What do young T1DM patients look for in ketone breath sensors?

Young patients with type 1 diabetes mellitus (T1DM) find the noninvasive nature of ketone breath sensor devices attractive, especially as compared with blood testing, according to a recent study. Still, concerns about such devices remain, including their ease of use, accuracy, and affordability.

“Breath ketone sensors for diabetes management have potential that may facilitate ketone testing in young people. Our study affirms features for young people that drive usability of breath sensors among this population and provides a model of user preference assessment,” the researchers said.

The study included 10 young T1DM patients who were given two commercially available breath ketone sensors for them to use over the course of the week. Participants were asked to use the device at least twice daily for 5 days. After a week, patients and their caregivers underwent semi-structured interviews to assess their experiences and preferences for future device designs.

Responses to the interview revealed that participants put a premium on the device’s accuracy and reliability, with all saying that these are must-haves for any ketone sensors. All but three participants also said that they preferred breath over blood testing, as long as the breath sensors were proven accurate. [PLoS One 2022;doi:10.1371/journal.pone.0269925]

Because the devices often returned no interpretable results, many participants questioned if the breath sensors were working in the first place. Some also questioned the trustworthiness of these devices. For two participants, these doubts were strong enough to make them prefer blood testing over breath devices.

Participants also provided feedback regarding the sensors’ set-up and displays. Many felt that the instructions to use the devices were too simplified and left out other important information. Specifically, respondents wanted more guidance regarding how to replace and buy new mouthpieces, and how to breathe into the device. Some also pointed out that instructions were only available in English. 

Moreover, participants emphasized how important it was that the breath devices display the actual ketone measurement, rather than representations of it. One participant even said that simplicity of display was not too important, as most young patients are “tech savvy.”

Many participants also did not expect that they would have to carry around the breath ketone sensors all the time, with one describing it as “awkward.” Opinions regarding device size and shape were varied: Some said they would prefer smaller devices, while others worried that making the breath sensors too compact could make it difficult to hold.

“Our study provides a case study in engaging with young people to provide feedback at a very early stage in product development. It is worth noting that the more tech-enhanced devices (those requiring an app or converting data into visual codes or trends) were relatively undervalued attributes by young users. They placed more emphasis on functionality and noted that aesthetics and being unobtrusive were also important,” the researchers said.

“Informed by this research, device engineers and designers will be able to develop user-friendly prototypes for performance testing in various clinical scenarios in which ketone testing is relevant in diabetes care,” they added.