The role of point-of-care β-hydroxybutyrate testing in the diagnosis of diabetic ketoacidosis: a review

Grape Seed Proanthocyanidin Extract Attenuates Cafeteria-Diet-Induced Liver Metabolic Disturbances in Rats: Influence of Photoperiod

This study investigated the influence of photoperiod (day length) on the efficacy of grape seed proanthocyanidin extract (GSPE) in mitigating metabolic disorders in obese rats fed a cafeteria diet. Rats were exposed to standard (L12), long (L18), or short (L6) photoperiods and treated with GSPE or vehicle. In the standard photoperiod, GSPE reduced body weight gain (50.5%), total cholesterol (37%), and triglycerides (34.8%), while increasing the expression of hepatic metabolic genes. In the long photoperiod, GSPE tended to decrease body weight gain, increased testosterone levels (68.3%), decreased liver weight (12.4%), and decreased reverse serum amino acids. In the short photoperiod, GSPE reduced glycemia (~10%) and lowered triglyceride levels (38.5%), with effects modified by diet. The standard photoperiod showed the greatest efficacy against metabolic syndrome-associated diseases. The study showed how day length affects GSPE's benefits and underscores considering biological rhythms in metabolic disease therapies.

Persistent hemichoreoathetosis-hemidystonia after nonketotic hyperosmolar hyperglycemia

Most commonly, hemichorea associated with nonketotic and ketotic hyperglycemia resolves with normalization of blood glucose. Herein, we present a case of hyperosmolar hyperglycemic left hemichoreoathetosis-hemidystonia that has persisted for over 1 year. The subject presented to the emergency room with dysarthria and manifested left hemichoreoathetosis-hemidystonia within 36 h of admission. Initial computed tomography (CT) showed hyperdensity in the right putamen and left caudate. Magnetic resonance imaging (MRI) showed T1 hyperintensity within the right putamen. Failure to detect these classic imaging abnormalities during hospitalization resulted in a delayed etiologic diagnosis. Modest symptomatic improvement in the severity of hemichoreoathetosis-hemidystonia has been noted with low dose tetrabenazine.

Evaluation of the point-of-care devices KetoSureTM and StatStrip Express® blood ketone tests using β-hydroxybutyrate spiked samples

Measurement of β-hydroxybutyrate (BHB) in blood is used clinically as a measure of ketosis when diabetic ketoacidosis is expected. With the introduction of point-of-care testing (POCT) for blood-BHB, nonproductive time is reduced to a minimum in a potential critical situation; however, studies have observed inferior quality of POCT-BHB. Recently, the POCT device KetoSure (Roche) has been introduced to the clinic. In this study, we evaluated the imprecision and linearity of KetoSure and compared this to the established StatStrip Express (Nova Biomedical) based on spiked full blood samples. We found comparable imprecision for KetoSure and StatStrip Express. However, linearity was only observed in the lower part of the measuring range for both devices. In a method comparison, higher values of BHB were measured by KetoSure than by an enzymatic endpoint spectrophotometric reference method (mean bias: 21% (95% confidence interval (CI): 4%-37%)). Conversely, StatStrip Express returned lower values of BHB (mean bias: -16% (95% CI: -38%-7%), while the widely applied POCT device FreeStyle Precision Neo (Abbott) returned values equivalent with the reference method (mean bias: 5% (95% CI: -14%-24%). In samples with concentrations of BHB above the measuring range, the POCT devices could be provoked to return falsely low results. In conclusion, the quality of KetoSure is in line with other established POCT devices; however, the KetoSure measures higher concentrations than other POCT devices. As, linearity only was observed in the lower part of the measuring range and as falsely low measures could be provoked, we advise users to interpret results with precaution.

Prevalence of and risk factors for diabetic ketosis in Chinese diabetic patients with random blood glucose levels >13.9 mmol/L: Results from the CHina study in prEvalence of diabetiC Ketosis (CHECK) study

BACKGROUND

The aim of the present study was to investigate the prevalence of diabetic ketosis (DK) and its risk factors in Chinese diabetes patients with severe hyperglycemia.

METHODS

The present multicenter cross-sectional study was performed on patients aged >16 years with diabetes mellitus (DM) and random blood glucose levels >13.9 mmol/L (>250 mg/dL). Blood ketones (β-hydroxybutyric acid) and urinary ketones (acetoacetic acid) were measured and information on patient demographic and clinical characteristics was collected.

RESULTS

Of 1235 patients enrolled in the study (93 with type 1 DM [T1DM]), 1142 with type 2 DM [T2DM]), 242 (19.6%) had DK (blood ketone levels ≥0.6 mmol/L). Proportionately, DK was more frequent and more severe in patients with T1DM than T2DM (55.9% vs 16.6%, respectively), but in absolute terms occurred in more patients with T2DM (52 vs 190). In patients with blood ketone levels ≥3 mmol/L, the cut-off point of blood glucose levels was 19.05 mmol/L. Risk factors significantly associated with higher blood ketone levels in T2DM included younger age, a shorter duration of diabetes, and not using antidiabetic medication within 12 months prior to the hyperglycemic episode.

