This study was carried out to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with ketosis-prone atypical diabetes (KPD) when using capillary versus urinary ketones. In this cross-sectional study, we included 20 people with KPD presented at the National Obesity Center of the Yaoundé Central Hospital with hyperglycemic decompensation (random capillary glucose ≥13 mmol/L) and significant ketosis (ketonuria≥++) requiring intensive insulin treatment. In all subjects, intensive insulin treatment was initiated at 10 UI per hour with simultaneous measurement of capillary beta-hydroxybutyrate and ketonuria every 2 hours until disappearance of ketonuria. Time-to-disappearance of urine ketones was compared with the time-to-normalization of capillary β-hydroxybutyrate concentrations. Subjects were aged 46±13 years with a median duration of diabetes of 1.5 (IQR: 0–2.5) years. On admission, the mean blood glucose was 22.8±5 mmol/L and capillary ketones level was 2.9±2.7 mmol/L. The median time-to-disappearance of ketonuria was 5 (IQR: 3–8) hours compared with the time-to-normalization of capillary β-hydroxybutyrate of 4 (IQR: 2–6) hours, p=0.0002. The absolute difference in time-to-normalization of ketonuria versus ketonemia was 2 (IQR: 1–3) hours and the relative time reduction of treatment was 32.5%±18.0%. Our results suggested that the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in people with KPD.
- diabetes mellitus
- diabetes complications
- disease management
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Contributors CGGNN, ES, and J-CM: study design and conception, data collection and analysis, drafting, and review of the manuscript. EL-Y, AM, MD, and MEE: data interpretation, editing, and review of the manuscript. All authors read and approved of the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was performed in accordance with the guidelines of the Helsinki Declaration and was approved by the Institutional Research Ethical Committee of the Faculty of Medicine and Biomedical Sciences of Yaoundé and by the institutional review board of the Yaoundé Central Hospital of Cameroon. All subjects provided written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The principal investigator, Professor Sobngwi Eugene, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.