Query: DKA biomarker

title: Lactate clearance during the first 2 hours after hospital admission: A useful biomarker for predicting 30 day mortality in patients with diabetic ketoacidosis
abstract: This study assessed whether lactate clearance (LC) during the first 2 hours after admission to the emergency department can be used to predict the 30 day mortality of patients diagnosed with diabetic ketoacidosis (DKA)

title: Microneedle Based Detection of Ketone Bodies along with Glucose and Lactate: Toward Real Time Continuous ISF Monitoring of Diabetic Ketosis/Ketoacidosis.
abstract: Diabetic ketoacidosis (DKA) a severe complication of diabetes mellitus with potentially fatal consequences, is characterized by hyperglycemia and metabolic acidosis due to the accumulation of ketone bodies which requires people with diabetes to monitor both glucose and ketone bodies. However, despite major advances in diabetes management mainly since the emergence of new generation continuous glucose monitoring (CGM) devices capable of in vivo monitoring of glucose directly in the interstitial fluid (ISF) the continuous monitoring of ketone bodies is yet to be addressed. Here, we present the first use of a real time continuous ketone bodies monitoring (CKM) microneedle platform. The system is based on the electrochemical monitoring of b hydroxybutyrate (HB) as the dominant biomarker of ketone formation. Such a real time assay has been realized using the b hydroxybutyrate dehydrogenase (HBD) enzymatic reaction and by addressing the major challenges associated with the stable confinement of the enzyme/cofactor couple (HBD/NAD+ and with a stable and selective low potential fouling free anodic detection of NADH. The resulting CKM microneedle device displays an attractive analytical performance, with high sensitivity (with low detection limit, 50 mM) high selectivity in the presence of potential interferences, along with good stability during prolonged operation in artificial ISF. The potential applicability of this microneedle sensor toward minimally invasive monitoring of ketone bodies has been demonstrated in phantom gel skin mimicking model. The ability to detect HB along with glucose and lactate on a single microneedle array has been demonstrated. These findings pave the way for CKM and for the simultaneous microneedle based monitoring of multiple diabetes related biomarkers toward a tight glycemic control.

title: IoT Based Ketoacidosis Detection
abstract: Ketoacidosis also known as DKA (diabetic ketoacidosis) is a serious condition which occurs in patients who suffers from diabetes. It affects people above 25 years of age. It occurs due to insufficiency of insulin. Detection of ketone is done by the nitroprusside based urinary dipstick ketone test and plasmlserum ketone analyses. Non invasive detection of ketoacidosis is done by breath analyzer. In this paper we are using breath acetone as a biomarker for ketoacidosis. The resultant ketoacidosis values are transmitted through ESP8266. The ESP8266 sends the sensorvalues to think speak (private cloud) The new channel is created in Think Speak private clouding and Channel API keys are generated to read and write the sensor data from ESP8266. Through this simple IoT device the physician is always connected to the patient and can be able to monitor thet ketoacidosis condition of the subject

title: Role of Ischemia Modified Albumin Serum Levels as an Oxidative Stress Marker in Children with Diabetic Ketoacidosis.
abstract: Ischemia modified albumin (IMA) is a biomarker that has been introduced recently for use in the evaluation of the oxidative stress. The aim of this study was to measure the ischemia modified albumin serum levels in pediatric patients with diabetic ketoacidosis (DKA) during acidosis and after the patient recovered from acidosis and to compare these with the control group.  Pediatric patients with Type I diabetes mellitus (T1DM) who were admitted to the pediatric intensive care unit with the diabetic ketoacidosis were assigned as the study group and healthy children who were admitted to outpatient clinic and decided as healthy after clinic and laboratory evaluation were selected as the control group. IMA and adjusted IMA levels were evaluated in the blood samples from the control group and the study group when the first time admitted to the intensive care unit during the acidosis period (DKA before treatment, DKA BT) and after recovered from acidosis (DKA after treatment, DKA AT) RESULTS A total of 24 pediatric patient with diabetic ketoacidosis and 30 healthy control child matching age and sex were included in the current study. The albumin levels in pediatric patients with T1DM during DKA BT were higher than the albumin levels after acidosis (4.101+ 0.373, 3.854+ 0.369 g/dL, respectively) (p<0.05) However, there was not any significant difference when these values were compared to the control group. Mean values of IMA and Adj IMA were statistically higher in DKA AT compared to the control group (0.748+ 0.150 vs 0.591+ 0.099, p 0.001; 0.708+ 0.125 vs 0.607+ 0.824, p 0.001, respectively) IMA and adjusted IMA level measured after recovered from acidosis was significantly higher compared to the level of IMA during DKA (0.748+ 0.150 vs 0.606+ 0.105 as absorbance unit, p<0.001; 0.708+ 0.125 vs 0.625+ 0.100, p<0.05, respectively) CONCLUSION In children with T1DM, even though acidosis recovered following the treatment in diabetic ketoacidosis, which is an oxidative stress marker, the ischemia modified albumin levels and adjusted ischemia modified albumin levels were high.

