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.
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 type 1 diabetes, 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 renal failure 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.
References
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. Lancet Diabetes Endocrinol. 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.
