What ADA 2026 Data Reveal About the Growing Gap in Ketone Monitoring: Eden Miller, DO

Diabetic ketoacidosis (DKA) remains one of the most serious yet preventable emergencies in diabetes care, and new data suggest the problem is getting worse. Research presented at the American Diabetes Association's 86th Scientific Sessions found that DKA hospitalization rates among people with type 1 diabetes rose approximately 24% between 2017 and 2024, with the sharpest increases seen in children. A separate analysis of nearly 40,000 pediatric hospitalizations found that DKA now accounts for nearly 60% of all diabetes-related hospital stays among youth, with costs reaching up to $38,000 per admission.

A key driver of that burden is recognition—or the lack of it. A study of more than 100,000 patients found that DKA is frequently difficult to identify at hospital admission because early symptoms such as nausea, fatigue, and abdominal pain overlap with common illnesses. Despite clinical guidance recommending ketone testing during periods of elevated glucose, 64% of patients do not test for ketones at all. While continuous glucose monitors have transformed diabetes management, they do not measure ketones, leaving a critical gap in early detection.

To discuss what these findings mean for patients, clinicians, and the health system, The American Journal of Managed Care^® (AJMC^®) spoke via email with Eden Miller, DO, a family practitioner, diabetologist, and cofounder of Diabetes Nation.

AJMC: The data show DKA hospitalization rates among people with type 1 diabetes rose roughly 24% between 2017 and 2024, with a more pronounced increase in pediatric populations. What do you attribute that trend to, and what does it signal for health systems and payers managing this patient population?

Miller: The increase in DKA hospitalizations, especially among children, reflects how difficult it can be for people and families to recognize symptoms early, since they often overlap with common illnesses like a stomach virus. At the same time, ketone monitoring isn’t always routine in diabetes care, and current methods such as urine tests or finger pricks are often underused. This can delay intervention and treatment for people with diabetes.

For health systems and payers, this trend highlights a clear gap: while glucose monitoring has advanced, it doesn’t provide visibility into rising ketones. That can delay care and lead to preventable hospitalizations, which are already a major driver of diabetes-related costs. Improving awareness of DKA, helping people understand what to do when ketones are rising, and enabling earlier recognition of risk are important opportunities to help reduce DKA risk.

AJMC: The study of over 100,000 patients found that early DKA symptoms frequently overlap with common illnesses, complicating timely diagnosis at admission. How are these diagnostic delays translating into downstream cost and utilization burdens, particularly given that DKA stays can reach $38,000 per hospitalization?

Miller: DKA can develop quickly, often within hours, so when diagnosis is delayed, patients may present after ketone levels have already been elevated for an extended period, and the condition has progressed to a more severe state. This increases the likelihood of hospitalization and the need for more intensive care. Delays in recognizing symptoms, knowing when to test, and identifying DKA early all contribute to higher health care utilization and downstream costs.

AJMC: Despite clinical guidance recommending ketone testing during periods of elevated glucose, the data suggest that monitoring remains significantly underutilized, with 64% of patients not testing at all. Where does responsibility lie for closing that gap: with clinicians, care teams, or the broader health system?

Miller: Closing this gap is a shared responsibility across patients, providers, and the broader care system. DKA education happens at diagnosis and isn’t consistently reinforced over time, which can make it harder for people to recognize DKA.

Patients and families need to understand the signs of DKA and have a clear plan for when to test and what to do if ketones are rising. At the same time, providers and care teams play a critical role in continuing education and encouraging use of current testing methods. Educating DKA and understanding the risk is an ongoing part of diabetes care, which is key to helping more people with diabetes recognize risk earlier and take action sooner.

AJMC: Abbott's Libre Duo has an FDA submission pending. Assuming clearance, how do you envision continuous ketone monitoring being integrated into existing diabetes care pathways, and what evidence will payers need to see to support coverage decisions

Miller: Dual glucose-ketone sensing represents the next advancement in diabetes care by adding visibility into rising ketone levels alongside glucose data, helping people better understand when to take action. Today, continuous glucose monitors have significantly advanced glucose management, but they don’t provide insight into ketones, which can rise even when glucose levels appear stable. Because ketones can increase quickly and lead to DKA, integrating this type of technology could support earlier recognition of risk and more timely intervention.

I’m hopeful that payers will recognize that earlier recognition of rising ketones has the potential to reduce diabetes-related hospitalizations and costs, especially among children—and in the end lessen the overall burden on people living with diabetes and the health care system.

AJMC: Is there anything else you'd like to highlight?

Miller: I would also emphasize that DKA remains one of the most preventable emergencies in diabetes care. These findings highlight the importance of improving awareness in doctors and patients—both in recognizing early symptoms and understanding when and how to check for ketones. Earlier recognition and action can make a meaningful difference, and advances like dual glucose-ketone sensing technology have the potential to support earlier detection of rising ketones, helping reduce avoidable hospitalizations and improve outcomes for people living with diabetes.

Reference

New Abbott data show many people with diabetes may not recognize symptoms of diabetic ketoacidosis. News release. Abbott. June 6, 2026. Accessed June 6, 2026. https://abbott.mediaroom.com/2026-06-06-New-Abbott-data-show-many-people-with-diabetes-may-not-recognize-symptoms-of-diabetic-ketoacidosis