Continuous Ketone Monitoring: A New Paradigm for Physiologic Monitoring

Abstract

In this issue of JDST, Alva and colleagues present for the first time, development of a continuous ketone monitor (CKM) tested both in vitro and in humans. Their sensor measured betahydroxybutyrate (BHB) in interstitial fluid (ISF). The sensor was based on wired enzyme electrochemistry technology using BHB dehydrogenase. The sensor required only a single retrospective calibration without a need for further adjustments over 14 days. The device produced a linear response over the 0-8 mM range with good accuracy. This novel CKM could provide a new dimension of useful automatically collected information for managing diabetes. Passively collected ISF ketone information would be useful for predicting and managing ketoacidosis in patients with type 1 diabetes, as well as other states of abnormal ketonemia. Although additional studies of this CKM will be required to assess performance in intended patient populations and prospective factory calibration will be required to support real time measurements, this novel monitor has the potential to greatly improve outcomes for people with diabetes. In the future, a CKM might be integrated with a continuous glucose monitor in the same sensor platform.

Ketone Supplementation: Meeting the Needs of the Brain in an Energy Crisis

“…Ketogenic therapies hold the added benefit of ease of monitoring. Ketones can be readily measured in the urine, blood, and breath with commercially available point of care meters while real-time, continuous ketone monitoring systems that are now in development may become available soon ( 106 ). Additionally, EKs could be used in conjunction with KD therapy to more rapidly induce a higher level of ketones, especially in settings where the temporal window of opportunity to treat may be limited, or in situations where contraindications or personal preferences undermine the ability to use KD therapy.…”

Continuous Ketone Monitoring Consensus Report 2021

“…Showing clear benefit will be important for policy changes that ensure reimbursement for those with the highest need. 19 Three types of trial designs can be used to test the efficacy and effectiveness of CKMs. First are randomized controlled trials (RCTs) to assess efficacy, which will be useful in assessing most of the endpoints presented in Table 5.…”

“…Showing clear benefit will be important for policy changes that ensure reimbursement for those with the highest need. 19…”

“…18 Education should include the importance of ketone testing including when and how to perform the test, the differences between urine and blood/interstitial fluid testing for ketones, and the appropriate responses to ketone results. Non-DKA states of fasting ketonemia and ketonuria 19 Ketosis can be a result of prolonged fasting or low-carbohydrate diets. 20…”

Treating an Unconscious Patient With Diabetes Wearing a Device Attached to Their Body

“…1 The wearable device industry includes products for a variety of purposes, including the treatment of diabetes. Wearable products for diabetes can continuously monitor concentrations of analytes like glucose 2 (and potentially ketones 3,4 ) in the interstitial fluid of the subcutaneous compartment and deliver drugs like insulin, 5 glucagon, 6 or incretins 7 into this space. All these devices are shrinking in size with each new generation, and they can look quite similar to each other.…”