Capillary Ketone Level and Future Ketoacidosis Risk in Patients with Type 1 Diabetes using Sodium-Glucose Linked Transporter Inhibitors

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posted on 2025-04-23, 19:43 authored by Priya Bapat, Sharon Dhaliwal, Cimon Song, Yucheng ZhangYucheng Zhang, Daniel Scarr, Abdulmohsen Bakhsh, Dalton Budhram, Natasha J. Verhoeff, Alanna Weisman, Michael Fralick, Noah M. Ivers, David Z.I. Cherney, George Tomlinson, Doug Mumford, Leif Erik Lovblom, Bruce A. Perkins

Objective: We aimed to determine if routine capillary blood ketone testing on well-days predicts future diabetic ketoacidosis (DKA) in T1D using sodium-glucose linked transporter inhibitors (SGLTi).

Research Design and Methods: We examined previously-collected data from empagliflozin-assigned participants in a T1D trial that included weekly fasted ketone levels. Over 6-12 months, ketone levels were subdivided into 28-day periods, and the outcome was subsequent adjudicated DKA or severe ketosis.

Results: Among 1,194 participants, 325 had 49 DKA and 568 severe ketosis events. On-treatment maximum ketone levels were higher in the 28-days prior to outcome compared to those without an outcome, with area under Receiver Operating Characteristic curve 0.76 (95% CI 0.71-0.82). Maximum ketone level ≥0.8 mmol/L had sensitivity 66.0%, specificity 79.6%, and diagnostic odds ratio 7.6.

Conclusions: Routine surveillance of capillary ketone levels in T1D using SGLTi may represent a DKA mitigation strategy, and implies a potential threshold for continuous ketone monitoring.