American Diabetes Association
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Point-of-Care Capillary Blood Ketone Measurements and the Prediction of Future Ketoacidosis Risk in Type 1 Diabetes

posted on 2023-08-24, 17:55 authored by Cimon Song, Sharon Dhaliwal, Priya Bapat, Daniel Scarr, Abdulmohsen Bakhsh, Dalton Budram, Natasha J. Verhoeff, Alanna Weisman, Michael Fralick, Noah M. Ivers, David ZI Cherney, George Tomlinson, Leif Erik Lovblom, Doug Mumford, Bruce A. Perkins

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.


This study was supported by Diabetes Canada (Operating Grant OG-3-21-5572-BP) and by the Data Sciences Institute at the University of Toronto. We are also grateful for support from the Menkes Fund.


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