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Breath Res."],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Breath analysis is a candidate non-invasive approach for detecting disturbances in glucose metabolism, but its clinical applicability has not been systematically assessed across analytical platforms and clinical targets. This systematised review evaluates breath-based biomarkers and analytical technologies for the detection of diabetes, prediabetes, insulin resistance, gestational diabetes, and hypoglycaemia, and for blood glucose estimation. A structured PubMed search identified human studies published between 2010 and 2025; 30 studies met the inclusion criteria. Most analysed volatile organic compounds using laboratory platforms such as gas chromatography\u2013mass spectrometry (MS) or proton transfer reaction MS, a growing number used portable sensor-based systems including electronic noses and single-gas sensors, and a smaller group used isotope-based breath tests measuring labelled carbon dioxide after substrate ingestion. Reported diagnostic performance was highest and most consistent for hypoglycaemia detection in type 1 diabetes mellitus (sensitivity and specificity approximately 90%\u201395%) and for isotope-based discrimination of prediabetes and diabetes subtypes (approximately 90%\u2013100%), whereas qualitative diabetes detection and quantitative blood glucose prediction were more variable. Both findings are based on a small number of studies, and the isotope-based results originate from a single research group and require independent replication. Performance depended strongly on signal complexity, with multivariable and spectral approaches outperforming single-compound methods. However, most studies used small cohorts and internal validation only, and sampling procedures and reporting were poorly standardised. Standardised protocols, larger externally validated cohorts, and platform selection matched to the intended clinical role are required before implementation.<\/jats:p>","DOI":"10.1088\/1752-7163\/aea638","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:49:48Z","timestamp":1789166988000},"page":"044002","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical applicability of breath measurements for detecting disturbances in systemic glucose metabolism: a systematised review"],"prefix":"10.1088","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8654-2531","authenticated-orcid":true,"given":"Ben Marino","family":"Scattolo","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern"},{"name":"Diabetes Center Berne"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1816-5156","authenticated-orcid":false,"given":"Cl\u00e9o","family":"Nicolier","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern"},{"name":"Diabetes Center Berne"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0356-6352","authenticated-orcid":false,"given":"Maria Luisa","family":"Balmer","sequence":"additional","affiliation":[{"name":"Diabetes Center Berne"},{"name":"Institute for Infectious Diseases, University of Bern"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9459-875X","authenticated-orcid":true,"given":"Lilian","family":"Witthauer","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern"},{"name":"Diabetes Center Berne"},{"name":"Department for Digital Medicine, University of Bern"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"266","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"jbraea638bib1","author":"International Diabetes Federation IDF Diabetes Atlas","year":"2025","edition":"11th edn","type":"web-resource"},{"key":"jbraea638bib2","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.2337\/dc25-S002","type":"journal-article","article-title":"2 diagnosis and classification of diabetes: standards of care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2024","journal-title":"Diabetes Care"},{"key":"jbraea638bib3","doi-asserted-by":"publisher","first-page":"800","DOI":"10.3390\/s19040800","type":"journal-article","article-title":"The progress of glucose monitoring\u2014a review of invasive to minimally and non-invasive techniques, devices and sensors","volume":"19","author":"Villena Gonzales","year":"2019","journal-title":"Sensors"},{"key":"jbraea638bib4","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7155\/8\/1\/014001","type":"journal-article","article-title":"A review of the volatiles from the healthy human body","volume":"8","author":"de Lacy Costello","year":"2014","journal-title":"J. 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