{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T13:55:17Z","timestamp":1784296517457,"version":"3.55.0"},"reference-count":20,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100013528","name":"Diabetes Canada","doi-asserted-by":"publisher","award":["OG-3-21-5572-BP"],"award-info":[{"award-number":["OG-3-21-5572-BP"]}],"id":[{"id":"10.13039\/100013528","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>We aimed to determine if routine capillary blood ketone testing on well days predicts future diabetic ketoacidosis (DKA) in type 1 diabetes (T1D) using sodium\u2013glucose cotransporter inhibitors (SGLTi).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We examined previously collected data from empagliflozin-assigned participants in a T1D trial that included weekly fasted ketone levels. Over 6\u201312 months, ketone levels were subdivided into 28-day periods, and the outcome was subsequent adjudicated DKA or severe ketosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 1,194 participants, 325 had 49 DKA and 568 severe ketosis events. On-treatment maximum ketone levels were higher in the 28 days before an outcome compared with levels in those without an outcome, with area under receiver operating characteristic curve of 0.76 (95% CI 0.71\u20130.82). Maximum ketone level \u22650.8 mmol\/L had sensitivity of 66.0%, specificity of 79.6%, and diagnostic odds ratio of 7.6.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Routine surveillance of capillary ketone levels in T1D using SGLTi may represent a DKA mitigation strategy and implies a potential threshold for continuous ketone monitoring.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc25-0125","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T17:01:44Z","timestamp":1746637304000},"page":"1016-1021","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":3,"title":["Capillary Ketone Level and Future Ketoacidosis Risk in Patients With Type 1 Diabetes Using Sodium\u2013Glucose Cotransporter Inhibitors"],"prefix":"10.2337","volume":"48","author":[{"given":"Priya","family":"Bapat","sequence":"first","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Dhaliwal","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cimon","family":"Song","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yucheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"3Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Scarr","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmohsen","family":"Bakhsh","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"4Kidney & Pancreas Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital & Research Centre, Alfaisal University, Riyadh, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton","family":"Budhram","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"3Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha J.","family":"Verhoeff","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Weisman","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-2445","authenticated-orcid":false,"given":"Michael","family":"Fralick","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"3Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah M.","family":"Ivers","sequence":"additional","affiliation":[{"name":"6Department of Family and Community Medicine, Women\u2019s College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4164-0429","authenticated-orcid":false,"given":"David Z.I.","family":"Cherney","sequence":"additional","affiliation":[{"name":"7Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"8Biostatistics Department, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Mumford","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif Erik","family":"Lovblom","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"8Biostatistics Department, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0046","authenticated-orcid":false,"given":"Bruce A.","family":"Perkins","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"2025052014525086400_B1","doi-asserted-by":"crossref","first-page":"e3169","DOI":"10.1002\/dmrr.3169","article-title":"Effects of sodium-glucose cotransporter (SGLT) inhibitors in addition to insulin therapy on glucose control and safety outcomes in adults with type 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Coimbatore, India, IEEE, p. 1\u20135","DOI":"10.1109\/ICCCI.2018.8441286"},{"key":"2025052014525086400_B10","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1111\/dom.14472","article-title":"Using machine learning to predict severe hypoglycaemia in hospital","volume":"23","author":"Fralick","year":"2021","journal-title":"Diabetes Obes Metab"},{"key":"2025052014525086400_B11","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S2213-8587(20)30280-1","article-title":"Effect of dapagliflozin as an adjunct to insulin over 52 weeks in individuals with type 1 diabetes: post-hoc renal analysis of the DEPICT randomised controlled trials","volume":"8","author":"Groop","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025052014525086400_B12","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1161\/CIRCULATIONAHA.113.005081","article-title":"Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus","volume":"129","author":"Cherney","year":"2014","journal-title":"Circulation"},{"key":"2025052014525086400_B13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1475-2840-13-28","article-title":"The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus","volume":"13","author":"Cherney","year":"2014","journal-title":"Cardiovasc Diabetol"},{"key":"2025052014525086400_B14","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","volume":"373","author":"Zinman","year":"2015","journal-title":"N Engl J Med"},{"key":"2025052014525086400_B15","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and cardiovascular and renal events in type 2 diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N Engl J Med"},{"key":"2025052014525086400_B16","doi-asserted-by":"crossref","first-page":"532","DOI":"10.2337\/dc15-1995","article-title":"Diabetic ketoacidosis with canagliflozin, a sodium\u2013glucose cotransporter 2 inhibitor, in patients with type 1 diabetes","volume":"39","author":"Peters","year":"2016","journal-title":"Diabetes Care"},{"key":"2025052014525086400_B17","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.2337\/dc20-0924","article-title":"Diabetic ketoacidosis and related events with sotagliflozin added to insulin in adults with type 1 diabetes: a pooled analysis of the inTandem 1 and 2 studies","volume":"43","author":"Peters","year":"2020","journal-title":"Diabetes Care"},{"key":"2025052014525086400_B18","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1089\/dia.2023.0605","article-title":"Beta-hydroxybutyrate levels and risk of diabetic ketoacidosis in adults with type 1 diabetes treated with sotagliflozin","volume":"26","author":"Boeder","year":"2024","journal-title":"Diabetes Technol Ther"},{"key":"2025052014525086400_B19","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1177\/19322968211008185","article-title":"Feasibility of continuous ketone monitoring in subcutaneous tissue using a ketone sensor","volume":"15","author":"Alva","year":"2021","journal-title":"J Diabetes Sci Technol"},{"key":"2025052014525086400_B20","doi-asserted-by":"crossref","first-page":"107932","DOI":"10.1016\/j.jdiacomp.2021.107932","article-title":"Incidence of diabetic ketoacidosis and its trends in patients with type 1 diabetes mellitus identified using a U.S. claims database, 2007\u20132019","volume":"35","author":"Li","year":"2021","journal-title":"J Diabetes Complications"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/6\/1016\/805589\/dc250125.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/6\/1016\/805589\/dc250125.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T18:53:00Z","timestamp":1747767180000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/48\/6\/1016\/158177\/Capillary-Ketone-Level-and-Future-Ketoacidosis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,23]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,4,23]]},"published-print":{"date-parts":[[2025,6,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc25-0125","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,23]]}}}