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The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice.
Diabet Med 2001; 18(8):640-5DM

Abstract

AIMS

To establish the role of the measurement of beta-hydroxybutyrate (beta-OHB) in distinguishing simple hyperglycaemia from ketosis, and as an indicator of adequate resolution of ketoacidosis, using an electrochemical blood ketone meter. The aim of the study is to assess the accuracy and precision of the meter and to develop clinical guidelines for the use of the ketone meter at home and in hospital.

PATIENTS AND METHODS

Twenty patients with poor glycaemic control (mean HbA1c 10.2%) were recruited from the diabetes clinic and 14 patients admitted with diabetic ketoacidosis (DKA) were recruited from two Accident and Emergency Departments. The blood obtained at each routine fingerprick test for glucose measurement was tested for beta-OHB using the ketone meter. Plasma beta-OHB concentrations were also measured on admission using a laboratory enzymatic method.

RESULTS

Paired glucose and beta-OHB meter readings (n = 1099) in clinic patients demonstrated that, in the absence of intercurrent illness, beta-OHB levels did not exceed 1 mmol/l, irrespective of glucose readings. In the 14 ketoacidotic patients, the mean plasma beta-OHB concentration, measured in the laboratory, on admission was 7.4 mmol/l (range 3.9-12.3 mmol/l). The median half-life of beta-OHB was 1.64 h (1st IQR 2.27 h, 3rd IQR 1.34 h). The median time taken, from the initiation of treatment, for beta-OHB concentrations to fall to below 1 mmol/l was 8.46 h (range 5-58.33 h).

CONCLUSION

Near patient blood ketone testing is a useful adjunct to blood glucose monitoring in distinguishing between ketosis and simple hyperglycaemia. The data suggest that beta-OHB levels > or = 1 mmol/l require further action and levels > 3 mmol/l necessitate medical review. In addition, the rate of fall of beta-OHB in DKA can be used as an indicator of the adequacy of treatment.

Authors+Show Affiliations

Oxford Centre for Diabetes, Endocrinology and Metabolism, The Radcliffe Infirmary, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Guideline
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11553201

Citation

Wallace, T M., et al. "The Hospital and Home Use of a 30-second Hand-held Blood Ketone Meter: Guidelines for Clinical Practice." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 18, no. 8, 2001, pp. 640-5.
Wallace TM, Meston NM, Gardner SG, et al. The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice. Diabet Med. 2001;18(8):640-5.
Wallace, T. M., Meston, N. M., Gardner, S. G., & Matthews, D. R. (2001). The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice. Diabetic Medicine : a Journal of the British Diabetic Association, 18(8), pp. 640-5.
Wallace TM, et al. The Hospital and Home Use of a 30-second Hand-held Blood Ketone Meter: Guidelines for Clinical Practice. Diabet Med. 2001;18(8):640-5. PubMed PMID: 11553201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice. AU - Wallace,T M, AU - Meston,N M, AU - Gardner,S G, AU - Matthews,D R, PY - 2001/9/13/pubmed PY - 2002/1/5/medline PY - 2001/9/13/entrez SP - 640 EP - 5 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 18 IS - 8 N2 - AIMS: To establish the role of the measurement of beta-hydroxybutyrate (beta-OHB) in distinguishing simple hyperglycaemia from ketosis, and as an indicator of adequate resolution of ketoacidosis, using an electrochemical blood ketone meter. The aim of the study is to assess the accuracy and precision of the meter and to develop clinical guidelines for the use of the ketone meter at home and in hospital. PATIENTS AND METHODS: Twenty patients with poor glycaemic control (mean HbA1c 10.2%) were recruited from the diabetes clinic and 14 patients admitted with diabetic ketoacidosis (DKA) were recruited from two Accident and Emergency Departments. The blood obtained at each routine fingerprick test for glucose measurement was tested for beta-OHB using the ketone meter. Plasma beta-OHB concentrations were also measured on admission using a laboratory enzymatic method. RESULTS: Paired glucose and beta-OHB meter readings (n = 1099) in clinic patients demonstrated that, in the absence of intercurrent illness, beta-OHB levels did not exceed 1 mmol/l, irrespective of glucose readings. In the 14 ketoacidotic patients, the mean plasma beta-OHB concentration, measured in the laboratory, on admission was 7.4 mmol/l (range 3.9-12.3 mmol/l). The median half-life of beta-OHB was 1.64 h (1st IQR 2.27 h, 3rd IQR 1.34 h). The median time taken, from the initiation of treatment, for beta-OHB concentrations to fall to below 1 mmol/l was 8.46 h (range 5-58.33 h). CONCLUSION: Near patient blood ketone testing is a useful adjunct to blood glucose monitoring in distinguishing between ketosis and simple hyperglycaemia. The data suggest that beta-OHB levels > or = 1 mmol/l require further action and levels > 3 mmol/l necessitate medical review. In addition, the rate of fall of beta-OHB in DKA can be used as an indicator of the adequacy of treatment. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/11553201/The_hospital_and_home_use_of_a_30_second_hand_held_blood_ketone_meter:_guidelines_for_clinical_practice_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=11553201.ui DB - PRIME DP - Unbound Medicine ER -