Blood β‐hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review
Abstract
Abstact: Aim: 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. Methods: MEDLINE , EMBASE , EBM Reviews, The Cochrane Library and CINAHL (until April 2012, no language restrictions, studies in humans) were searched for experimental and observational studies comparing the effectiveness of blood β‐hydroxybutyrate and urine acetoacetate testing. Outcomes examined were prevention of diabetic ketoacidosis, time to recovery from diabetic ketoacidosis, healthcare costs and patient or caregiver satisfaction. Additional sources included reference lists, conference proceedings and contact with experts in the field. Results: Four studies (two randomized controlled trials and two cohort studies) met eligibility criteria, including 299 participants across 11 centres. Risk of bias was low to moderate. Blood ketone testing compared with urine testing was associated with reduced frequency of hospitalization (one study), reduced time to recovery from diabetic ketoacidosis (three studies), cost benefits (one study) and greater satisfaction (one study, intervention group only). No study assessed prevention of diabetic ketoacidosis. Meta‐analysis could not be performed because of heterogeneity in study design and published data. Conclusions: There is evidence suggesting that blood β‐hydroxybutyrate testing is more effective than urine acetoacetate testing in reducing emergency department assessment, hospitalization and time to recovery from diabetic ketoacidosis, as well as potentially lowering healthcare expenditure. Further research in both young people and adults is needed.
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Access to blood ketone tests at home is recommended by many authors since these tests may reduce hospitalizations for DKA.
“In addition, access to blood ketone tests at home is recommended by many authors since these tests may reduce hospitalizations for DKA. 14 , 15 , 16”
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Danne, T., Garg, S., Peters, A. L., Buse, J. B., Mathieu, C., Pettus, J. H., Alexander, C. M., Battelino, T., Ampudia-Blasco, F. J., Bode, B. W., et al. (2019) · Diabetes Care · doi:10.2337/dc18-2316 · Cited by 379 · see citing works
Assessment and monitoring of glycemic control in children and adolescents with diabetes
Rewers, M. J., Pillay, K., de Beaufort, C., Craig, M. E., Hanas, R., Acerini, C. L., & Maahs, D. M. (2014) · Pediatric Diabetes · doi:10.1111/pedi.12190 · Cited by 316 · see citing works
Self-citationBrooke, J., Stiell, M., & Ojo, O. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13090837 · Cited by 57 · see citing works
Controversies around the measurement of blood ketones to diagnose and manage diabetic ketoacidosis
Kilpatrick, E. S., Butler, A. E., Ostlundh, L., Atkin, S. L., & Sacks, D. B. (2022) · Diabetes Care · doi:10.2337/dc21-2279 · Cited by 41 · see citing works
Wersäll, J. H., Adolfsson, P., Forsander, G., & Hanas, R. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13377 · Cited by 21 · see citing works
- Authors
- Klocker, A. A., Phelan, H., Twigg, S. M., & Craig, M. E.
- Affiliations
- School of Women's and Children's Health University of New South Wales Sydney NSW Australia
- John Hunter Children's Hospital Newcastle NSW Australia
- Faculty of Medicine University of Sydney NSW Australia
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2013-06-23
- Volume
- 30
- Issue
- 7
- Pages
- 818-824
- ISSN
- 0742-3071
- 1464-5491
- Cited by
- 84
- References
- 0
- Language
- en
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