Ketone Monitoring

Abstract

Ketone monitoring has become increasingly relevant in modern diabetes management, driven by advances in diabetes technology and the expanding use of therapies associated with an increased risk of ketosis, particularly sodium–glucose cotransporter-2 (SGLT2) inhibitors. Historically, ketone testing was primarily reserved for suspected diabetic ketoacidosis (DKA); however, it is now recognized as an essential tool for the early detection of ketosis, prevention of euglycemic DKA, and management of individuals using advanced automated insulin delivery systems. Blood β-hydroxybutyrate measurement remains the reference standard for clinical assessment, offering superior sensitivity and real-time metabolic information compared with urine ketone testing. More recently, the development of Continuous Ketone Monitoring (CKM) has introduced a novel paradigm in diabetes care. These emerging sensors enable continuous assessment of interstitial ketone concentrations and may eventually be integrated with continuous glucose monitoring (CGM) and hybrid closed-loop insulin delivery systems, providing an additional layer of metabolic safety.

Recent evidence suggests that CKM may identify the onset of ketosis before the appearance of clinical manifestations, enabling earlier intervention and reducing the risk of progression to diabetic ketoacidosis. Furthermore, the simultaneous integration of glucose and ketone data is expected to support more sophisticated predictive algorithms, particularly for individuals with type 1 diabetes during intercurrent illness, insulin delivery failure, or treatment with SGLT2 inhibitors.

In the coming years, CKM is expected to transform diabetes management by complementing glucose monitoring with direct assessment of energy metabolism, thereby enabling a more preventive, personalized, and safer approach to diabetes care.