Abbott Libre Duo

Abbott's Libre Duo is the first wearable that senses two things at once — your glucose and your ketones — from a single sensor the size of a FreeStyle Libre 3.¹² Both values update every minute, so for the first time you can watch ketones the way you already watch glucose, without a fingerstick blood-ketone strip or a urine test that only captures a single moment.¹

Why ketones matter. When insulin runs short — a kinked pump cannula, an illness, a missed dose, or while taking an SGLT2 inhibitor — ketones (specifically beta-hydroxybutyrate, or BHB) can climb toward diabetic ketoacidosis (DKA), a life-threatening emergency.³⁴ Crucially, ketones can rise before glucose does, so a glucose-only CGM can look reassuring while trouble is already building.⁵ DKA is common, dangerous, and expensive — single episodes have been estimated to cost up to roughly $36,000.⁵ A diabetes expert consensus had specifically called for exactly this: one sensor that measures both glucose and BHB together.⁴ For context, BHB is usually under 0.5 mmol/L normally and can exceed 3 mmol/L in DKA.⁵

And the problem is getting worse, not better. At the ADA 2026 conference in June, Abbott presented four real-world analyses of the DKA burden. DKA hospitalisations among people with type 1 diabetes rose roughly 24% between 2017 and 2024 — from 50 to 62 admissions per 1,000 people — despite a decade of better glucose sensors.⁶ Among young people with diabetes (type 1 or type 2), DKA now accounts for nearly 60% of all diabetes-related hospitalisations, and a pediatric DKA stay can cost up to $38,000.⁶ (That pediatric per-stay figure sits alongside the roughly $36,000 general estimate above — different populations, same uncomfortable order of magnitude.) These are Abbott's own analyses, presented at a conference rather than peer-reviewed, and Abbott plainly has an interest in the conclusion — but the direction of travel matches the independent literature: watching glucose alone has not solved DKA.⁴⁷

How it works and what you wear. The Libre Duo measures interstitial glucose and BHB using a single subcutaneous sensor.³ Two versions are CE-marked: the Libre Duo wears up to 15 days and is for adults 18+, while the Libre Duo 10 Day wears up to 10 days and covers ages 2 and older.¹ It is built on the Libre 3 platform, which is factory-calibrated (no routine fingerstick calibration) and among the smallest CGMs available.² It connects to Abbott's Libre app ecosystem, including caregiver sharing and cloud data for clinicians.²

Accuracy — what we can and can't say yet. Glucose accuracy is expected to track the well-established Libre 3 platform, but a published, peer-reviewed MARD for the Duo's glucose channel and a formal accuracy figure for its ketone channel are not yet available; early real-world data using the dual sensor are only now being reported.⁸ We will update this entry with hard numbers (including low-range performance) once the pivotal data are published. Treat the accuracy claims here as provisional.

Alerts and closed loops. Beyond standard glucose alerts, the headline is continuous ketone visibility, giving an early warning of rising BHB so you can act on sick-day rules before DKA.³⁹ Abbott says the US 10-day sensor meets both the existing iCGM standard and a new integrated continuous glucose and ketone monitoring (iCGK) standard, and that it is designed to connect with automated insulin delivery (AID) systems.¹⁰ That is not the same as a loop that doses from ketones. Abbott's 25 August plan is pairing with iLet and twiist by the end of 2026, and with Insulet, Tandem and MiniMed in 2027 — company timing, not a shipping pairing.¹⁰ Sequel's earlier public agreement to integrate twiist with the dual sensor is the same programme, now with a US authorization in hand but still no commercial AID product.¹¹

Who it's for, access, and what's coming. It's aimed at anyone at risk of DKA — type 1 diabetes, insulin-treated type 2, SGLT2-inhibitor users, pregnancy, and children (via the 10 Day version).⁷⁹ Two versions are CE-marked in Europe (May 2026): up to 15 days for adults 18+, and Libre Duo 10 Day for ages 2+.¹ On 25 August 2026 the FDA authorized Libre Duo 10 Day through the De Novo pathway for people aged 2 and older with diabetes, after reviewing six studies in more than 600 participants.¹²¹⁰ Authorization is not a launch. Abbott plans to launch the 10-day sensor in the US later in 2026, and still describes a phased European launch later in 2026; it is not sold in either market as of this cutoff.¹⁰¹ Abbott's US labelling warns that the Urgent Low Glucose alarm and Urgent High Ketones alarm may not detect every instance of glucose below 55 mg/dL (3.1 mmol/L) or ketones above 3.0 mmol/L, and that ketone output should be read with glucose and symptoms.¹⁰ Pricing has not been announced. We keep this as a pipeline device because clearance/CE is not the same as being able to buy it.

