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Simple Breath Test May Aid Early Diagnosis in Children

Increased breath acetone was linked to increases in beta hydroxybutyrate (a ketone) levels in the blood…

Researchers may have identified a chemical marker for type 1 diabetes in the breath of children. Around 1 in 4 children with type 1 diabetes are unaware they have a condition until they develop diabetic ketoacidosis. The new marker could pave the way for a breath test that allows for early diagnosis in children.

The CDC reports that type 1 diabetes affects almost 2 in every 1000 children and the numbers continue to increase. A recent study found that between 2001 and 2009, incidence of type 1 diabetes among children under 9 years old rose by 21%.

Children are currently diagnosed through utilization of a blood test, which can cause trauma for young children. There are many reports of misdiagnosed children, where adults overlook common symptoms such as increased thirst, urination, fatigue, and weight loss as symptoms of other disorders. There have been reports of approximately 16% of cases where doctors initially misdiagnosed children with a respiratory infection. A delayed diagnosis in children with type 1 diabetes can result in negative and life threatening conditions.
In this study, Professor Gus Hancock and colleagues of the Department of Chemistry at University of Oxford, UK, found that a sweet-smelling ketone disposed of through breath — acetone — may be an early indicator for ketone accumulation in the blood, which can lead to diabetic coma or even death if left untreated.

The researchers found that increased breath acetone was linked to increases in beta hydroxybutyrate (a ketone) levels in the blood. The team collected breath samples from 113 children and adolescents between the ages 7-18 diagnosed with type 1 diabetes.

The researchers measured the levels of acetone and another ketone called isoprene in the participants’ breath. They then compared them with the ketone and glucose levels in the blood which were taken at the same time as the breath samples. They found that participants who had increased levels of acetone in their breath also had increased levels of beta hydroxybutyrate in their blood. There was a weak association between increased breath acetone and increased blood glucose but the researchers concluded that single breath measurements of acetone do not provide a good measure of blood glucose levels in this cohort.

Prof. Hancock said, “Our results have shown that it is realistically possible to use measurements of breath acetone to estimate blood ketones. If the relationship between breath acetone and blood ketone levels are true at higher levels of ketones, a simple breath test could assist with the management of sick days in children with diabetes, preventing hospital admission by providing a warning of the possible development of DKA.”

Practice Pearls:

  • Study collected breath and blood samples simultaneously from 113 children and adolescents with type 1 diabetes
  • Results showed that increased breath acetone linked to increased beta hydroxybutyrate levels in the blood
  • Could lead to a new way of testing and managing diabetes in children with type 1 diabetes

Comparison of breath gases, including acetone, with blood glucose and blood ketones in children and adolescents with type 1 diabetes, Gus Hancock, et al., Journal of Breath Research, doi:10.1088/1752-7155/8/4/046010, published online 25 November 2014.