Continuous Ketone Monitoring Consensus Report 2021

Abstract

This article is the work product of the Continuous Ketone Monitoring Consensus Panel, which was organized by Diabetes Technology Society and met virtually on April 20, 2021. The panel consisted of 20 US-based experts in the use of diabetes technology, representing adult endocrinology, pediatric endocrinology, advanced practice nursing, diabetes care and education, clinical chemistry, and bioengineering. The panelists were from universities, hospitals, freestanding research institutes, government, and private practice. Panelists reviewed the medical literature pertaining to ten topics: (1) physiology of ketone production, (2) measurement of ketones, (3) performance of the first continuous ketone monitor (CKM) reported to be used in human trials, (4) demographics and epidemiology of diabetic ketoacidosis (DKA), (5) atypical hyperketonemia, (6) prevention of DKA, (7) non-DKA states of fasting ketonemia and ketonuria, (8) potential integration of CKMs with pumps and automated insulin delivery systems to prevent DKA, (9) clinical trials of CKMs, and (10) the future of CKMs. The panelists summarized the medical literature for each of the ten topics in this report. They also developed 30 conclusions (amounting to three conclusions for each topic) about CKMs and voted unanimously to adopt the 30 conclusions. This report is intended to support the development of safe and effective continuous ketone monitoring and to apply this technology in ways that will benefit people with diabetes.

Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future

“…Recently, these devices have increased in popularity as a means to monitor adherence to a ketogenic diet, and use ketone testing strips to provide rapid (< 10 s) feedback to users on their blood [R-βHB]. Indeed, the demand for monitoring KBs in diabetic ketoacidosis, and non-diabetic states of ketosis, has stimulated the development of novel technologies for continuous monitoring of circulating [KB] through sampling of the subcutaneous interstitial fluid [116][117][118][119].…”

Gaps in our knowledge of managing inpatient dysglycaemia and diabetes in non‐critically ill adults: A call for further research

“…This hypothesis has yet to be tested. How the use of recently developed continuous ketone monitoring may help guide management also remains unknown 80 …”

“…How the use of recently developed continuous ketone monitoring may help guide management also remains unknown. 80 Similarly, using an electronic prescribing system would allow those on intravenous insulin to be identified-in particular, if they were prescribed a fixed rate intravenous insulin infusion, for which the only indication would be either DKA or hyperosmolar hyperglycaemic state. An ideal situation would be the linking of the point-of-care results, with the electronic prescribing system, to help further inform the inpatient diabetes team.…”

Monitoring of paediatric type 1 diabetes

“…The electrochemical sensor used wired enzyme technology to measure ß-hydroxybutyrate in interstitial fluid with a linear response over the range 0-8 mmol/l, delivering good accuracy and stability both in vitro and in vivo for 14 days with a single retrospective calibration. Considerable additional work will be needed before this device receives approval for clinical use [60].…”