Breath Acetone Correlates With Capillary β-hydroxybutyrate in Type 1 Diabetes.
Kai E Jones, Max C Petersen, Alexander M Markov et al.
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In 30 seconds
This randomized crossover study assessed whether breath acetone (BrACE) tracks capillary β-hydroxybutyrate (BOHB) in adults with type 1 diabetes during outpatient care and supervised insulin withdrawal, with and without dapagliflozin. Twenty participants completed two 14-day outpatient periods and subsequent supervised withdrawal studies. BrACE and BOHB were moderately correlated during outpatient care (ρ = .41; 95% CI = 0.36 to 0.45) but strongly correlated during insulin withdrawal (ρ = .81; 95% CI = 0.77 to 0.85). A BrACE threshold > 5 ppm had 93% sensitivity and 87% specificity for detecting BOHB ≥ 1.5 mmol/L.
Key findings
- During outpatient periods, 1425 paired readings showed a moderate BrACE–BOHB correlation (ρ = .41; 95% CI = 0.36 to 0.45; P < .0001).
- During supervised insulin withdrawal, 246 paired values showed a strong correlation (ρ = .81; 95% CI = 0.77 to 0.85).
- BrACE > 5 ppm detected capillary BOHB ≥ 1.5 mmol/L with 93% sensitivity and 87% specificity.
Why it matters
Breath acetone offers a noninvasive way to estimate blood ketone concentration, but its performance differed by setting. The stronger relationship during supervised insulin withdrawal suggests potential usefulness when ketones are rising under monitored conditions, while the more modest outpatient correlation cautions against assuming breath readings reliably substitute for capillary measurements in routine unsupervised care.
What to keep in mind
The study included 20 participants, and outpatient correlation was only moderate; the findings do not establish performance in broader populations or clinical outcomes from using breath measurements.