Point-of-care blood test for ketones in patients with diabetes: primary care diagnostic technology update

Abstract

#### Clinical Question In patients with diabetes, does a point-of-care test for blood ketones improve the diagnosis and management of diabetic ketoacidosis compared to standard practice? Earlier diagnosis of capillary blood ketones associated with hyperglycaemia facilitates the prevention of ketoacidosis, as well as prompt treatment.1 Urine ketone strips are semi-quantitative and measurements do not accurately reflect current conditions if the urine has been in the bladder for several hours (for example, overnight) before testing. Bottled strips can lose their accuracy if the bottle has been open for several months. Results can also be affected by medications, giving false-positive results in the presence of drugs containing sulphydryl groups, or false-negative reactions in the presence of ascorbic acid. In some cases, patients may also be unable to provide a urine sample (for example, due to confusion). Three portable point-of-care (POC) blood ketone meters were identified, which require ∼1 μl of blood and a test time of ∼10 seconds: the Precision Xtra® (called Optium Xceed in the UK; Abbott Diabetes Care; detection range 0.1-6 mmol/l); the Nova Max® PLUS blood glucose and beta-ketone monitoring system (Nova Biomedical; detection range 0.1-8 mmol/l), and the GlucoMen® Lx Plus (A. Menarini Diagnostics; detection range 0.1-8 mmol/l). DKA remains a leading cause of hospitalisation and the main cause of morbidity and death in children and adolescents with …