Continuous Ketone Monitoring in Diabetic Ketoacidosis: Multicenter Method-Comparison Study

This was a prospective multicenter method-comparison study conducted at two United States Emergency Departments from August 2024 - August 2025. Adults (>18 years) meeting the American Diabetes Association definition of DKA were included. BOHB was measured via SiBio CKM and compared with simultaneously collected venous BOHB every two hours during DKA treatment. Following DKA resolution, study staff removed CKM and assessed for complications. The primary outcome was level of agreement via Bland-Altman analysis between simultaneously collected CKM and venous BOHB values. Additional outcomes included correlation (r) between concurrent CKM and venous BOHB values, first detection of DKA resolution (BOHB

Continuous ketone monitoring (CKM) could optimize diabetic ketoacidosis (DKA) treatment by monitoring beta-hydroxybutyrate (BOHB) continuously and minimally invasively, assessing response to treatment and identifying DKA resolution in real time. However, data on agreement between interstitial and venous BOHB during DKA treatment is lacking. Our objectives were to assess feasibility of CKM during DKA treatment and agreement between interstitial and venous BOHB.

Thirty four patients were enrolled, with mean age 40.8 years, 56% male, 50% Black, 79% type I diabetes, and mean presenting BOHB 7.0 mmol/L (range 2.5-13.5). We analyzed 164 paired CKM and venous BOHB values (mean [SD] paired values per patient: 4.8 [3.8], range 1-16). Bland-Altman analysis found the average difference between CKM – venous BOHB was -0.38 mmol/L [95%CI -1.63, 0.88]. CKM values were strongly correlated with venous BOHB (r= 0.96, p

CKM during DKA treatment was feasible, provided clinically accurate BOHB readings, and detected DKA resolution earlier than standard care. CKM-guided DKA treatment is a promising strategy with potential to improve quality and value of DKA care. Future trials can assess CKM’s impact on DKA clinical outcomes, patient experience, and cost-effectiveness.