title: IoT based personal health care monitoring device for diabetic patients
abstract: This paper presents a non invasive breath test to monitor the condition of diabetic patients. It is identified as an easier technique and quick diagnoses of diabetic ketoacidosis (DKA) DKA is a preventable acute complication of type 1 diabetes mellitus. Common diabetic test on patients are done on urinary test and blood ketone test to monitor for diabetes condition. However, those methods are considers as invasive, inconvenient and expensive. Recently, breath acetone has been considered as a new ketone biomarker because it is non invasive, convenient, and accurate reflection of the body's ketone level. This research presents a method of monitoring ketone level by using breath measurement. Main objective of this research is to present an easy handheld health care on monitoring diabetic level with breath. Method consists of development of hardware connection with Internet of Things (IoT) system to facilitate the process of patients' diagnosis and personal monitoring. In this system, Arduino board is used to read the sensor with sense the breath. Breath value level is log to system using wireless communication. Data collection is interfaced to web page. Ketone level is measured as the amount of breath acetone is collected when patients exhale into a mouthpiece that consists of gas sensor. The reading from Arduino is shared to the database via ESP 8266 Wi Fi Module and can be accessed by the patients or registered doctors. This research is significant where patients can independently monitor their diabetic health and the IoT system can be alerted directly to medial officers in the hospitals.

title: Prion Proteins Without the Glycophosphatidylinositol Anchor: Potential Biomarkers in Neurodegenerative Diseases
abstract: Prion protein (PrP) is a biomolecule that is involved in neuronal signaling, myelinization, and the development of neurodegenerative diseases. In the cell, PrP is shed by the ADAM10 protease. This process generates PrP molecules that lack glycophosphatidylinositol anchor, and these molecules incorporate into toxic aggregates and neutralize toxic oligomers. Due to this dual role, these molecules are important biomarkers for neurodegenerative diseases. In this review, we present shed PrP as a potential biomarker, with a focus on PrP226* which may be the main biomarker for predicting neurodegenerative diseases in humans.

title: Increased serum levels of ischemia modified albumin and C reactive protein in type 1 diabetes patients with ketoacidosis
abstract: Ischemia modified albumin (IMA) levels have been advocated as a biomarker for evaluating the oxidative stress status. No data are showed on the potential role of IMA in type 1 diabetes (T1D) We aimed to establish the correlation among serum levels of IMA, C reactive protein (CRP) and diabetic ketoacidosis (DKA) in patients with T1D. Fifty seven patients with T1D, 27 patients with DKA, and 40 controls were enrolled. Serum IMA and CRP levels were measured and evaluated to distinguish from DKA. CRP and IMA levels were significantly elevated in patients with DKA at admission to the hospital compared to non DKA and control subjects. CRP and IMA levels were higher in non DKA patients than in controls. CRP, plasma glucose, and IMA levels were reduced after insulin treatment. Serum IMA levels were an independent risk marker for DKA (OR 1.225, p 0.002, 95 CI: 1.076 1.394) Receiver operating characteristic curve analyses showed no difference in the areas under curve for serum IMA and CRP values. This study indicates that IMA and CRP levels were significantly correlated with DKA diagnosis. IMA can act as a biomarker that reflects the presence of DKA.

