The Evaluation Of Ketones Intensive measurement in women with Gestational diabetes (EVOKING) study

Abstract

Purpose. Women with gestational diabetes mellitus (GDM) are frequently asked to check their ketones levels by measuring ketonuria before breakfast. However, ketosis could be present even before lunch and dinner. Furthermore, blood ketones measurement could be a more accurate test. Our aim was to evaluate the effect of a blood ketones intensive measurement in the detection of ketosis in women with GDM with negative urinary ketone test. Methods. This was a single center, observational, prospective study involving consecutive women with GDM. Only women with negative fasting urinary ketone tests were included. During the same gestational weeks (30-32 weeks) to all women was suggested to perform a blood ketones test before main meals. Ketosis was defined as the presence for at least 25% of the time of fasting blood ketones levels >0.1 mmol/L and >0.2 mmol/L before lunch and dinner. Results. Overall, a total of 101 women (mean age 34.7±4.8 years, pre-pregnancy BMI 28.2±5.2 kg/m²) were studied. Blood ketones were present in 37.6% of the cases before breakfast, 13.9% before lunch and 11.9% before dinner. Women with at least one daily presence of blood ketones were 40.6% of the sample. Fasting blood ketones presence was correlated with ketones presence before lunch (r=0.63, p<0.0001) and before dinner (r=0.55, p<0.0001) and with one hour after breakfast mean glucose levels (r=0.23, p=0.02). Conclusions. Blood glucose ketones testing in women with GDM can detect a great number of ketosis episodes that urinary ketones test. Intensive blood ketones measurement should be recommended to women with GDM.