title: The role of point-of-care 3-hydroxybutyrate testing in patients with type 2 diabetes undergoing coronary angiography.
abstract: OBJECTIVE
  Ketone bodies, 3-hydroxybutyrate (3BOHB), and acetoacetate derive from increased free fatty acid beta-oxidation, thus reflecting marked insulin deprivation with or without decompensated diabetes. Objectives of this study were (1) to determine circulating levels of 3BOHB in patients with and without type 2 diabetes (T2DM), before and after an elective coronary angiography; (2) to detect 3BOHB modification during the procedure; (3) to study possible associations between 3BOHB and clinical parameters/outcomes.
  
  
  METHODS
  Sixteen T2DM (72 ± 11 years) and 22 matched controls (71 ± 12 years) undergoing elective coronary angiography were enrolled. In all subjects, biohumoral parameters were determined at hospital admission. Point-of-care determinations of 3BOHB, glucose, and creatinine were performed, at 7 a.m, immediately before and after the procedure. The duration of the fasting period and of the procedure was recorded.
  
  
  RESULTS
  T2DM had significantly higher fasting (0.538 ± 0.320 vs 0.255 ± 0.197 mM/l;   p = 0.005) and pre-procedural (0.725 ± 0.429 vs 0.314 ± 0.205; p = 0.002) 3BOHB concentrations than controls. Similarly, absolute increment of 3BOHB from the morning value was significantly greater in T2DM (0.369 ± 0.252 vs 0.127 ± 0.135 in controls; p = 0.002). Significant correlations were observed between pre-procedure 3BOHB and glucose levels (r = 0.586; p < 0.0001) and between pre-procedure 3BOHB and fasting creatinine concentrations (r = 0.364; p = 0.029).
  
  
  CONCLUSIONS
  An overnight fasting period and a concomitantly stressful condition induce inappropriate 3BOHB increase in T2DM. Point-of-care capillary 3BOHB may be useful before any procedural/surgical intervention in these patients.
authors.affiliation: Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy. saula.dekreutzenberg@unipd.it.
authors.forename: S
authors.initials: S
authors.lastname: Vigili de Kreutzenberg
authors.affiliation: Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Avogaro
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000378:metabolism*; D000090:Acetoacetates / Q000378:metabolism; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005215:Fasting; D005260:Female; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000378:metabolism; D007558:Italy / Q000453:epidemiology; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies
chemical_list: D000090:Acetoacetates; D001786:Blood Glucose; D007328:Insulin; C016635:acetoacetic acid; D020155:3-Hydroxybutyric Acid
keywords: 3-Hydroxybutyrate; Coronary heart disease; Fasting; Ketone Bodies; Point-of-care