Breath Acetone Correlates with Capillary β-hydroxybutyrate in Type 1 Diabetes

Area of Science:

• Metabolic monitoring
• Biomarker analysis
• Diabetes management

Background:

• Breath acetone (BrACE) is a noninvasive marker of ketone metabolism.
• Type 1 diabetes (T1D) management requires monitoring of ketone levels.
• Capillary blood β-hydroxybutyrate (BOHB) is a key indicator of ketosis.

Purpose of the Study:

• To assess the correlation between BrACE and capillary BOHB in T1D patients.
• To evaluate BrACE as a noninvasive alternative for BOHB monitoring.
• To compare BrACE-BOHB correlation during outpatient care versus supervised insulin withdrawal.

Main Methods:

• Randomized crossover study design.
• 14-day outpatient periods with/without dapagliflozin.
• Supervised insulin withdrawal studies.
• Paired BrACE and BOHB measurements.
• Spearman's rank correlation and ROC analysis.

Main Results:

• Moderate correlation between BrACE and BOHB during outpatient care (ρ = 0.41).
• Strong correlation between BrACE and BOHB during insulin withdrawal (ρ = 0.81).
• BrACE > 5 ppm showed 93% sensitivity and 87% specificity for BOHB ≥ 1.5 mmol/L.

Conclusions:

• Breath acetone measurement offers a noninvasive estimate of blood BOHB in T1D.
• BrACE correlation with BOHB is suboptimal during unsupervised outpatient care.
• Strong BrACE-BOHB correlation during supervised insulin withdrawal supports its utility in specific clinical scenarios.