Rodolfo Galindo, MD, is an Associate Professor of Medicine at the University of Miami, and Director of the Comprehensive Diabetes Center of UHealth and the Director of Diabetes Management for Jackson Health System, in Miami.

Rodolfo Galindo, MD

Continuous Ketone Monitoring: The Next Breakthrough in Diabetes Care?

Continuous glucose monitoring has transformed 

 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.

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.

Beyond DKA prevention, he noted CKM may have broad applications across diverse patient populations. Individuals with 

, particularly those using SGLT2 inhibitors, could benefit from enhanced safety monitoring. Additional use cases include patients on ketogenic diets, athletes, and individuals using insulin pumps, where interruptions in insulin delivery may increase ketosis risk. Galindo also pointed to potential utility in specialized populations, such as patients with 

 or pregnant individuals, where metabolic regulation differs from typical patterns.

Despite the enthusiasm, Galindo acknowledged important challenges, chief among them being the risk of information overload. As seen with CGM adoption, not all patients benefit equally from continuous data streams, and excessive alerts could contribute to stress or “alarm fatigue.” He stressed the importance of patient selection and education to ensure CKM is implemented in a way that enhances care without adding unnecessary burden.

Looking ahead, ongoing clinical trials and regulatory decisions will determine how quickly CKM enters routine practice. International expert panels have already begun developing preliminary guidance, recognizing that clinicians will need frameworks to interpret and act on this new type of data. For now, Galindo remains optimistic, describing CKM as a powerful tool not only for improving patient outcomes, but also for advancing the broader understanding of human metabolism.

Editors’ note: Galindo reports relevant disclosures with Boehringer Ingelheim, Dexcom, Novo Nordisk, AstraZeneca, Bayer, Eli Lilly and Company, and Medtronic.

US Centers for Disease Control and Prevention. Continuous Glucose Monitors. September 30, 2025. Accessed April 23, 2026. 

https://www.cdc.gov/diabetes/treatment/continuous-glucose-monitors.html

Dhatariya K, Bergenstal RM, Al-Sofiani M, et al. Continuous ketone monitoring for people with diabetes: international expert recommendations on the application of a new technology. 

. 2026;14(1):82-92. doi:10.1016/S2213-8587(25)00331-6

Galindo R. Continuous Ketone Monitoring: Current State of Affairs and Potential Clinical Implications.Presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, April 22-24, 2026.

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Galindo describes how CKM may transform diabetes care by enabling real-time insights, improving DKA prevention, and advancing metabolic understanding.

Rodolfo Galindo, MD

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