Point-of-Care Capillary Blood Ketone Measurements and the Prediction of Future Ketoacidosis Risk in Type 1 Diabetes
Background/Aim: Rather than during illness while diabetic ketoacidosis (DKA) is developing, we aimed to determine if levels of routine point-of-care capillary blood ketones could predict future DKA.
Methods: We examined previously-collected data from placebo-assigned participants in an adjunct-to-insulin medication trial program that included fasted capillary blood ketone levels twice per week in a 2-month baseline period. Outcome was 6 to 12-month trial-adjudicated DKA.
Results: DKA events occurred in 12 of 484 participants at median 105[43,199] days. Maximum ketone levels were higher for cases compared to controls (0.8[0.6,1.2] vs 0.3[0.2,0.7] mmol/L, p=0.002), had nonparametric area under the Receiver Operating Characteristic curve 0.77 (95% CI 0.66-0.88). Ketone level ≥0.8 mmol/L had sensitivity 64%, specificity 78%, likelihood ratios positive and negative of 2.9 and 0.5.
Conclusion: This proof-of-concept that routine capillary ketone surveillance can identify individuals at high risk of future DKA implies a role for future technologies including continuous ketone monitoring.