A New Dual Glucose-Ketone Monitor: Expert Perspective

The FDA has authorized the Libre Duo 10 Day Continuous Dual Glucose Ketone Monitoring System (Abbott), the first wearable in the United States to continuously track ketone levels and the first anywhere to monitor ketones and glucose together in a single device. For pharmacists counseling individuals with diabetes, the clearance introduces a new monitoring parameter—real-time ketone trends—with direct implications for how patients at risk of diabetic ketoacidosis (DKA) are educated and followed, particularly those on insulin or sodium-glucose cotransporter 2 (SGLT2) inhibitors who can develop DKA even when glucose readings appear near normal.¹

The clearance matters at the pharmacy counter before it matters anywhere else. Pharmacists are frequently the most accessible point of contact for patients managing insulin or SGLT2 inhibitor regimens, and a device that surfaces rising ketones in real time shifts the counseling conversation from reactive sick-day rules toward proactive alert interpretation. Until now, patients who needed to check ketones relied on blood or urine tests that captured only a single point in time and couldn't show whether levels were climbing or falling. The Libre Duo 10 Day measures both ketones and glucose in the interstitial fluid every minute, day and night, and issues automatic alerts when ketones reach a concerning threshold—information that can prompt earlier intervention before DKA becomes an emergency.¹

To unpack what the technology changes for patients and their care teams, Pharmacy Times spoke with Eden Miller, DO, a board-certified family practitioner, diabetologist, and fellow of the American Board of Obesity Medicine who also lives with type 1 diabetes. Miller shared her perspective on which patients stand to benefit most and how continuous, background ketone monitoring reshapes the way families and clinicians catch a developing DKA episode.

Pharmacy Times: For pediatric patients and their caregivers, what does continuous, background ketone monitoring change about how families catch a developing DKA episode compared with intermittent blood or urine ketone testing?

Eden Miller, DO: DKA accounts for nearly 75% of pediatric hospitalizations for people with type 1 diabetes, so monitoring ketones for that group is important. The Libre Duo 10 Day system will provide alerts when ketones are rising so families can make informed decisions when they need to. Having access to real-time visibility for glucose levels needed for daily diabetes management while also monitoring rising ketones in the background can help avoid additional mental or physical burden for people with diabetes.²

Pharmacy Times: Which patients on your panel would you prioritize for a dual glucose-ketone sensor first, and are there patients for whom you'd hold off until the automated insulin delivery integrations arrive?

Miller: Libre Duo 10 Day is designed for people living with diabetes (aged 2 and older) who may be at higher risk of elevated ketones. This includes people with type 1 or type 2 diabetes who use insulin or other glucose-lowering medications, such as [SGLT2s]. People living with diabetes who are interested in the Libre Duo 10 Day system should talk with their health care provider to determine the best path forward.

REFERENCES

1. Halpern L. FDA clears first continuous glucose-ketone monitor. Pharmacy Times. Updated August 27, 2026. Accessed August 27, 2026. https://www.pharmacytimes.com/view/fda-clears-first-continuous-glucose-ketone-monitor

2. Sherr J, Virdi N, Lee A, Poon Y. 2124-P: Burden of diabetic ketoacidosis among young with diabates: A hospital claims analysis. Diabetes. 2026;75(Supplement_1):2124-P. doi:10.2337/db26-2124-P