The relative benefits of blood- and urine-ketone testing for assessing ketosis in diabetes patients are discussed, with a look at why the American Diabetes Association states that blood-ketone monitoring is preferred for diagnosing diabetic ketoacidosis in type 1 diabetes patients. For confirmation of ketosis and ketoacidosis in the home or the decentralized setting, health care professionals and patients with diabetes have had access to urine-ketone dipstick methods for more than 30 years. There are serious limitations to urine-ketone measurements, both in terms of accuracy and predictive value, however. The advent of the specific measurement of the major ketone in blood, beta-hydroxybutyrate, provided a new option.
With annual medical costs to treat patients with DKA in excess of $1 billion, the pharmacoeconomic implications of appropriate management of type 1 diabetes also are a central focus of the discussion.