Jones Kai E, Petersen Max C, Markov Alexander M, Salam Maamoun, Krutilova Petra, McKee Alexis M, Bohnert Kathryn L, Adamson Samantha E, McGill Janet B
Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO, USA.
J Diabetes Sci Technol. 2025 Apr 22:19322968251334640. doi: 10.1177/19322968251334640.
Breath acetone (BrACE) is an end product of ketone metabolism that is measurable by noninvasive breath ketone analyzers. We assessed the correlation between capillary blood β-hydroxybutyrate (BOHB) and BrACE in people with type 1 diabetes during 14 days of outpatient care with and without dapagliflozin treatment and during supervised insulin withdrawal studies with and without dapagliflozin.
In this randomized crossover study, participants completed two 14-day outpatient periods with or without dapagliflozin 10 mg daily. Each 14-day unsupervised outpatient period was followed by a 1-day supervised insulin withdrawal study. Paired BOHB and BrACE measurements were obtained 3 times daily during outpatient periods, then hourly during supervised insulin withdrawal. The correlation between BrACE and BOHB was assessed by Spearman's ρ.
Twenty people with type 1 diabetes completed the study. During outpatient periods, BrACE and BOHB were moderately correlated (n = 1425 paired readings; ρ = .41; 95% CI = 0.36 to 0.45; < .0001). However, BrACE and BOHB were strongly correlated during insulin withdrawal (n = 246 paired values, ρ = .81; 95% CI = 0.77 to 0.85). In ROC analysis, BrACE > 5 ppm demonstrated optimal sensitivity (93%) and specificity (87%) for detecting capillary BOHB ≥ 1.5 mmol/L. No serious adverse events occurred.
In adults with type 1 diabetes, measurement of breath acetone provides a noninvasive estimate of blood BOHB concentration. The correlation between BrACE and BOHB was suboptimal during unsupervised outpatient care, but was strong during supervised insulin withdrawal.
clinicaltrials.gov (NCT05541484).
呼气丙酮（BrACE）是酮代谢的终产物，可通过非侵入性呼气酮分析仪进行测量。我们评估了1型糖尿病患者在接受和不接受达格列净治疗的14天门诊护理期间以及在接受和不接受达格列净的监督胰岛素撤药研究期间，毛细血管血β-羟基丁酸（BOHB）与BrACE之间的相关性。
在这项随机交叉研究中，参与者完成了两个14天的门诊周期，分别接受或不接受每日10 mg达格列净治疗。每个14天的非监督门诊周期后进行为期1天的监督胰岛素撤药研究。在门诊期间每天进行3次配对的BOHB和BrACE测量，然后在监督胰岛素撤药期间每小时进行一次测量。通过Spearman's ρ评估BrACE与BOHB之间的相关性。
20名1型糖尿病患者完成了该研究。在门诊期间，BrACE与BOHB呈中度相关（n = 1425对配对读数；ρ = 0.41；95%CI = 0.36至0.45；P <.0001）。然而，在胰岛素撤药期间，BrACE与BOHB呈强相关（n = 246对配对值，ρ = 0.81；95%CI = 0.77至0.85）。在ROC分析中，BrACE > 5 ppm对检测毛细血管BOHB≥1.5 mmol/L具有最佳敏感性（93%）和特异性（87%）。未发生严重不良事件。
在1型糖尿病成人患者中，测量呼气丙酮可对血液BOHB浓度进行非侵入性估计。在非监督门诊护理期间，BrACE与BOHB之间的相关性欠佳，但在监督胰岛素撤药期间相关性较强。
clinicaltrials.gov（NCT05541484）。
