Future of Continuous Ketone Monitoring and Its Utility for Safe Use of Sodium-glucose Cotransporter-2 Inhibitors in Type 1 Diabetes.

Continuous ketone monitoring (CKM) may address the principal barrier to adjunctive sodium-glucose cotransporter-2 inhibitor use in type 1 diabetes: Unrecognized ketosis and euglycemic diabetic ketoacidosis. Unlike conventional urine or capillary ketone testing, CKM provides real-time β-hydroxybutyrate trends and may identify rising ketones before clinical symptoms. Emerging dual glucose-ketone sensors could improve risk stratification, support earlier intervention, refine ketone mitigation protocols, and potentially integrate with automated insulin delivery systems. Although promising, CKM remains an emerging technology. Studies are needed to define actionable thresholds, validate outcomes, and determine whether it can safely expand the use of adjunctive therapies in type 1 diabetes.