Continuous glucose monitoring has transformed diabetes care by revealing the dynamic nature of glycemic control, but a critical piece of metabolic insight has remained largely static: ketone measurement. Traditionally assessed through intermittent blood or urine testing, ketones offer a snapshot of a process that is constantly evolving in response to changes in insulin, nutrition, and overall metabolic stress.
Key Takeaways
- Continuous ketone monitoring (CKM) is an emerging technology in development that enables real-time measurement of ketone levels, often alongside glucose.
- Early studies show heterogeneous relationships between glucose and ketone levels, indicating variability in human ketone regulation.
- CKM development is largely focused on reducing the risk and improving detection of diabetic ketoacidosis, which remains a common acute diabetes complication.
- Potential clinical applications include use in type 1 diabetes, patients using SGLT2 inhibitors, insulin pump users, and other populations at risk for ketosis.
- Implementation considerations include the potential for increased data burden, underscoring the need for appropriate patient selection and education.
As interest grows in more comprehensive, real-time monitoring, continuous ketone tracking is emerging as a potential next step that could deepen understanding of metabolic regulation and improve the prevention and management of acute complications such as diabetic ketoacidosis.
At the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026, emerging technologies in diabetes care took center stage, with Rodolfo Galindo, MD, honing in on CKM in his session “Continuous Ketone Monitoring: Current State of Affairs and Potential Clinical Implications.”
CKM is currently in development in the US and is expected to resemble existing continuous glucose monitoring systems, potentially integrating ketone sensing into devices similar to Abbott’s FreeStyle Libre platform.
“This is a new technology that is in development, and there are a couple of companies working on it, specifically in the US Abbott has been leading this, and based on the studies that they have published, the device is going to be very similar, or maybe incorporated into the Libre devices,” he explained.
While still under regulatory review, Galindo said early studies suggest CKM could offer real-time insights into ketone dynamics, much like CGM transformed glucose monitoring.
He emphasized that the true value of CKM lies not simply in measuring ketones continuously, but in uncovering patterns that static, point-in-time testing cannot capture. Drawing parallels to CGM, he noted that traditional approaches to metabolic monitoring rely heavily on single measurements, which fail to reflect the body’s constant physiological fluctuations. Early data from dual glucose-ketone monitoring systems reveal significant variability in how glucose and ketone levels interact, underscoring gaps in current understanding of human metabolism.
A key clinical driver behind CKM development is the persistent burden of diabetic ketoacidosis (DKA). Despite advances in CGM, DKA remains one of the most common acute crises. Galindo suggested that continuous ketone data could shift diagnostic and management paradigms, moving beyond static thresholds to incorporate dynamic factors such as rate of change and duration of ketone elevation, enabling earlier detection and intervention and potentially reducing hospitalizations.
