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28-05-2024 | Ketoacidosis | Review Article

Innovations and applications of ketone body monitoring in diabetes care

Author: Naoki Sakane

Published in: Diabetology International

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Abstract

Ketone bodies, comprising β-hydroxybutyric acid (BHB), acetoacetate (AcAc), and acetone, play a vital role as essential energy substrates. In individuals with diabetes, ketone bodies can be elevated under various conditions, including diabetic ketoacidosis, use of sodium-glucose transporter type 2 (SGLT2) inhibitors, and extreme carbohydrate restriction. There are three methods for measuring ketone bodies. Urine ketone analysis (AcAc) is a standard clinical test, whereas blood ketone testing (BHB+AcAc) is valuable in identifying or resolving diabetic ketoacidosis. Recently, technology for measuring breath acetone has been introduced, which provides an easy means of monitoring ketogenic diets in obese individuals. The basic breath alcohol detector also reacts with breath acetone. Therefore, it is important for professional drivers taking SGLT2 inhibitors to be cautious as workplace breath alcohol detectors may show false-positive results. Conversely, if a positive result is obtained, a detailed examination of ketosis is necessary. This review provides an overview of ketone body measurements in individuals with diabetes.
Literature
4.
go back to reference Shimelash RA, Belay GM, Aknaw W, Shibabaw AT, Adebabay AA, Gedefaw GD, Kassie TD, Zemariam AB. Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: a retrospective follow-up study. Front Clin Diabetes Healthc. 2023;31(4):1204133. https://doi.org/10.3389/fcdhc.2023.1204133.CrossRef Shimelash RA, Belay GM, Aknaw W, Shibabaw AT, Adebabay AA, Gedefaw GD, Kassie TD, Zemariam AB. Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: a retrospective follow-up study. Front Clin Diabetes Healthc. 2023;31(4):1204133. https://​doi.​org/​10.​3389/​fcdhc.​2023.​1204133.CrossRef
9.
go back to reference Laffel L. Ketone bodies a review of physiology pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412–26.CrossRefPubMed Laffel L. Ketone bodies a review of physiology pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412–26.CrossRefPubMed
15.
go back to reference Tanda N, Hinokio Y, Washio J, Takahashi N, Koseki T. Analysis of ketone bodies in exhaled breath and blood of ten healthy japanese at OGTT using a portable gas chromatograph. J Breath Res. 2014;8(4): 046008.CrossRefPubMed Tanda N, Hinokio Y, Washio J, Takahashi N, Koseki T. Analysis of ketone bodies in exhaled breath and blood of ten healthy japanese at OGTT using a portable gas chromatograph. J Breath Res. 2014;8(4): 046008.CrossRefPubMed
18.
19.
go back to reference Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87(5):337–46.PubMed Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87(5):337–46.PubMed
22.
go back to reference Lee K, Park IB, Yu SH, Kim SK, Kim SH, Seo DH, Hong S, Jeon JY, Kim DJ, Kim SW, Choi CS, Lee DH. Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2019;16(12):1161–71. https://doi.org/10.2147/DMSO.S209938.CrossRef Lee K, Park IB, Yu SH, Kim SK, Kim SH, Seo DH, Hong S, Jeon JY, Kim DJ, Kim SW, Choi CS, Lee DH. Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2019;16(12):1161–71. https://​doi.​org/​10.​2147/​DMSO.​S209938.CrossRef
25.
go back to reference Mahendran Y, Vangipurapu J, Cederberg H, Stancáková A, Pihlajamäki J, Soininen P, Kangas AJ, Paananen J, Civelek M, Saleem NK, Pajukanta P, Lusis AJ, Bonnycastle LL, Morken MA, Collins FS, Mohlke KL, Boehnke M, Ala-Korpela M, Kuusisto J, Laakso M. Association of ketone body levels with hyperglycemia and type 2 diabetes in 9,398 Finnish men. Diabetes. 2013;62(10):3618–26. https://doi.org/10.2337/db12-1363.CrossRefPubMedPubMedCentral Mahendran Y, Vangipurapu J, Cederberg H, Stancáková A, Pihlajamäki J, Soininen P, Kangas AJ, Paananen J, Civelek M, Saleem NK, Pajukanta P, Lusis AJ, Bonnycastle LL, Morken MA, Collins FS, Mohlke KL, Boehnke M, Ala-Korpela M, Kuusisto J, Laakso M. Association of ketone body levels with hyperglycemia and type 2 diabetes in 9,398 Finnish men. Diabetes. 2013;62(10):3618–26. https://​doi.​org/​10.​2337/​db12-1363.CrossRefPubMedPubMedCentral
30.
go back to reference Silva VB, Fonseca L, Duarte DB, Puga FM, Assuncao G, Garrido S, Teixeira S, Vilaverde J, Cardoso MH. Efficacy and safety of SGLT2 inhibitors in individuals with type 1 diabetes under continuous subcutaneous insulin infusion: a real-world study. Endocr Regul. 2023;57(1):144–51. https://doi.org/10.2478/enr-2023-0018.CrossRefPubMed Silva VB, Fonseca L, Duarte DB, Puga FM, Assuncao G, Garrido S, Teixeira S, Vilaverde J, Cardoso MH. Efficacy and safety of SGLT2 inhibitors in individuals with type 1 diabetes under continuous subcutaneous insulin infusion: a real-world study. Endocr Regul. 2023;57(1):144–51. https://​doi.​org/​10.​2478/​enr-2023-0018.CrossRefPubMed
Metadata
Title
Innovations and applications of ketone body monitoring in diabetes care
Author
Naoki Sakane
Publication date
28-05-2024
Publisher
Springer Nature Singapore
Published in
Diabetology International
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-024-00735-4
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