Investigation and identification of breath acetone as a potential biomarker for type 2 diabetes diagnosis

Acetone is regarded as a promising biomarker for the noninvasive diagnosis and monitoring of diabetes. We collected breath acetone from 25 type 2 diabetics (T2D) and 44 healthy subjects using aluminum foil bags (3 L), and the samples were analyzed by gas chromatography–mass spectrometry. T2D patients had significantly higher acetone levels (mean = 2.167 ppmv (1 ppmv = 1 μL/L), standard error (SE) = 0.231) than healthy volunteers (mean = 0.488 ppmv, SE = 0.025; P < 0.0001). The receiver operating characteristics curve showed that the optimum diagnostic cutoff value for exhaled acetone was 0.891 ppmv (area under the curve 0.999, sensitivity 100 %, and specificity 97.7 %) in T2D patients relative to healthy subjects. Thus, breath acetone could be a useful marker for the high accuracy diagnosis and monitoring of diabetes. In addition, the ratios of the mean acetone concentration in ambient air relative to that in the total exhaled air and in the net exhaled air were 1:18 and 1:17, respectively. The post-breakfast acetone concentrations (mean = 0.437 ppmv, SE = 0.035) were slightly lower than the pre-breakfast levels (mean = 0.553 ppmv, SE = 0.047; P > 0.05). Thus, the increased acetone concentrations in T2D patients are affected strongly by physiological factors related to the disease, rather than the ambient air and diet.