Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications

Abstract

By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.

Fit‐for‐Purpose Biometric Monitoring Technologies: Leveraging the Laboratory Biomarker Experience

“…The roadmap to this qualification was pioneering and highlighted a number of the potential pitfalls, namely the lack of a framework to design experiments for qualification for this specific application, clearly defined performance parameters, and acceptance criteria to interpret the data needed to obtain a qualification for use in drug development. 82 The most common principle is the measurement of interstitial fluid via the glucose-oxidase electrochemical reaction 83 with interstitial fluid harvesting every 10 seconds and an average glucose value is recorded every 1-5 minutes 24 hours a day. 84 Although several BG sensing mechanisms have been utilized, analytic validation of the data obtained from the sensors includes quantification of accuracy using primarily the mean absolute relative difference between CGM sensor output and the reference standard highly accurate laboratory instrument, collected in a hospital setting.…”

“…Notably, accuracy of commercial grade CGMs show a mean absolute relative difference of between 5% and 10% on BG levels (based on an ideal BG range of 70-140 mg/ dL). 83 Analytical validation has been obtained on remote monitoring of BG levels, BG level variability, minimum and maximum glycemic values, and number of severe hypoglycemic episodes. 85 BioMeT features include the continuous nature of the data, highly complex usability testing, and the extensive user training required prior to using a CGM device.…”

How was the <i>Diabetes Metabolism Journal</i> added to MEDLINE?

“…Its importance to users, such as researchers, clinicians, educators, administrators, allied health professionals, students, and policy-makers, was another point to address in the MEDLINE journal selection process [4]. On the MEDLINE listing application, we also provided specific examples of original articles relevant to the metabolic characteristics of Asians [5], subjects that can be linked to health care policies [6], environmental issues such as endocrine disruptors [7], and next-generation artificial intelligence and new diabetes treatment technologies [8].…”

Data Analysis and Accuracy Evaluation of a Continuous Glucose-Monitoring Device

“…In addition, an interference current I BE (I BE = I I ) is measured by the BE, and a mixed signal (I WE ) is measured by the WE which includes the I G and I I , so it would help to remove the interference and obtain a purer glucose signal for measuring the interstitial glucose (IG) concentration with better sensitivity and accuracy. The sensor insertion site also could be placed in the abdomen or the upper arm without local anesthesia, just so it is not affected by daily activities [13,14]. On the other hand, the recorder is separated from the sensor with a small size and waterproof and easy to be carried.…”