References

1. Abbott. Abbott secures CE Mark for world's first dual glucose-ketone sensing technology for people with diabetes. Abbott Media Room (2026). https://abbott.mediaroom.com/2026-05-27-Abbott-secures-CE-Mark-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes ↩ ↩² ↩³ ↩⁴ ↩⁵

2. Abbott. Abbott Announces Development of Novel Continuous Glucose-Ketone Monitoring System. Abbott Media Room (2022). https://abbott.mediaroom.com/2022-06-03-Abbott-Announces-Development-of-Novel-Continuous-Glucose-Ketone-Monitoring-System ↩ ↩² ↩³

3. Miller E, Miller K, Bergenstal RM. Integrating Continuous Dual Glucose-Ketone Monitoring into Clinical Practice. Diabetes Technol Ther (2025). https://pubmed.ncbi.nlm.nih.gov/41267371/ ↩ ↩² ↩³

4. Virdi N, Poon Y, Abaniel R, Bergenstal RM. Prevalence, Cost, and Burden of Diabetic Ketoacidosis. Diabetes Technol Ther (2023). https://pubmed.ncbi.nlm.nih.gov/37306442/ ↩ ↩² ↩³

5. Kerr D. Integrating Ketone and Glucose Monitoring for Optimized Diabetes Management: Highlights from the ADA 2025 Conference. Diabetes Metab Syndr Obes (2025). https://pmc.ncbi.nlm.nih.gov/articles/PMC12319150/ ↩ ↩² ↩³

6. Abbott data reinforce DKA opportunity after dual sensor milestone. Drug Delivery Business (2026) — reporting Abbott's real-world analyses presented at ADA 2026. https://www.drugdeliverybusiness.com/abbott-ada-2026-dka-opportunity/ ↩ ↩²

7. Sherr JL, Cobry EC. The Future of Dual Glucose-Ketone Monitoring in Youth with Diabetes. Diabetes Technol Ther (2025). https://pubmed.ncbi.nlm.nih.gov/41267374/ ↩ ↩²

8. Bergenstal RM, Virdi N, Quadri F, Alva S. Monitoring Ketonemia in People with Diabetes: Preliminary Findings from Real-World Studies. Diabetes Technol Ther (2025). https://pubmed.ncbi.nlm.nih.gov/41267372/ ↩

9. Kong YW, Morrison D, Lu JC, et al. Continuous ketone monitoring: Exciting implications for clinical practice. Diabetes Obes Metab (2024). https://pubmed.ncbi.nlm.nih.gov/39314201/ ↩ ↩²

10. Abbott. Abbott receives FDA authorization for world's first dual glucose-ketone sensing technology for people with diabetes. Abbott Media Room (25 August 2026). https://abbott.mediaroom.com/2026-08-25-Abbott-receives-FDA-authorization-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes ↩ ↩² ↩³ ↩⁴ ↩⁵

11. Sequel Med Tech. Sequel Med Tech to Integrate twiist Automated Insulin Delivery (AID) System with Abbott's Future Dual Glucose-Ketone Sensor. GlobeNewswire (2025). https://www.globenewswire.com/news-release/2025/05/22/3086535/0/en/Sequel-Med-Tech-to-Integrate-twiist-Automated-Insulin-Delivery-AID-System-with-Abbott-s-Future-Dual-Glucose-Ketone-Sensor.html ↩

12. U.S. FDA. FDA Authorizes First Wearable Device That Continuously Monitors Both Ketone Levels and Blood Sugar (25 August 2026). https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-wearable-device-continuously-monitors-both-ketone-levels-and-blood-sugar ↩