Comparison of breath gases, including acetone, with blood glucose and blood ketones in children and adolescents with type 1 diabetes

Abstract

Previous studies have suggested that breath gases may be related to simultaneous blood glucose and blood ketone levels in adults with type 2 and type 1 diabetes. The aims of this study were to investigate these relationships in children and young people with type 1 diabetes in order to assess the efficacy of a simple breath test as a non-invasive means of diabetes management. Gases were collected in breath bags and measurements were compared with capillary blood glucose and ketone levels taken at the same time on a single visit to a routine hospital clinic in 113 subjects (59 male, age 7 years 11 months-18 years 3 months) with type 1 diabetes. The patients were well-controlled with relatively low concentrations of the blood ketone measured (β hydroxybutyrate, 0-0.4 mmol l(-1)). Breath acetone levels were found to increase with blood β hydroxybutyrate levels and a significant relationship was found between the two (Spearman's rank correlation ρ = 0.364, p < 10(-4)). A weak positive relationship was found between blood glucose and breath acetone (ρ = 0.16, p = 0.1), but led to the conclusion that single breath measurements of acetone do not provide a good measure of blood glucose levels in this cohort. This result suggests a potential to develop breath gas analysis to provide an alternative to blood testing for ketone measurement, for example to assist with the management of type 1 diabetes.

Continuous Monitoring of Breath Acetone, Blood Glucose and Blood Ketone in 20 Type 1 Diabetic Outpatients Over 30 Days

“…BK ranges 0-0.5 mmol/L and 0-4.3 mmol/L in the healthy and T1D subjects respectively, with corresponding global means of 0.16 and 0.25 (mmol/L). The results indicate that the T1D subjects have a higher mean BA concentration than the healthy controls, which is consistent with the published data in the literatures [3,26,[30][31][32].…”

“…An elevated mean BA in T1D patients was also observed in Wang et al work, in which BA in 34 T1D patients and 15 healthy individuals was measured using a CRDS-based breath acetone analyzer [26]. In a recent work by Blaikie et al BA in 113 young T1D patients (age of 7-18) in a clinic at the Oxford Children's Hospital was measured using a softionization mass spectrometer [32]. Their results show that the average value (0.51 ppm) is higher than that found for a healthy cohort of the same age group reported by Spanel et al [9].…”

“…In other published works, no correlation between BA and BG in T1D patients was found. For instance, more recently, Blaikie et al measured BA from 113 young T1D patients aged 7-18 years in a clinic at the Oxford Children's Hospital using a soft-ionization mass spectrometer, no correlation between BA and BG was found [32]. In the present study, the IMBA concentrations measured in the 20 T1D outpatients over 30 days show no obvious correlation to the IMBG levels, as shown in Figure 4 (R=0.17, P=0.43).…”

Stachyose combined with tea polyphenols mitigated metabolic disorders in high fructose diet-fed mice as studied by GC-MS metabolomics approach

“…Among the three biomarkers, β-hydroxybutyric acid was regarded as an intermediate product of energy metabolism and the diabetes diagnosis biomarker, its metabolic level had a significant increase due to peripheral lipolysis induced by insulin resistance (Blaikie et al, 2014;Bresciani, Pietra, Corradin, Giunti, & Fracassi, 2014). Our data also showed that HF diet caused a significant increase in serum β-hydroxybutyric acid level.…”

Exhaled Breath Isoprene Rises During Hypoglycemia in Type 1 Diabetes

“…VOCs were measured by soft-ionization mass spectrometry (V&F AIRSENSE Compact Ion Molecule Reaction Mass Spectrometer) by a researcher blinded to clamp glucose values (2). VOC values were adjusted to 5% exhaled CO 2 .…”