) image sensors. A research paper published in July used CMOS to analyze glucose levels in mice. The abstract notes that: “This simple, effective, and consistent method for glucose measurement shows that CMOS image sensors are efficient devices for monitoring glucose in point-of-care applications.” [2]

Diagnostic Devices

What are the future prospects for sensor-based glucose monitoring? Researchers continue to explore sensor-based glucose monitoring. As diabetic patients know, frequent blood testing is necessary to manage the disease, and most currently available monitoring options are invasive (i.e., blood sampling, implanted devices, etc.). Continuous glucose monitoring (CGM) alternatives are being developed to minimize (or avoid) the inconvenience and pain of blood draws and potentially boost testing compliance rates. Minimally invasive CGM systems typically measure fluids in the skin. Inaccuracy, however, led to withdrawal of one device (GlucoWatch) from the market. [3]

With external transdermal sensors, non-invasive monitors apply electrochemical and optical technologies to determine glucose levels. Ongoing issues that need resolution are poor signal-to-noise ratios, sensitivity, wearability, etc. While the hardware prospects seem dismal, predictive algorithms may help. Another interesting finding in one study indicated that patients using CGM devices achieved better-than-expected diabetic management. [4]

The Market:

Global revenues for glucose monitoring devices are forecast to reach $16.0 billion in 2014. [5] The most interesting development is the opportunity presented by mobile devices. Fitness and health data tracking applications are well established. Connecting the physical testing components (finger stick, meter, test strip results, etc.) to data processing via smartphone is relatively easy. For example, LabStyle Innovations Corporation (Newark DE) has already developed a prototype in its Dario device that is progressing through regulatory requirements in Europe and the United States.

Historical revenue estimates and new projections suggest the diabetic monitoring market continues to grow rapidly as more individuals are diagnosed and treated. As data is gathered, medical alert dogs may be proven to be a useful alternative for the few patients who obtain them. The market impact is negligible, but the benefits for those fortunate individuals are probably profound.

Accuracy is the major barrier to faster development and implementation of non-invasive continuous glucose monitoring. As more data is gathered, medical alert dogs may be proven to be a useful alternative for the few patients who obtain them. The market impact is negligible, but the benefits for those fortunate individuals are probably profound.

2017 Update

The 2017 Global Diabetes Devices Market report from Transparency Market Research estimates that total revenues will rise from $37.2 billion in 2016 to $66.1 billion by 2025. More conservatively, a 2016 report published by Grand View Research Inc. forecasts a global market of $35.5 billion by 2024. Both sources attribute growth to increasing numbers of individuals who are diagnosed with diabetes and availability of affordable, compact, simple, minimally invasive monitoring systems.

While device accuracy is still an issue, the effectiveness of self-monitoring of blood glucose (SMBG) can also impacted by frequency of testing and user competency. Combining continuous monitoring of interstitial fluid with SMBG may be the best option for some individuals to sustain near-normal glycemic levels.

[1] Rooney NJ, Morant S, Guest C (2013) Investigation into the Value of Trained Glycaemia Alert Dogs to Clients with Type I Diabetes. PLoS ONE 8(8): e69921. doi:10.1371/journal.pone.0069921

[2] “CMOS Image Sensors as an Efficient Platform for Glucose Monitoring,” July 2013

[3] “Future Perspectives in Glucose Monitoring Sensors,” European Endocrinology, 2013.

[4] Ibid.

[5] “Glucose Monitoring Devices Markets – Worldwide,” Renub Research, 2010.

[6] “Self-monitoring of Blood Glucose in Management of Adults with Diabetes Mellitus,” UpToDate.com.

[7] “Diabetes Devices Market to Witness Increase in Revenues by 2025, CompanyNewsOnline.Wordpress.com, December 2017.

[8] “Diabetes Devices Market Size to Reach $35.5 Billion by 2024,” GrandviewResearch.com, May 2016.