Abstract
An analysis of exhaled volatile organic compounds (VOC) may deliver systemic information quicker than available invasive techniques. Metabolic aberrations in pediatric type 1 diabetes (T1DM) are of high clinical importance and could be addressed via breathomics. Real-time breath analysis was combined with continuous glucose monitoring (CGM) and blood tests in children suffering from T1DM and age-matched healthy controls in a highly standardized setting. CGM and breath-resolved VOC analysis were performed every 5 minutes for 9 hours and blood was sampled at pre-defined time points. Per participant (n = 44) food intake and physical activity were identical and a total of 22 blood samples and 93 minutes of breath samples were investigated. The inter-individual variability of glucose, insulin, glucagon, leptin, and soluble leptin receptor relative to food intake differed distinctly between patients and controls. In T1DM patients, the exhaled amounts of acetone, 2-propanol, and pentanal correlated to glucose concentrations. Of note, the strength of these correlations strongly depended on the interval between food intake and breath sampling. Our data suggests that metabolic adaptation through postprandial hyperglycemia and related oxidative stress is immediately reflected in exhaled breath VOC concentrations. Clinical translations of our findings may enable point-of-care applicability of online breath analysis towards personalized medicine.
Highlights
Through recent advances in human medicine, the immediate assessment of disease-driven metabolic effects and variations has gained clinical significance, especially for metabolic disorders such as diabetes which are large contributors to global disease burdens
Within this study we found distinct concentration changes of serum parameters and breath volatile organic compounds (VOC) that could be linked to metabolic processes
Oxygenated compounds in exhaled breath such as acetone, 2-propanol, and pentanal showed significant correlations to blood glucose and interstitial glucose concentrations in the T1DM group, but much less pronounced correlations in the healthy control group
Summary
Through recent advances in human medicine, the immediate assessment of disease-driven metabolic effects and variations has gained clinical significance, especially for metabolic disorders such as diabetes which are large contributors to global disease burdens. Insulin monotherapy is hardly able to restore metabolic homeostasis and the interplay with leptin and glucagon as the glucoregulatory partner of insulin [5,6,7]. This might explain at least in part why T1DM patients are at high risk to develop serious comorbidities at a young age [8,9]
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