Transforming Diabetes Management: Continuous Ketone Monitoring Offers New Hope for DKA Prevention, Study

The study revealed that continuous ketone monitoring (CKM) is poised to revolutionize T1D management, offering significant benefits for patients navigating this complex condition. As technology evolves, the integration of CKM into routine care represents a promising advancement to address the specific needs of individuals living with T1D.

"By alleviating the demands of care and improving situational awareness—especially if accomplished with minimal additional cost—we propose that continuous ketone measurement is a natural advancement in the management of type 1 diabetes, enhancing safety in self-monitoring for individuals living with the condition," the researchers wrote.

Historically, diabetes management has focused primarily on glucose levels, given their potential for rapid and dangerous fluctuations. High blood sugar levels can lead to severe complications, necessitating constant vigilance. However, ketones—byproducts of fat metabolism—are crucial for monitoring diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition that can occur when insulin levels are insufficient.

David N. O'Neal, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia, and colleagues emphasize that early detection of ketosis is essential for preventing and managing DKA. Currently, individuals with diabetes typically measure ketones through capillary blood or urine tests. However, these methods have drawbacks, including the need to carry testing strips that have a limited shelf life and the requirement for users to actively initiate the testing process.

Recent studies have demonstrated the feasibility of CKM using a sensor inserted subcutaneously that measures ketones in interstitial fluid through an enzymatic electrochemical reaction. This technology allows for ketone readings to be updated every five minutes.

In the future, the researchers anticipate that commercial devices will include alarms connected to standardized thresholds and trend indicators. To reduce the burden on users, it is essential that CKM functionality be integrated with other glucose management tools, such as continuous glucose monitors and insulin pumps.

They advocate for the availability of CKM for all individuals at risk of diabetic ketoacidosis recommending that these devices be worn continuously. Those who may benefit the most include individuals with type 1 diabetes, pregnant women, patients on sodium-glucose co-transporter (SGLT) inhibitors that increase the risk of DKA, those with a history of recurrent DKA, individuals engaging in high-intensity exercise, and those who are socially or geographically isolated or following low-carbohydrate diets.

The authors suggest that by providing continuous ketone profiles, these devices will offer crucial clinical insights that have been previously unavailable to people living with diabetes and their healthcare professionals.

"Additional research is necessary to identify the most effective responses for users based on continuous ketone monitoring data and to evaluate how the use of continuous ketone monitors affects hospitalizations related to diabetic ketoacidosis," they concluded.

Reference:

Kong YW, Morrison D, Lu JC, Lee MH, Jenkins AJ, O'Neal DN. Continuous ketone monitoring: Exciting implications for clinical practice. Diabetes Obes Metab. 2024 Sep 24. doi: 10.1111/dom.15921. Epub ahead of print. PMID: 39314201.