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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.
Diabet Med 2006; 23(3):278-84DM

Abstract

AIMS

Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. 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.

METHODS

One hundred and twenty-three children, adolescents and young adults, aged 3-22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels > or = 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (> or = 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months.

RESULTS

There were 578 sick days during 21,548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05).

CONCLUSIONS

Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings.

Authors+Show Affiliations

Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA 02215, USA. Lori.laffel@joslin.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16492211

Citation

Laffel, L M B., et al. "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." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 23, no. 3, 2006, pp. 278-84.
Laffel LM, Wentzell K, Loughlin C, et al. 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. Diabet Med. 2006;23(3):278-84.
Laffel, L. M., Wentzell, K., Loughlin, C., Tovar, A., Moltz, K., & Brink, S. (2006). 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. Diabetic Medicine : a Journal of the British Diabetic Association, 23(3), pp. 278-84.
Laffel LM, et al. 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. Diabet Med. 2006;23(3):278-84. PubMed PMID: 16492211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Laffel,L M B, AU - Wentzell,K, AU - Loughlin,C, AU - Tovar,A, AU - Moltz,K, AU - Brink,S, PY - 2006/2/24/pubmed PY - 2006/8/15/medline PY - 2006/2/24/entrez SP - 278 EP - 84 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 23 IS - 3 N2 - AIMS: Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. 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. METHODS: One hundred and twenty-three children, adolescents and young adults, aged 3-22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels > or = 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (> or = 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months. RESULTS: There were 578 sick days during 21,548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05). CONCLUSIONS: Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/16492211/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_ L2 - https://doi.org/10.1111/j.1464-5491.2005.01771.x DB - PRIME DP - Unbound Medicine ER -