Continuous ketone monitoring (CKM) is coming. Just as continuous glucose monitoring (CGM) is transforming diabetes care with improved glucose management and more time in range, CKM could dramatically improve patient outcomes and significantly reduce the risk of diabetes-related ketoacidosis (DKA).

“DKA being a life-threatening medical emergency, if you’ve got a way of predicting and preventing that, you can potentially save lives,” said Ketan Dhatariya, MBBS, MSc, MD, MS, FRCP, PhD, Consultant in Diabetes and Endocrinology and Professor of Medicine, Norwich Medical School, University of East Anglia, United Kingdom, and Norfolk and Norwich University Hospitals NHS Foundation Trust. “The other potential advantage is that with CKM, you may be able to give SGLT2 (sodium-glucose cotransporter-2) inhibitors to people with type 1 diabetes safely. SGLT2 inhibitors  are associated with an increased risk of developing DKA, particularly in those with type 1 diabetes, but being able to use SGLT2 inhibitors in this group by using CKM would give people the same SGLT2 inhibitor benefits those with type 2 diabetes get every day.”

Dr. Dhatariya will open a symposium, Continuous Ketone Monitoring—Innovations and Clinical Applications, on Monday, June 23, from 8:00–9:30 a.m., in Room W185 A–D of the McCormick Place Convention Center. On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85^th Scientific Sessions, from June 25–August 25.

Multiple diabetes device manufacturers are adapting existing CGM devices to add CKM, with at least one device in clinical testing. The goal is one device with a single display for both CGM and CKM data.

What displays look like, alert thresholds, recommended actions for different alert levels, and other details are still being worked out, Dr. Dhatariya said. He is part of a group preparing a CKM consensus document for publication later this year.

Lori M. Laffel, MD, MPH, Professor of Pediatrics at Harvard Medical School and Director of the Clinical Translational Research Core at Joslin Diabetes Center, will discuss current methods used to detect ketones and approaches to prevent DKA.

Point-of-care ketone monitoring using capillary blood is standard-of-care in most of the world, Dr. Dhatariya said, though not commonly in North America. Point-of-care monitoring, typically using ketone-specific strips and the same meters used for glucose monitoring, can provide ketone data in about 30 seconds.

“We’ve had ketone monitoring methods for many users, but most people never, ever check, even in highly engaged populations,” said Jennifer L. Sherr, MD, PhD, Professor of Pediatrics and Pediatric Endocrinology, and Medical Director for Pediatric Diabetes at Yale University School of Medicine.

Dr. Sherr will discuss ketone sensor performance criteria and the latest study data.

“If we’re not measuring ketones, it’s going to be very problematic to detect or intervene to prevent further metabolic decompensation, such as occurs with DKA,” she added.

Richard M. Bergenstal, MD, Executive Director of the HealthPartners Institute’s International Diabetes Center, will discuss the potential clinical impact of CKM.

The initial impact will be dramatic improvement in the diagnosis and prevention of DKA, Dr. Sherr said. Even individuals on continuous insulin infusion and CGM need a fallback. Pumps and monitors can both fail, leading to insulin interruption, which can predispose someone to developing ketosis.

“Continuous ketone monitoring is the safety net that could help people stay out of the hospital,” she said. “As a pediatric endocrinologist, I see youths who have repeated episodes of DKA. CKM could make a huge difference.”

Longer term, clinicians may see CKM expand the use of SGLT2 inhibitors to individuals with type 1 diabetes. The class is currently contraindicated in type 1 due to the increased risk of DKA.

“This is the beginning of a journey with CKM, just as we began the journey with CGM maybe 10 years ago,” Dr. Dhatariya said. “If you’ve got a CKM, it’s a game-changer for people with diabetes.”