CONCLUSIONS

The prevalence of DK is lower in patients with T2DM than T1DM, but the number of patients with DK is higher for those with T2DM because of more T2DM patients in China. Patients with T2DM who have a younger age, shorter duration of diabetes, and a lack of antidiabetic treatment will suffer from DK more often than older patients with longer T2DM duration and receiving antidiabetic treatment.

Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) remains a common medical emergency. Over the last few years, new national guidelines have changed the focus in managing the condition from being glucose-centered to ketone-centered. With the advent of advancing technology and the increasing use of hand-held, point-of-care ketone meters, greater emphasis is placed on making treatment decisions based on these readings. Furthermore, recent warnings about euglycemic DKA occurring in people with diabetes using sodium-glucose co-transporter 2 (SGLT-2) inhibitors urge clinicians to inform their patients of this condition and possible testing options. This review describes the reasons for a change in treating DKA, and outlines the benefits and limitations of using ketone readings, in particular highlighting the difference between urine and capillary readings.

Blood versus urine ketone monitoring in a pediatric cohort of patients with type 1 diabetes: a crossover study

BACKGROUND

The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D).

METHODS

Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients (n = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial. Moreover, we evaluated levels of awareness of ketone production in a series of 58 patients and sometimes parents via a multiple-choice questionnaire.

RESULTS

Based on self-monitoring data, patients experienced a mean of 4.8 HE/month (range 0-9.3). Patients performed accurate ketone tests more frequently during urine (46%) than during blood-testing (29%) periods (p < 0.05); while globally, 50% of ketone tests were inaccurate (i.e. without HE). Ketosis occurred significantly more often during urine (46.4%) than during blood (14.8%) monitoring (p = 0.01), although no episodes of diabetic ketoacidosis (DKA) were noticed. Duration of hyperglycemia was not different whether patients measured ketones or not, suggesting that ketone monitoring did not affect correction of glycemia. Patients evaluated blood monitoring more frequently as being practical, reliable, and useful compared with urine testing. Scores in the awareness questionnaire were globally low (36.8%) without difference between patients and their parents.

CONCLUSIONS

Although our study shows differences in outcomes (e.g. accurate use, detection of ketosis) of urine versus blood ketone monitoring, these did not affect the occurrence of HE. Whereas ketone monitoring is part of standardized diabetes education, its implementation in daily routine remains difficult, partly because patient awareness about mechanisms of ketosis is lacking.

Water soluble polyhydroxyalkanoates: future materials for therapeutic applications

Polyhydroxyalkanoates (PHAs) are excellent candidate biomaterials due to their exceptional biodegradability and biocompatibility. However, PHAs need to have tunable hydrophilicity, chemical functionalities, and appropriate hydrolytic stability to expand their therapeutic applications towards more advanced areas. In this Tutorial Review, we present the most recent progress in the synthetic strategies of PHA-based water soluble polymers, including the functionalisation of PHAs with polar functional groups and the block/graft copolymerization of PHAs with hydrophilic components in various polymeric architectures. These chemically modified water soluble PHAs have significant impact on materials engineering and show great value in the fulfilment of smart biomaterials in emerging areas. The applications of water soluble PHAs in controlled drug release, cancer therapy, DNA/siRNA delivery and tissue engineering in new aspects are discussed. In addition, water soluble PHA monomer production will be briefly introduced, with emphasis on its bio-significance in medical physiology and the therapeutic effect in the treatment of diseases.

Plasma metabolomics reveals a potential panel of biomarkers for early diagnosis in acute coronary syndrome

Discovery of new biomarkers is critical for early diagnosis of acute coronary syndrome (ACS). Recent advances in metabolomic technologies have drastically enhanced the possibility of improving the knowledge of its physiopathology through the identification of the altered metabolic pathways. In this study, analyses of peripheral plasma from non-ST segment elevation ACS patients and healthy controls by gas chromatography-mass spectrometry (GC-MC) permitted the identification of 15 metabolites with statistical differences (p < 0.05) between experimental groups. Additionally, validation by GC-MC and liquid chromatography-MC permitted us to identify a potential panel of biomarkers formed by 5-OH-tryptophan, 2-OH-butyric acid and 3-OH-butyric acid. This panel of biomarkers reflects the oxidative stress and the hypoxic state that suffers the myocardial cells and consequently constitutes a metabolomic signature of the atherogenesis process that could be used for early diagnosis of ACS.

Physiological importance of poly-(R)-3-hydroxybutyrates

Poly-(R)-3-hydroxybutyrates (PHB), linear polymers of (R)-3-hydroxybutyrate, are components of all biological cells in which short polymers (<200 monomer residues) are covalently attached to certain proteins and/or noncovalently associated with polyphosphates - inorganic polyphosphate (polyP), RNA, and DNA. The low concentrations, lack of unusual atoms or functional groups, and flexible backbones of this complexed PHB, referred to as cPHB, make them invisible to many analytical procedures; whereas other physical properties - water-insolubility, high intrinsic viscosity, temperature sensitivity, multiple bonding interactions with other molecules - make them requisite participants in vital physiological processes as well as contributors to the development of certain diseases.