ReviewDiabetes care2022
Controversies Around the Measurement of Blood Ketones to Diagnose and Manage Diabetic Ketoacidosis.
Review in Diabetes care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 21 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 30 citations in OpenAlex.
- A review of capillary β-hydroxybutyrate cut-off levels for the exclusion and identification of diabetic ketoacidosis.Journal of diabetes investigation · 2026Review
- Sex-Specific Determinants of the Ketone Body β-Hydroxybutyrate in the General Population.The Journal of clinical endocrinology and metabolism · 2026Article
- Diabetic Ketoacidosis: Considerations and Residual Controversies in Management After the 2024 ADA, EASD, JBDS, AACE, and DST Joint ConsensusEndocrine, metabolic & immune disorders drug targets · 2026Review
- Ketone Management in Pediatric Diabetes Centers in the USA: Current Practices and a Call for Improved Standardization.Hormone research in paediatrics · 2026Article
- Ketosis and ketoacidosis in hospitalized patients receiving SGLT2 inhibitor therapy.Diabetes, obesity & metabolism · 2025Article
- Comparison between blood ketone and blood gas analysis indices in management of diabetic ketoacidosis.Journal of rural medicine : JRM · 2025Article
- Are Regular Aerobic Exercisers With Type 1 Diabetes Following Current Physical Activity Self-Management Guidelines? Insights From an Online Survey.Clinical diabetes : a publication of the American Diabetes Association · 2025Article
- Diagnostic Accuracy of End-Tidal Carbon Dioxide for Assessing Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis.Archives of academic emergency medicine · 2025Article
- Challenging management dogma where evidence is non-existent, weak, or outdated: part II.Intensive care medicine · 2024Review
- Hyperglycaemic crises in adults with diabetes: a consensus report.Diabetologia · 2024Article
- Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.Diabetes care · 2024Review
- Update on Measuring Ketones.Journal of diabetes science and technology · 2024Review
- Novel Approach to Continuation of Elective Procedures in People at Risk for Sodium-Glucose Cotransporter 2 Inhibitor-Associated Euglycemic Ketoacidosis.Diabetes spectrum : a publication of the American Diabetes Association · 2024Article
- Does Treatment with Sodium-Glucose Cotransporter-2 Inhibitors Affect Adherence to International Society Criteria for Diabetic Ketoacidosis in Adult Patients with Type 2 Diabetes? A Retrospective Cohort Analysis.Journal of diabetes research · 2024Observational
- The effectiveness of blood glucose and blood ketone measurement in identifying significant acidosis in diabetic ketoacidosis patients.Diabetology & metabolic syndrome · 2023Article
- Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus.Diabetes care · 2023Review
- Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus.Clinical chemistry · 2023Article
- Utility of plasma beta-hydroxybutyrate to define resolution of diabetic ketoacidosis.Pediatric diabetes · 2022Article
- Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future.Sports medicine (Auckland, N.Z.) · 2022Review
- Hospital Diabetes Meeting 2022.Journal of diabetes science and technology · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
5 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The measurement of blood ketones in preference to urine ketones has become a well-established tool in the diagnosis and management of diabetic ketoacidosis (DKA). However, there remains considerable disparity between diabetes guidelines regarding if, how, and when this test should be used. While recent guidelines now mainly emphasize blood measurement, several issues nonetheless remain. Many laboratories still measure blood ketones using a semiquantitative test that does not measure the predominant ketone, β-hydroxybutyrate (BOHB), which may hinder patient management. Even when BOHB is measured, the evidence for cutoffs used in DKA diagnosis or exclusion is limited, while its use in gauging severity, treatment progress, and resolution is not fully clear. Lastly, although employing point-of-care meters instead of a laboratory for BOHB measurement brings undoubted benefits, this approach has its own challenges. This article provides a perspective on these topics to complement current recommendations and to suggest how future research may improve its use in the DKA context.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.