To explore the clinical value of serum β-hydroxybutyric acid and blood glucose levels in the diagnosis of diabetic ketoacidosis (DKA).

Forty-two patients with type 1 diabetes who were admitted to The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force from September 2018 to March 2021 were included as the research objects, including 24 males and 18 females, with an age of (33.10±15.22). At the same time, 50 patients with type 2 diabetes [28 males and 22 females, (35.24±13.26) years old] and 50 healthy people with no obvious abnormal physical examination results [27 males and 23 females, (34.62±17.18) years old] were selected with matched gender, age, and weight of the patients with type 1 diabetes. Data analysis was carried out in accordance with the design of case-control study. Blood samples were collected for the examination of serum β-hydroxybutyric acid and blood glucose levels. The incidences of DKA in the type 1 and 2 diabetic patients were recorded. The differences in serum β-hydroxybutyric acid and blood glucose levels between the patients with type 1 and 2 diabetes and between the DKA patients and the non-DKA patients were analyzed. The correlation between serum β-hydroxybutyric acid and blood glucose levels in the diabetic patients was analyzed.

According to Kruskal-Wallis rank sum test, the serum β-hydroxybutyric acid and blood glucose levels were 5.92 (0.61, 10.42) mmol/L and 24.83 (17.37, 29.52) mmol/L in the type 1 diabetes group, were 0.18 (0.11, 0.93) mmol/L and 19.42 (11.76, 29.33) mmol/L in the type 2 diabetes group, and were 0.12 (0.05, 0.24) mmol/L and 5.28 (4.06, 6.74) mmol/L in the healthy control group. The serum β-hydroxybutyric acid and blood glucose levels in the type 1 diabetes group were higher than those in the healthy control group and those in the type 2 diabetes group (all P＜0.05), and those in the type 2 diabetes group were higher than those in the healthy control group (both P＜0.05). 1n this study, 26 of the 42 patients with type 1 diabetes developed DKA, and the incidence of DKA was 61.9%; 9 of the 50 patients with type 2 diabetes developed DKA, and the incidence of DKA was 18.0%. According to the Chi-square test, the incidence of DKA in the patients with type 1 diabetes was higher than that in the patients with type 2 diabetes (χ²=17.436, P＜0.001). According to Kruskal-Wallis rank sum test, the serum β-hydroxybutyric acid and blood glucose levels of the DKA patients with type 1 and 2 diabetes were higher than those of the non-DKA patients (type 1 diabetes: H_{β-hydroxybutyric acid}=17.354, P＜0.001; H_{blood glucose}=2.724, P＜0.001. type 2 diabetes: H_{β-hydroxybutyric acid}=15.286, P＜0.001; H_{blood glucose}=2.627, P＜0.001). Correlation results showed that there were significant correlations between serum β-hydroxybutyric acid levels and blood glucose levels in the patients with type 1 and 2 diabetes (t₁=0.740, P₁＜0.001, R²₁=0.5474; t₂=0.575, P₂＜0.001, R²₂=0.3306).

The increase in serum β-hydroxybutyric acid and blood glucose levels and the incidence of DKA in type 1 diabetes patients are higher than those in type 2 diabetes patients. The serum β-hydroxybutyric acid and blood glucose levels of patients with type 1 and 2 diabetes and DKA are higher than those of non-DKA patients. The serum β-hydroxybutyric acid levels of patients with type 1 and 2 diabetes increase with blood glucose level.

Type 1 diabetes; Type 2 diabetes; β-hydroxybutyric acid; Blood glucose; Diabetic ketoacidosis