title: Sodium glucose co transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol
abstract: Recent phase 3 clinical trials have evaluated the impact of adding sodium glucose co transporter (SGLT) inhibitors to the type 1 diabetes armamentarium. These trials studied SGLT2 inhibitors (dapagliflozin and empagliflozin) and a dual SGLT1 and SGLT2 inhibitor (sotagliflozin) and demonstrated that these oral non insulin antihyperglycaemic medications are able not only to improve glycaemic control, but also to reduce body weight and extend time in range without increasing rates of hypoglycaemia in type 1 diabetes. Diabetic ketoacidosis (DKA) is a feature of type 1 diabetes and the risk is increased when SGLT inhibitors are used in type 1 diabetes. To minimize the risk of DKA and still gain the multiple benefits, we developed the "STOP DKA Protocol " an easily accessible and practical tool, that provides a risk mitigation strategy for reducing DKA in patients with type 1 diabetes being treated with SGLT inhibitors.

title: Association of socioeconomic status and DKA readmission in adults with type 1 diabetes: analysis of the US National Readmission Database
abstract: To identify patient and hospital predictors of recurrent diabetic ketoacidosis (DKA) admissions in adults in the USA with type 1 diabetes, focusing on socioeconomic indicators.  This cross sectional study used the National Readmission Database to identify adult patients with type 1 diabetes admitted for DKA between 2010 and 2015. The index DKA admission was defined as the first admission within the calendar year and the primary outcome was recurrent DKA admission(s) within the same calendar year. Multivariable logistic regression analysis was performed using covariates of patient and hospital factors at the index admission to determine the odds of DKA readmission(s)  Among 181 284 index DKA admissions, 39 693 (22% had at least one readmission within the calendar year, of which 33 931 (86% and 5762 (14% had 1 3 and =4 DKA readmissions, respectively. When compared with the highest income quartile, patients in the first and second income quartiles had 46% (95% CI 30% to 64% and 34% (95% CI 19% to 51% higher odds of four or more DKA readmissions, respectively. Medicaid and Medicare insurance were both associated with a 3.3 fold adjusted risk (95% CI 3.0 to 3.7) for =4 readmissions compared with private insurance, respectively. Younger age, female sex, and discharge against medical advice were also predictive.  Lower socioeconomic status and Medicaid insurance are strong predictors of DKA readmissions in adults with type 1 diabetes in the USA. Further studies are needed to understand the mediators of this association to inform multilevel interventions for this high risk population.  The association of socioeconomic status (SES) and hospital admission for DKA has been studied in pediatrics with type 1 diabetes, but the data in adults are limited, and studies evaluating recurrent DKA admissions are scarcer. To our knowledge, this is the first study to describe predictors of recurrent DKA admissions in adults with type 1 diabetes on a national level in the USA. We found that those at highest risk of recurrent DKA are young women with low SES who had Medicaid or Medicare insurance. These findings should prompt further studies to explore the mediators of these disparities in patients with type 1 diabetes, as recurrent DKA results in high healthcare utilization and increased risk of long term complications.

title: Increasing Hospitalizations for DKA: A Need for Prevention Programs
abstract: Diabetic ketoacidosis (DKA) is a diabetes emergency associated with high morbidity in patients with diabetes (1) In patients with type 1 diabetes, DKA can occur at new onset of diabetes but can also recur due to lack of insulin use and precipitating causes such as infection. DKA is a hallmark of type 1 diabetes; however, DKA is increasingly recognized in patients with type 2 diabetes (2) In contrast to patients with type 1 diabetes who require life long insulin therapy, most patients with type 2 diabetes who present with DKA can recover insulin secretion and maintain glycemic control with oral antidiabetes medications (3) While inpatient mortality rates for DKA are generally very low, <1% in the U.K. (4) and in the U.S. (5) DKA is the leading cause of mortality among children and young adults with type 1 diabetes, accounting for ~50% of all deaths in this population (1) In addition, rates vary substantially based on health care setting; a recent analysis conducted in India reported that up to 30% of hospitalized DKA cases result in inpatient death (6) The article by Zhong et al. (7) in this issue of Diabetes Care examines temporal trends of DKA according to the diagnosis of type 1 and type 2 diabetes between the years 1998 and 2013 in the U.K. This report used the Clinical Practice Research Datalink and the Hospital Episode Statistics databases. Overall, the authors found that hospitalizations for DKA increased in the U.K. for patients with both type 1 and type 2 diabetes. Most cases of DKA were associated with type 1 diabetes, but one in five cases of DKA were associated with a patient history of type 2 diabetes. For patients with type 1 diabetes, DKA admissions increased from 1998 to 2007 and then the rate stabilized from 2007