School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
Diabet Med. 2013 Jul;30(7):818-24. doi: 10.1111/dme.12136.
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.
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.
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.
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.
糖尿病酮症酸中毒是 1 型糖尿病的一种危及生命的并发症。血β-羟丁酸检测现在作为检测酮症的尿液乙酰乙酸检测的替代方法已广泛应用。本研究旨在回顾毛细血管或血清β-羟丁酸与尿液乙酰乙酸检测在预防和治疗糖尿病酮症酸中毒方面的效果。
在 MEDLINE、EMBASE、EBM Reviews、The Cochrane Library 和 CINAHL（截至 2012 年 4 月，无语言限制，研究对象为人类）上搜索比较血β-羟丁酸和尿乙酰乙酸检测效果的实验和观察性研究。评估的结果包括预防糖尿病酮症酸中毒、从糖尿病酮症酸中毒中恢复的时间、医疗保健费用和患者或护理人员的满意度。其他来源包括参考文献、会议记录以及与该领域专家的联系。
四项研究（两项随机对照试验和两项队列研究）符合入选标准，包括 11 个中心的 299 名参与者。偏倚风险为低到中度。与尿液检测相比，血液酮检测与住院频率降低（一项研究）、从糖尿病酮症酸中毒中恢复的时间缩短（三项研究）、成本效益（一项研究）和更高的满意度（一项研究，仅干预组）相关。没有研究评估糖尿病酮症酸中毒的预防。由于研究设计和已发表数据的异质性，无法进行荟萃分析。
有证据表明，与尿液乙酰乙酸检测相比，血β-羟丁酸检测在减少急诊科评估、住院和从糖尿病酮症酸中毒中恢复的时间方面更有效，并且可能降低医疗保健支出。需要在年轻人和成年人中进行进一步的研究。
