Interpretation of the 2026 international expert consensus on continuous ketone monitoring

Xin Chunxiao; Yin Jun

doi:10.16689/j.cnki.cn11-9349/r.2026.03.018

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Electronic Journal of Metabolism and Nutrition of Cancer ›› 2026, Vol. 13 ›› Issue (3) : 450-456. DOI: 10.16689/j.cnki.cn11-9349/r.2026.03.018

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Interpretation of the 2026 international expert consensus on continuous ketone monitoring

¹Xin Chunxiao, ²Yin Jun

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Abstract

Diabetic ketoacidosis (DKA) is one of the most severe acute complications of diabetes, characterized by insidious onset, rapid progression, and high mortality risk. Of particular concern is the potential occurrence of "euglycemic DKA" in patients receiving sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy or using insulin pumps, which poses a significant challenge to traditional monitoring strategies centered on hyperglycemia as the core warning signal, carrying a substantial risk of missed diagnosis. Against this backdrop, continuous ketone monitoring (CKM), as an emerging wearable technology, offers new possibilities for the early identification and tiered management of DKA risk. Unlike traditional fingerstick blood or urine ketone tests that only provide sporadic, non-continuous static values, CKM utilizes a subcutaneous sensor to continuously monitor interstitial fluid beta-hydroxybutyrate (BHB) concentrations, dynamically reflecting ketone body fluctuations and providing reference for intervention decisions through threshold alerts and trend information. The recent international expert consensus on CKM published in Lancet Diabetes & Endocrinology suggests that CKM holds promise as a valuable adjunctive tool in diabetes management, with potential priority applications in individuals with recurrent DKA, elderly or frail patients, those using SGLT2 inhibitors, and certain users of automated insulin delivery systems. Based on this expert consensus, this article interprets the application background, technical principles, clinical application scenarios, threshold settings, and future research directions of CKM, aiming to provide a reference for its rational clinical application and subsequent research, thereby facilitating the transition of diabetes management from a traditional "glucose-centric" model towards a comprehensive early warning system that considers multidimensional metabolic risks.

Key words

Continuous ketone monitoring / Diabetic ketoacidosis / β-hydroxybutyrate / Euglycemic diabetic ketoacidosis / Clinical application

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Xin Chunxiao, Yin Jun. Interpretation of the 2026 international expert consensus on continuous ketone monitoring[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(3): 450-456 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.03.018

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