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Wiley InterScience | ||||||||||||
  Diabetic MedicineVolume 23 Issue 3, Pages 278 - 284 Published Online: 24 Nov 2005 Journal compilation © 2010 Diabetes UK
Abstract | References | Full Text: HTML, PDF (Size: 149K) | Related Articles | Citation Tracking  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 Portions of the paper were presented at the American Diabetes Association Annual Scientific Meeting, 2002, San Francisco. Copyright © 2005 Diabetes UK KEYWORDS Type 1 diabetes • diabetic ketoacidosis • β-hydroxybutyrate • urine ketones • sick day management Diabet. Med. (2005) 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 ≥ 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. Accepted 4 May 2005 Final Acceptance 3 August 2005 | 
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