.AkshayJainEndo and Bruce Perkins, MD, discuss prediction of DKA episodes in people living with type 1 diabetes.
Welcome from sunny San Diego, where we are at the 83rd American Diabetes Association Conference. With me is Professor Bruce Perkins from the University of Toronto.
I started a pump program years ago at Toronto General. Everyone who received a pump would get training to understand what ketones are and what DKA is. Inevitably, a few months later, I'd see someone who had a sick day with gastroenteritis. I'd ask about ketones, and they would ask me,"What's a ketone?" It's hard. People with diabetes have to manage so much information.
We could study this in a general type 1 population because this protocol was used in a randomized placebo-controlled trial. The placebo group never got SGLT inhibitors — they thought maybe they did, but they didn't — and we could see thresholds. It turns out that they predict quite well the risk for DKA — not perfectly, but pretty well.
I think the biggest implication of this is that in development now are continuous ketone meters likely to harmonize with continuous glucose meters. If one is going to be using such a thing, why only get alerted on a sick day? Why not get alerted that they're the kind of person who might be generally at more DKA risk in the next month? That's the concept behind that research.Predictive ketone monitoring. I love that concept.
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