Use of capillary ketones monitoring in treatment of mild ketotic crisis in adults with ketosis prone atypical diabetes

Introduction : the utility of capillary ketones monitoring is known in the management of type 1 diabetes and severe diabetic ketoacidosis, but not in adults with ketosis-prone atypical diabetes (KPD) or mild ketosis. The objective was to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with KPD when using capillary versus urinary ketones. Methods : from February to end March 2015, a total of 20 (9/20 newly diagnosed) patients, aged 46 ±12 years and classified as KPD presented at the National Obesity Center of the Yaounde Central Hospital with marked hyperglycemia and significant ketosis (ketonuria ≥ ++) requiring intensive insulin treatment. The mean plasma glucose and urinary ketones levelon admission was 22.8±5mmol/L and 2.9± 2.7 mmol/L respectively. No patient had severe acidosis (HCO3 Results : the time-to-normalization of ketonuria ranged between 2 and 14 hours, and that of ketonemia between 1 and 10 hours. The mean time-to-disappearance of ketonuria was 6.3 ± 3.6 hours with a median time of 5 hours, while the mean time-to-normalization of capillary β-hydroxybutyrate was 4.2± 2.7 hours with the median of 4 hours (p = 0.0002). The absolute difference in time-to-normalization of ketonuria versus ketonemia was 2[1-3] hours (median [interquartile difference]) and relative time reduction of treatment to 32.5±18.0%. Conclusion : the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in adults with ketosis prone diabetes and therefore reduce admission rates and costs.