Blood β‐hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review

  title={Blood $\beta$‐hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review},
  author={Andreas Klocker and Helen Phelan and S. M. Twigg and Maria E. Craig},
  journal={Diabetic Medicine},
  pages={818 - 824}
Diabetic ketoacidosis is a life‐threatening complication of Type 1 diabetes. Blood β‐hydroxybutyrate testing is now widely available as an alternative to urine acetoacetate testing for detecting ketosis. The aim of this study was to review the effectiveness of capillary or serum β‐hydroxybutyrate compared with urine acetoacetate testing in prevention and management of diabetic ketoacidosis. 
Evaluation of Nova StatStrip and FreeStyle Precision Pro blood ketone tests using 3‐hydroxybutyrate doped samples
The most clinically useful blood ketone in the diagnosis, management, and recovery of diabetes ketoacidosis in both adults and children is 3‐hydroxybutyrate. In the absence of laboratory routine
Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis
Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss.
Plasma β-Hydroxybutyrate for the Diagnosis of Diabetic Ketoacidosis in the Emergency Department
β-Hydroxybutyrate accurately predicts DKA in children and adolescents and may provide a more optimal definition of DKA for management decisions and treatment targets, according to a cross-sectional retrospective study of pediatric patients presenting to an urban pediatric emergency department.
Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis.
  • K. Dhatariya
  • Medicine
    The review of diabetic studies : RDS
  • 2016
The reasons for a change in treating DKA are described, and the benefits and limitations of using ketone readings are outlined, in particular highlighting the difference between urine and capillary readings.
The use of point-of-care blood ketone monitors in the management of diabetic ketoacidosis in adults
A meta-analysis comparing the use of blood ketone measurement with urinaryketone measurement in DKA showed that, in the few studies that were good enough to include, measurement ofBlood ketones was associated with reduced emergency department assessment, hospitalizations and a shorter time to recovery.
Diabetic ketoacidosis in adults
Diabetic ketoacidosis may follow absolute insulin deficiency or relative insulin deficiency, and may occur in the presence of increased levels of counter-regulatory hormones such as glucagon, cortisol, and catecholamines.
Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis
  • S. Misra, N. Oliver
  • Medicine
    Diabetic medicine : a journal of the British Diabetic Association
  • 2015
The various existing methods of ketone measurement are reviewed, the precision of capillary blood ketone as compared with other measures, its diagnostic accuracy in predicting ketoacidosis and other clinical applications including prevention, assessment of severity and resolution of keto acidosis are reviewed.
Diabetic ketoacidosis
This Primer by Umpierrez and colleagues reviews the epidemiology, pathophysiology, diagnosis and management of diabetic ketoacidosis, the most common acute hyperglycaemic emergency in people with diabetes mellitus and provides practical recommendations for the management of DKA in adults and children.
Evaluation of the Accuracy of Capillary Hydroxybutyrate Measurement Compared with Other Measurements in the Diagnosis of Diabetic Ketoacidosis: A Systematic Review
Capillary β-OHB testing was found to have high sensitivity, specificity, positive predictive value and negative predictive value in identifying DKA compared to urinary ketone testing.
Ketosis and diabetic ketoacidosis in response to SGLT2 inhibitors: Basic mechanisms and therapeutic perspectives
The role of the kidney and potential links to renal gluconeogenesis and uric acid handling are discussed, and potential beneficial effects of modestly elevated ketone body levels on organ function that may have therapeutic relevance for the observedbeneficial effects of SGLT2 inhibitors on the kidneys and cardiovascular system are outlined.


Sick day management using blood 3‐hydroxybutyrate (3‐OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial
This prospective, two‐centre study assessed sick day management using blood 3‐hydroxybutyrate (3‐OHB) monitoring compared with traditional urine ketone testing, aimed at averting emergency assessment and hospitalization.
Blood ketone bodies in patients with recent‐onset type 1 diabetes (a multicenter study)
This work has shown that using nitroprusside strips for urine KB detection react only with acetoacetate (AcAc) and not with the most prevalent KB moiety – 3β‐hydroxybutyrate (3HB) – that is in equilibrium with AcAc (up to 10:1 ratio).
Are blood ketones a better predictor than urine ketones of acid base balance in diabetic ketoacidosis
The findings of this study suggest that blood ketone measurement is a better predictor of acid base status than urine ketones measurement.
The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.
Quantitative determination of beta-HBA levels seems to offer useful information for monitoring DKA in newly-diagnosed diabetic children and for reducing time and costs in an Intensive Care Unit.
Hydroxybutyrate near‐patient testing to evaluate a new end‐point for intravenous insulin therapy in the treatment of diabetic ketoacidosis in children
A near‐patient testing device for capillary blood hydroxybutyrate measurement in evaluating a new end‐point for intravenous insulin therapy in the treatment of diabetic ketoacidosis (DKA) in children is evaluated.
Can serum beta-hydroxybutyrate be used to diagnose diabetic ketoacidosis?
Serum beta-hydroxybutyrate levels in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO(3) level for that purpose.
Can we prevent diabetic ketoacidosis in children?
New technologies that can detect the blood ketone 3β‐hydroxybutyrate (3β‐OHB) instead of traditional urine ketones appears to provide opportunity for early identification and treatment of impending DKA leading to reduced need for hospitalization and potential cost‐savings.
Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes
  • L. Laffel
  • Medicine
    Diabetes/metabolism research and reviews
  • 1999
Recently, inexpensive quantitative tests of 3HB levels have become available for use with small blood samples (5–25 µl) and offer new options for monitoring and treating diabetes and other states characterized by the abnormal metabolism of ketone bodies.
Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies: an overview.
DKA is still a severe complication potentially arising during prolonged hyperglycemic episodes with possibly fatal consequences, and education of patients and their social environment to promote frequent testing and to lower their glucose levels is of paramount importance in preventing the development of severe DKA.