Introduction and Context
Diabetic ketoacidosis (DKA) remains one of the most serious acute complications of diabetes, carrying substantial morbidity, mortality, and healthcare costs. Although DKA is classic in type 1 diabetes, it also occurs in type 2 diabetes and has become more frequent in settings of euglycemic DKA associated with sodium–glucose co-transporter-2 (SGLT2) inhibitor therapy. Current international diagnostic frameworks for DKA rely on a triad: hyperglycaemia, metabolic acidosis, and ketonemia/ketonuria. Historically, ketone assessment has been episodic—urine dipstick or point-of-care (POC) blood beta-hydroxybutyrate (BHB)—measured during sick days or clinical review.
Continuous ketone monitoring (CKM) is an emerging technology analogous to continuous glucose monitoring (CGM). CKM sensors sample interstitial fluid and produce ongoing ketone concentration estimates, potentially alerting users to rising ketone burden hours before an episodic test would be done. Recognizing both the promise and the potential harms (alarm fatigue, anxiety, false reassurance), an international expert panel convened to create practical recommendations for CKM application. Their consensus, published by Dhatariya et al. and endorsed by the International Society for Pediatric and Adolescent Diabetes (ISPAD), aims to define actionable thresholds and workflows for clinicians and people with diabetes to use CKM safely and effectively (Dhatariya et al., Lancet Diabetes Endocrinol. 2026).
