Once a week is enough for the ketone strip

The edition in brief

Four findings for diabetes practice. Using the EASE 2 and EASE 3 trial repository of 1410 participants with type 1 diabetes, investigators simulated different frequencies of well-day capillary ketone testing over a month to predict ketoacidosis or severe ketosis in the following month. Once-weekly testing was the lowest frequency that preserved accuracy against a twice-weekly baseline - area under the curve 0.692 against 0.678 for the maximum-ketone model and 0.719 against 0.711 for a gradient-boosted tree, neither difference significant. In the DCCT repository, 1441 participants had 180 ketoacidosis events over an average 6.5 years; 179 of them occurred after stimulated C-peptide had fallen to 0.2 nmol/mL or below, and detectable C-peptide carried a hazard ratio of 0.07 (95% CI 0.01 to 0.48). The FDA has a Class II recall running on multiple compounded semaglutide multi-dose vials from a single US compounding firm, for particulate matter identified as nylon or polyamide and silk or proteinaceous material. A single-centre study of 68 people found that starting the Omnipod 5 hybrid closed loop in impaired awareness of hypoglycaemia reduced time below range from 2.8% to 1.7% and weekly sensor-detected hypoglycaemia episodes from 5.4 to 4.0, but at twelve months the burden remained about double that of matched people with normal awareness. And a multidisciplinary group has set out a roadmap for getting SGLT inhibitors licensed for heart and kidney protection in type 1 diabetes, arguing that surrogate endpoints could make registrational trials feasible provided ketoacidosis safety protocols are properly evaluated.