Abbott has secured CE mark approval for Libre Duo, its new sensor designed to continuously monitor both glucose and ketones in people with diabetes.
The move could eventually allow CGM systems to warn of rising ketones before many people would normally think to check. For PWD worried about pump failures, illness or unexplained high glucose levels overnight, continuous ketone monitoring could add an entirely new layer of warning.
Most CGM launches focus on familiar territory such as smaller devices, longer wear times, shorter warm-up periods or improved accuracy. Important improvements, certainly, but still refinements of existing glucose monitoring technology.
Libre Duo feels different because it introduces something current CGM systems do not routinely provide: continuous ketone visibility.
The warning sign glucose alone cannot always explain
For many people with diabetes, ketones are not regularly monitored, yet the possibility of them going high can still be a daily concern.
Ketones are chemicals produced when the body starts breaking down fat for energy because there is not enough insulin available to use glucose properly. Small amounts are not always dangerous, but rising ketone levels in someone who depends on insulin can signal that the body is moving towards diabetic ketoacidosis, or DKA.
DKA is one of the most serious risks for PWD.
It happens when ketones build up to dangerous levels, making the blood acidic. Symptoms can include vomiting, abdominal pain, rapid breathing, exhaustion, confusion and severe dehydration. Left untreated, DKA can become life-threatening.
For some insulin pump users, the fear is not simply high glucose itself, but how quickly things can deteriorate if insulin delivery silently fails overnight.
Why ketones are usually checked too late
Unlike glucose, ketones are still largely monitored manually.
Most people only check them when there is already a reason for concern, such as persistent high glucose, illness, vomiting, suspected pump failure or feeling unexpectedly unwell.
That reactive approach often works appropriately. Ketones are not constantly relevant in the same way glucose is, and not every person with diabetes will want or need continuous ketone monitoring.
But there is an obvious limitation. By the time someone feels ill enough to think about ketone testing, the situation may already be escalating.
That is the gap Abbott is trying to target.
Where continuous ketone monitoring could matter most
The strongest argument for continuous ketone monitoring is earlier warning.
A blocked cannula, failed infusion set or interrupted overnight insulin delivery may cause ketones to rise before the seriousness of the situation is immediately obvious from glucose readings alone.
Potential situations where earlier ketone visibility could matter include:
- infusion set failure
- blocked or kinked cannulas
- overnight insulin interruption
- illness-related insulin resistance
- unexplained persistent hyperglycaemia
- prolonged high glucose that does not respond as expected
Today, most CGMs warn about glucose trends. Libre Duo is attempting to warn about metabolic danger itself.
That is why Libre Duo has the potential to become more than simply another sensor launch.
Abbott appears to have moved first
Abbott first discussed glucose-ketone monitoring several years ago, but the competitive landscape is now becoming clearer.
Earlier this month, Dexcom used its Investor Day to outline the future direction of its G8 platform, describing sensor architecture intended to support additional analytes beyond glucose over time. Ketone monitoring appears to be part of that longer-term vision, even if it is not expected in the first G8 generation.
That makes Abbott’s CE mark particularly significant.
While competitors are signalling where the market may eventually head, Abbott appears to have taken the first major regulatory step towards actually commercialising continuous glucose-ketone monitoring.
And Abbott may be uniquely positioned to move quickly.
FreeStyle Libre already has enormous scale across global diabetes markets, particularly in Europe. That existing user base, clinical familiarity and connected ecosystem could give Abbott a major commercial advantage if continuous ketone monitoring proves valuable in practice.
More than a standalone sensor
Libre Duo also appears to fit into something bigger than a single product launch.
Several insulin pump manufacturers have already announced plans involving Abbott’s glucose-ketone platform, pointing towards future integration with hybrid-closed loop systems.
That matters because current systems automate insulin delivery using glucose data alone. They do not directly monitor ketones or insulin deficiency.
Adding ketone data could eventually strengthen safety features in situations where insulin delivery problems emerge.
Keeping it practical
One reason Libre Duo may attract attention is that Abbott is not asking users to wear separate glucose and ketone devices.
Instead, both measurements come from a single wearable sensor.
That practical detail matters more than it might sound.
Diabetes technology only succeeds in the real world if people actually want to use it. Even genuinely useful innovation can struggle if it creates extra hardware, additional hassle or more alarm fatigue.
When could Libre Duo actually launch?
CE mark approval is a major regulatory milestone, but it does not mean immediate broad availability.
Abbott says it plans to launch Libre Duo systems in select European countries later in 2026, suggesting a phased rollout rather than an immediate Europe-wide release.
The company has announced two versions:
- Libre Duo, with up to 15 days wear for adults aged 18 and over
- Libre Duo 10 Day, with up to 10 days wear for children aged two and above
For UK readers, the more important question may be NHS access.
A CE mark allows a product to be marketed in Europe, but NHS availability is a separate process. In England, adoption of new diabetes technology often depends on NICE recommendations, evidence review, cost-effectiveness assessment and commercial pricing negotiations between manufacturers and the NHS.
Even highly promising diabetes technology can take time to move from regulatory approval to widespread NHS access.
Access may also vary across the UK, with England, Scotland, Wales and Northern Ireland following different technology adoption pathways and timelines.
Abbott also says the sensors are designed to work with leading hybrid-closed loop systems, but connected system availability will depend on separate approvals, commercial agreements and rollout plans from pump partners.
The remaining questions
Libre Duo is an ambitious concept, but important questions remain.
How accurate will continuous ketone monitoring prove in everyday use? How useful will alerts actually be? Could alarm fatigue become a problem? And how many people will realistically want continuous ketone visibility outside higher-risk groups?
Pricing and reimbursement may also determine whether Libre Duo becomes mainstream or remains more specialised initially.
Editor’s view
Libre Duo feels like one of the most strategically important diabetes tech launches Abbott has announced in years.
Glucose monitoring has advanced rapidly over the past decade, while ketone testing has remained comparatively old-fashioned. That disconnect has long stood out, particularly for people at meaningful risk of DKA.
Abbott may not be alone in chasing continuous ketone monitoring, but right now it appears to have moved first.
If Libre Duo performs well in the real world, competitors may need to accelerate quickly.
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