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. 2024 Oct 15:1-9.
doi: 10.1159/000541430. Online ahead of print.

Ketone Management in Pediatric Diabetes Centers in the USA: Current Practices and a Call for Improved Standardization

Brynn E Marks  1   2 , Seema Meighan  1 , Emily E Fivekiller  3 , Estella Escobar  3 , Cari Berget  3
Affiliations

Ketone Management in Pediatric Diabetes Centers in the USA: Current Practices and a Call for Improved Standardization

Brynn E Marks et al. Horm Res Paediatr. .

Abstract

Introduction: Diabetic ketoacidosis (DKA) is the leading cause of mortality among youth with type 1 diabetes (T1D). Guidelines for DKA prevention exist; however, specific guidance about when to check ketones and how to manage youth using insulin pumps and automated insulin delivery (AID) systems is lacking.

Methods: A 35-item online survey exploring clinical ketone management practices for youth with T1D in the USA was distributed to diabetes healthcare professionals (HCPs). Survey responses, including multiple-choice and Likert scale questions, were summarized and rates of agreement and disagreement (Likert scale 4, 5 vs. 1, 2, 3) are reported.

Results: In total, 123 HCPs (51% physicians, 26% diabetes educators, 19% nurse practitioners) from 47 institutions completed the survey. Seventy percent worked at academic specialty centers. Ninety-seven percent reported >50% continuous glucose monitoring use in their clinic and 72% reported >50% insulin pump use. Although 79% reported having ketone management protocols, the level and duration of hyperglycemia at which ketone monitoring was advised ranged from >200 to 350 mg/dL and from 0 min to >6 h of duration. While 72% had distinct ketone management protocols for pump users, only 29% had specific protocols for AID. Sixty-two percent agreed that DKA due to infusion site failure was a significant problem in their practice, and 70% agreed there was a need to standardize ketone management guidelines.

Conclusions: The preventable nature and high incidence of DKA highlight the need to build consensus for clinical ketone management and to develop tools to facilitate management, especially as the use of diabetes technologies continues to increase.

Keywords: Automated insulin delivery; Diabetes self-management; Diabetic ketoacidosis; Insulin pumps; Ketosis; Type 1 diabetes.

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Conflict of interest statement

Conflict of Interest Statement

B.E.M. is supported by the National Institutes of Health (PI: Marks, NIH: K23DK129827) and has received investigator-initiated research support from Tandem Diabetes Care, Inc., and the Cystic Fibrosis Foundation; industry sponsored research support from Medtronic; and research supplies from DexCom, Inc. and Diagnostics. S.M. has received a speaker honorarium from DexCom. C.B. reports consulting and speaking honoraria from Insulet, Medtronic, Tandem, DexCom, and Embecta. E.E. and E.F. report no conflicts of interest.

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