The next major development in diabetes technology could involve monitoring more than just blood sugar. Abbott has received US Food and Drug Administration (FDA) authorisation for Libre Duo 10 Day, which it describes as the world’s first wearable device capable of continuously tracking both glucose and ketones through a single sensor.
The device is intended to help with everyday diabetes management by monitoring glucose while also detecting increases in ketone levels that can occur before diabetic ketoacidosis (DKA), a potentially life-threatening complication.
DKA is most commonly associated with type 1 diabetes, an autoimmune condition that often begins at a younger age, but it can also occur in people with type 2 diabetes, which is much more common and is frequently associated with insulin resistance and lifestyle factors.
The importance of the new device lies in its ability to expand continuous glucose monitoring (CGM) beyond glucose. Traditional CGMs track blood sugar, while ketones generally have to be checked separately through blood or urine tests, typically when glucose levels are high, a person is unwell or symptoms suggest a problem.
Abbott says Libre Duo 10 Day can monitor ketones continuously in the background and alert users when levels begin to rise.
For people who are particularly vulnerable to DKA, continuous monitoring could provide an earlier indication that the body is entering a dangerous metabolic state, rather than requiring ketone testing only after symptoms appear.
Why ketones are important
Glucose is normally the body's main source of energy. When there is insufficient effective insulin, the body starts breaking down fat instead, producing ketones. If ketones build up too quickly, they can make the blood acidic and trigger DKA.
DKA can develop within hours and, without treatment, can progress to coma or even death. Abbott describes it as the most common hyperglycaemic emergency associated with diabetes and notes that hospitalisations related to DKA have increased significantly over the past decade.
An important concern is that ketone levels can sometimes rise without a dramatic increase in glucose. As a result, glucose readings alone may not always provide an early indication that DKA is developing.
Continuous ketone monitoring could potentially address this gap.
Currently, ketone testing is generally performed intermittently. A blood or urine test provides information about the ketone level at a particular point in time. A continuous sensor could instead track whether ketones are remaining stable, increasing or declining, potentially giving users more time to respond before the condition becomes an emergency.
Diabetologist Dr Shashank Joshi described the development as a major advancement, saying the technology could provide people with diabetes an earlier warning and additional time to act before elevated ketones develop into life-threatening DKA.
He also called it a significant step forward in diabetes technology and noted that the sensor is authorised for people with diabetes aged two and above.
Diabetes burden is driving demand for technology
The development comes as diabetes continues to affect a huge number of people worldwide.
India has one of the world's largest diabetes populations, with around 10.1 crore people living with diabetes and another 13.6 crore estimated to have prediabetes.
The scale of the problem has increased demand for technologies that can provide more detailed information about glucose levels than occasional finger-prick tests.
CGMs have gradually become more common in diabetes management in India. Abbott introduced its FreeStyle Libre system in the country in 2020, allowing users to obtain real-time glucose readings without routine finger-prick testing, and has subsequently expanded its product range.
The company launched the latest-generation Libre 2 Plus in India in 2025. It provides automatic glucose readings every minute and can also offer optional alerts.
The increasing use of CGMs reflects a broader change in diabetes care. Instead of focusing solely on whether blood sugar is high or low, doctors and patients can examine glucose patterns, trends and measures such as “time in range”.
The dual glucose-and-ketone sensor could potentially take that approach further by adding continuous information about another important metabolic marker. Further clinical experience will help determine how much this added information changes diabetes management in everyday use.
