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Around 1 in 4 children with type 1 diabetes are unaware they have the condition until they develop diabetic ketoacidosis – a potentially life-threatening complication. But in a new study, researchers claim to have identified a chemical marker for type 1 diabetes in the breath of children, paving the way for a breath test that allows early diagnosis.

The research team, including Prof. Gus Hancock of the Department of Chemistry at the University of Oxford in the UK, publish their findings in the Journal of Breath Research.

According to the Centers for Disease Control and Prevention (CDC), type 1 diabetes affects almost 2 in every 1,000 children and adolescents, and the numbers are increasing. A recent study found that between 2001 and 2009, incidence of type 1 diabetes among children aged under 9 years rose by 21%.

Type 1 diabetes can be diagnosed through a blood test, but Prof. Hancock notes that such tests can be traumatic for young children.

There are also some cases where type 1 diabetes is misdiagnosed in children. The symptoms of the condition, which include increased thirst and urination, fatigue and weight loss, can be mistaken for symptoms of other disorders.

A 2008 study published in the journal Pediatric Endocrinology, Diabetes and Metabolism, for example, found that among 335 children with new-onset type 1 diabetes, doctors initially misdiagnosed the condition in 16% of cases. In most of these cases, children were misdiagnosed with a respiratory system infection.

A delayed diagnosis means that some children are diagnosed with type 1 diabetes when they have already developed diabetic ketoacidosis (DKA). This occurs when severe lack of insulin causes the body to break down fat for energy. This can lead to a build-up of acids called ketones in the blood, which can cause a diabetic coma and even death.

In this latest study, however, Prof. Hancock and colleagues found that a sweet-smelling ketone disposed of through the breath – acetone – may be an early indicator of ketone accumulation in the blood.

To reach their findings, the team collected breath samples from 113 children and adolescents aged 7-18 years who had been diagnosed with type 1 diabetes.

The researchers measured levels of acetone and another ketone called isoprene in the participants’ breath and compared them with ketone and glucose levels in the blood, measurements of which were taken at the same time as breath samples were collected.

Prof. Hancock and colleagues found that participants who had increased levels of acetone in their breath also had increased levels of a ketone called β hydroxybutyrate in their blood. The team has already produced a prototype of a small hand-held device to measure ketone levels in the breath, which is currently being tested in clinical trials.