Current and Emerging Technology for Continuous Glucose Monitoring

Diabetes has become a leading cause of death worldwide. Although there is no cure for diabetes, blood glucose monitoring combined with appropriate medication can enhance treatment efficiency, alleviate the symptoms, as well as diminish the complications. For point-of-care purposes, continuous glucose monitoring (CGM) devices are considered to be the best candidates for diabetes therapy. This review focuses on current growth areas of CGM technologies, specifically focusing on subcutaneous implantable electrochemical glucose sensors. The superiority of CGM systems is introduced firstly, and then the strategies for fabrication of minimally-invasive and non-invasive CGM biosensors are discussed, respectively. Finally, we briefly outline the current status and future perspective for CGM systems.This work was supported by the National Natural Science Foundation of China (61471233, 21504051), the Program for Professor of Special Appointment (Eastern Scholar) at SIHL, the Sailing Project and Basic Research Program from Science and Technology Commission of Shanghai Municipality (14YF1410600, 14JC1406402), Shuguang and ChenGuang project supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation (14SG52, 13CG62), the key subject of Shanghai Polytechnic University (Material Science and Engineering, XXKZD1601)

The rise of technology in diabetes care. Not all that is new is necessarily better.

Health-care technologies have brought many benefits to the medical profession and to patients. The introduction of the continuous subcutaneous insulin infusion (CSII) pump and continuous glucose monitoring (CGM) devices offers patients with type 1 diabetes (T1D) the opportunity to optimize their blood glucose control and are increasingly being championed as a routine treatment approach for young people. However, the current evidence base does not convincingly support arguments for the generalized application of CSII and CGM into routine clinical practice. The 'patient-medical device interface' is clearly a complex paradigm, and central to its success is the degree of adherence, understanding, and engagement demonstrated by the patient with the technology. The introduction CSII/CGM technologies into the daily routine care of the patient imposes both psychological and 'time-effort' burdens that many patients and families with T1D will find demanding. The current application of these devices cannot therefore be considered a panacea for the self-management of T1D, and raises a number of challenging problems, including those of a practical, health-economic, and ethical nature that need to be fully resolved before it and other emerging technologies can be considered to have achieved this status.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/pedi.1236

A systematic bibliometric analysis on the clinical practice of CGM in diabetes mellitus from 2012 to 2022

BackgroundContinuous glucose monitoring (CGM) has revolutionized diabetes management, but a comprehensive analysis of its clinical implementation is lacking. This study aims to explore CGM in diabetes practice over the past decade using bibliometric analysis. It will identify trends, research focal points, and provide a framework for future investigations.Materials and methodsThe Web of Science Core Collection (WOSCC) was utilized to acquire literature pertaining to the employment of continuous glucose monitoring (CGM) in diabetes that was published between the years 2012 and 2022, and to conduct a comprehensive analysis of the associated citation data. To achieve bibliometric visualization and analysis of the collated data, the bibliography package in the Rstudio(v.4.2.2), Citespace 6.2.R4, and VOS viewer were employed.ResultsA total of 3024 eligible publications were extracted from 91 countries, with the United States being the leading country in terms of the number of issued articles. Furthermore, the annual publication rate has shown a gradual increase during the past decade. Among the various journals in this field, DIABETES TECHNOLOGY & THERAPEUTICS was identified as the most highly cited one. Keyword clustering analysis of the extracted publications indicates that the research hotspots in the past decade have primarily focused on “continuous glucose monitoring”, “glycemic variability”, “type 1 diabetes”, “hypoglycemia”, and “glycemic control”. Moreover, the analysis of keyword emergence reveals that “Time In Range” and “Young Adult” represent the current research frontiers for the years 2012-2022.ConclusionThe concept of Time in Range (TIR) has garnered considerable attention as a significant area of inquiry and an emerging research trend in the clinical practice of Continuous Glucose Monitoring (CGM) for Diabetes Mellitus. Moreover, recent investigations have demonstrated a growing focus on young adults with type 1 diabetes as the research population of interest. In the foreseeable future, research endeavors will persist in the pursuit of improving glycemic management among young adults through the utilization of continuous glucose monitoring (CGM) technology, while also delving into the examination of the Time in Range metric via supplementary clinical investigations

Minimizing hypoglycemia while maintaining glycemic control in diabetes

In the accompanying Perspective, Cryer identifies a number of different areas where therapeutic interventions have the potential to reduce hypoglycemia without compromising glycemic control. Some approaches provide well defined clinical benefits, a few offer dramatic reductions in hypoglycemia but remain out of reach for most people while others, although promising have yet to be properly evaluated. (Table 1) In this Perspective, I examine the evidence which underpins these interventions. It is beyond the scope of this article to review the data for each potential intervention in detail but the reader is directed to the appropriate source where appropriate. The Perspective focuses on treatment of Type 1 diabetes as most of the potential specific therapies have been evaluated in this group although I have commented in relation to recent trials of intensive therapy in Type 2 diabetes

A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data.

BackgroundIn type 1 diabetes (T1D), periodic review of blood glucose and insulin dosing should be performed, but it is not known how often patients review these data on their own. We describe the proportion of patients with T1D who routinely downloaded and reviewed their data at home.Materials and methodsA cross-sectional survey of 155 adults and 185 caregivers of children with T1D at a single academic institution was performed. "Routine Downloaders" (downloaded four or more times in the past year) were also considered "Routine Reviewers" if they reviewed their data most of the time they downloaded from devices. Logistic regression was used to identify factors associated with being a Routine Reviewer.ResultsOnly 31% of adults and 56% of caregivers reported ever downloading data from one or more devices, whereas 20% and 40%, respectively, were considered Routine Downloaders. Only 12% of adults and 27% of caregivers were Routine Reviewers. Mean hemoglobin A1c was lower in Routine Reviewers compared with non-Routine Reviewers (7.2±1.0% vs. 8.1±1.6% [P=0.03] in adults and 7.8±1.4% vs. 8.6±1.7% [P=0.001] in children). In adjusted analysis of adults, the odds ratio of being a Routine Reviewer of one or more devices for every 10-year increase in age was 1.5 (95% confidence interval, 1.1, 2.1 [P=0.02]). For every 10 years since diabetes diagnosis, the odds ratio of being a Routine Reviewer was 1.7 (95% confidence interval, 1.2, 2.4 [P=0.01]). For caregivers, there were no statistically significant factors associated with being a Routine Reviewer.ConclusionsA minority of T1D patients routinely downloads and reviews data from their devices on their own. Further research is needed to understand obstacles, provide better education and tools for self-review, and determine if patient self-review is associated with improved glycemic control

Mobihealth: mobile health services based on body area networks

In this chapter we describe the concept of MobiHealth and the approach developed during the MobiHealth project (MobiHealth, 2002). The concept was to bring together the technologies of Body Area Networks (BANs), wireless broadband communications and wearable medical devices to provide mobile healthcare services for patients and health professionals. These technologies enable remote patient care services such as management of chronic conditions and detection of health emergencies. Because the patient is free to move anywhere whilst wearing the MobiHealth BAN, patient mobility is maximised. The vision is that patients can enjoy enhanced freedom and quality of life through avoidance or reduction of hospital stays. For the health services it means that pressure on overstretched hospital services can be alleviated