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Screening for Diabetes Through Breath Acetone Levels

Medical students are always taught about the distinctive, fruity breath of a patient in diabetic ketoacidosis — a life threatening metabolic crisis. The basis of this odor, acetone, is present on all of our breath, but even seemingly healthy diabetics will have a slightly higher level than non-diabetics. Can this subtle difference be used to help detect and screen who’s got diabetes?

Detection of illness through breath analysis is an emerging field in medical diagnostics, and is one which we’ve covered extensively. Sparing a few exceptions, however, the field has yet to make a large impact on patient care. Oxford Medical Diagnostics (OMD), a company that specializes in gas analysis, is attempting to change that through their diabetes screening device based on breath acetone levels that they expect to hit the market in the next six to eight months. Following that, they plan to launch a handheld device in a few years.

The breakdown of excess Acetyl CoA from fatty acid metabolism in patients with diabetes leads to differences in the levels of acetone in the blood. This acetone is excreted through urine and exhaled through the lungs. For healthy humans, breath acetone concentrations range from .3 to .9 parts per million (ppm) but for those with type two diabetes, concentrations can rise to more than 1.8 parts per million (in type 1 diabetes, these can be much higher still).

Detecting these small differences requires extremely sensitive equipment. The technology behind Oxford Medical’s electronic nose is a type of laser spectroscopy called Cavity Enhanced Absorption Spectroscopy (CEAS), in which laser light bounces back and forth between mirrors so that the overall path length of the light beam extends to a few kilometers. This allows more time for absorption and thus increases the sensitivity of the device.

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Ben Roeves