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Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review.
Diabet Med. 2013 Jul; 30(7):818-24.DM

Abstract

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.

Authors+Show Affiliations

School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

23330615

Citation

Klocker, A A., et al. "Blood Β-hydroxybutyrate Vs. Urine Acetoacetate Testing for the Prevention and Management of Ketoacidosis in Type 1 Diabetes: a Systematic Review." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 30, no. 7, 2013, pp. 818-24.
Klocker AA, Phelan H, Twigg SM, et al. Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review. Diabet Med. 2013;30(7):818-24.
Klocker, A. A., Phelan, H., Twigg, S. M., & Craig, M. E. (2013). Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review. Diabetic Medicine : a Journal of the British Diabetic Association, 30(7), 818-24. https://doi.org/10.1111/dme.12136
Klocker AA, et al. Blood Β-hydroxybutyrate Vs. Urine Acetoacetate Testing for the Prevention and Management of Ketoacidosis in Type 1 Diabetes: a Systematic Review. Diabet Med. 2013;30(7):818-24. PubMed PMID: 23330615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review. AU - Klocker,A A, AU - Phelan,H, AU - Twigg,S M, AU - Craig,M E, PY - 2012/07/26/received PY - 2012/11/02/revised PY - 2013/01/15/accepted PY - 2013/1/22/entrez PY - 2013/1/22/pubmed PY - 2014/1/16/medline SP - 818 EP - 24 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 30 IS - 7 N2 - 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. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/23330615/Blood_β_hydroxybutyrate_vs__urine_acetoacetate_testing_for_the_prevention_and_management_of_ketoacidosis_in_Type_1_diabetes:_a_systematic_review_ L2 - https://doi.org/10.1111/dme.12136 DB - PRIME DP - Unbound Medicine ER -