Portions of the paper were presented at the American Diabetes Association Annual Scientific Meeting, 2002, San Francisco.
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
Article first published online: 24 NOV 2005
Volume 23, Issue 3, pages 278–284, March 2006
How to Cite
Laffel, L. M. B., Wentzell, K., Loughlin, C., Tovar, A., Moltz, K. and 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, 23: 278–284. doi: 10.1111/j.1464-5491.2005.01771.x
- Issue published online: 16 FEB 2006
- Article first published online: 24 NOV 2005
- Accepted 4 May 2005 Final Acceptance 3 August 2005
- Type 1 diabetes;
- diabetic ketoacidosis;
- urine ketones;
- sick day management
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 ≥ 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (≥ 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.