ArticleEndocrine2026
β-hydroxybutyrate as an early predictive biomarker of diabetes remission following intensive dietary intervention.
Article in Endocrine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAlthough intensive weight management achieves considerable success in diabetes remission, individual response varies substantially. We aimed to evaluate the predictive ability of early β-hydroxybutyrate (BHB) for type 2 diabetes (T2D) remission following an intensive dietary intervention in Southeast Asian individuals, and explore the metabolomic signatures associated with remission.
methodsWe analysed 45 adults with obesity and T2D (age:42 ± 10 years, 66.7% male, body mass index:33.7 ± 4.2 kg/m²) who completed 12 weeks of total diet replacement (TDR; ~800 kcal/day) in a secondary care setting. Blood BHB levels were measured at week 2 of TDR using point-of-care testing (POCT). Metabolomic analysis was performed on baseline and post-TDR plasma samples from 33 participants using nuclear magnetic resonance spectroscopy. Remission was defined as HbA1c < 6.5% and fasting plasma glucose<7 mmol/L without glucose-lowering medications.
resultsFollowing TDR, 64.4% of participants achieved remission with 8.2% mean weight loss. Increasing remission rates were observed across POCT-BHB tertiles (p-trend=0.001), with the highest tertile independently associated with remission (risk ratio:3.11, 95% CI:1.63-5.94, p < 0.001). Addition of POCT-BHB to a base model (baseline age, sex, weight, and HbA1c) increased the area under the receiver operating characteristic curve from 0.72-0.94. The optimal POCT-BHB cut-off value was 0.575 mmol/L, yielding 72.4% sensitivity and 93.8% specificity. Metabolomic analysis revealed that remitters exhibited enhanced ketone metabolism and distinct lipoprotein remodelling.
conclusionIn this real-world implementation of an intensive weight management programme, our preliminary findings identified week 2 POCT-BHB as a potentially useful biomarker for predicting diabetes remission in clinical practice.
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