Abstract：
Diabetic ketoacidosis (DKA) is a life-threatening complication, which is most common in individuals with type 1 diabetes (T1D) and is a significant risk for morbidity and mortality, and it is an economic burden on individuals, health care systems, and payers. Younger children, minority ethnic groups, and those with limited insurance are at the greatest risk for presentation of DKA at T1D diagnosis. Although monitoring ketone levels is an essential part of acute illness management and for both early detection and prevention of a DKA episode, studies have reported poor adherence to ketone monitoring. Ketone monitoring is particularly important for patients treated with sodium glucose cotransporter 2 inhibitor (SGLT2i) medications, in which DKA can present with only moderately elevated glucose levels, referred to as euglycemic DKA (euDKA). A majority of people with T1D and many with type 2 diabetes (T2D), particularly those using insulin therapy, are using continuous glucose monitoring (CGM) as their preferred method for measurement and management of glycemia. These devices provide a continuous stream of glucose data that enables users to take immediate action to mitigate and/or prevent severe hyperglycemic or hypoglycemic events. An international consensus of leading diabetes experts has recommended the development of continuous ketone monitoring systems, ideally a system that combines CGM technology with measurement of 3-β-OHB into a single sensor. In this narrative review of current literature, we report on the prevalence and burden of DKA, examine challenges to detecting and diagnosing this condition, and discuss a new monitoring option for DKA prevention.
摘要：
糖尿病酮症酸中毒（DKA）是一种危及生命的并发症，这在1型糖尿病（T1D）患者中最常见，并且是发病率和死亡率的显着风险，这对个人来说是一种经济负担，卫生保健系统,和付款人。年幼的孩子,少数民族,而保险有限的患者在T1D诊断时出现DKA的风险最大。尽管监测酮水平是急性疾病管理的重要组成部分，但对于早期发现和预防DKA发作而言，研究报告酮监测依从性差.酮监测对于使用钠葡萄糖协同转运蛋白2抑制剂（SGLT2i）药物治疗的患者尤为重要。其中DKA只能出现适度升高的葡萄糖水平，称为正常血糖DKA（euDKA）。大多数患有T1D的人和许多患有2型糖尿病（T2D）的人，特别是那些使用胰岛素治疗的人，使用连续血糖监测（CGM）作为他们测量和管理血糖的首选方法。这些设备提供连续的葡萄糖数据流,其使得用户能够立即采取行动以减轻和/或防止严重的高血糖或低血糖事件。领先的糖尿病专家的国际共识建议开发连续酮监测系统，理想情况下，将CGM技术与3-β-OHB测量结合到单个传感器中的系统。在这篇对当前文学的叙事综述中，我们报告了DKA的患病率和负担，检查检测和诊断这种情况的挑战，并讨论了DKA预防的新监测方案。
