Christian Maino Vieytes, Graduate Student, The University of Illinois at Urbana-Champaign
Diabetes Mellitus is a severe medical condition that requires careful and continuous attention from both diabetic patients, their physicians, and other members of the medical team. This condition requires frequent, and in many cases continuous, assessment of blood glucose (or “blood sugar”) levels. At times, this may leave patients challenged with the task of checking their blood sugar at inconvenient moments throughout the day. Fortunately, many advances have been made in the field of glucose monitoring to make the lives of diabetes patients easier.
Diabetes is a disease that affects the body’s systems that regulate blood sugar. The primary organ involved in this chronic illness is the pancreas, which produces a hormone called insulin that is responsible for regulating blood sugar. The disease has two types: types 1 and 2. Type 1 diabetes arises primarily in younger children and is an autoimmune form of the condition. The body’s immune system recognizes the pancreas as a “foreign invader” and therefore mounts an attack that ends with the partial destruction of the pancreas. This destruction leaves the body without a source of insulin, which leads to high levels of blood sugar if left unchecked. Type 2 diabetes is more common in the population and typically affects adults (although children are becoming increasingly more susceptible with the obesity crisis). In this form of the illness, the body can produce the insulin it needs; however, the body’s cells cannot respond to the insulin that has been made. Again, this can result in dangerously high levels of blood sugar.
Management of Diabetes
Self-monitoring of blood glucose is crucial for proper management of the disease in those affected.1 Regular evaluation of blood sugar allows diabetes patients to correct their blood sugar. This blood glucose management is achieved by self-administering a form of insulin (to lower blood sugar levels found to be high) or eating something to increase blood sugar (if they find low blood sugar). This monitoring system also allows patients to check whether or not they can engage in physical exercise or take other medications.2 Moreover, checking one’s blood sugar usually requires patients to prick their fingers, up to seven times per day, to get a blood sample that they can run through their blood glucose monitoring device3. Pain from finger pricking is a common complaint amongst diabetes patients, and long term consequences of pricking include infection and numbness.4 As you may be able to guess, a more automated system is bound to be less of an inconvenience.
The Latest Technologies
The field of diabetes-care has moved towards disease-management that embraces what is called “Continuous Blood Glucose Monitoring.” In most cases, this involves a sensor placed beneath the skin, which checks blood sugar levels at regular intervals throughout the day. This type of technology avoids the need to prick one’s finger multiple times per day and provides alerts to the user for periods of both low or high blood sugar.5 The significant downsides of these types of systems are that they require re-calibration on the part of the user at frequent intervals and that they also may be invasive.6 Nevertheless, new technologies are arising that aim to avoid these issues. These include:
- Sweat-sensing wrist band (similar to a Fitbit) that reports on blood glucose levels7
- A micro-needle glucose-sensing patch that is placed on the forearm8
- A non-invasive mouthguard that uses saliva for glucose-sensing9
- A contact lens that uses ocular (eye) fluid to sense glucose (currently being developed by tech giants, Google and Novartis10
- Glucose-sensing eyeglasses11
What is most exciting about these technologies is not each instrument, but rather the amount of research focusing on developing innovative alternatives for blood-glucose monitoring. Another significant aspect is that most of these new technologies offer the capability of storing blood-glucose data, which can later be used by physicians and other members of the medical team to individualize and improve a patient’s treatment program.4
We expect the field to grow and new technologies to emerge. However, a substantial challenge facing the industry is making these technologies more affordable and accessible to the public.12,13 This is something to keep an eye on with the advent of newer products.
- Schnell O, Barnard K, Bergenstal R, et al. Clinical Utility of SMBG: Recommendations on the Use and Reporting of SMBG in Clinical Research. Diabetes Care. 2015;38(9):1627-1633. doi:10.2337/dc14-2919
- Kirk JK, Stegner J. Self-monitoring of blood glucose: practical aspects. J Diabetes Sci Technol. 2010;4(2):435-439. doi:10.1177/193229681000400225
- McLachlan K, Jenkins A, O?Neal D. The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy. Aust N Z J Obstet Gynaecol. 2007;47(3):186-190. doi:10.1111/j.1479-828X.2007.00716.x
- Olczuk D, Priefer R. A history of continuous glucose monitors (CGMs) in self-monitoring of diabetes mellitus. Diabetes Metab Syndr Clin Res Rev. 2018;12(2):181-187. doi:10.1016/j.dsx.2017.09.005
- Rodbard D. Continuous Glucose Monitoring: A Review of Successes, Challenges, and Opportunities. Diabetes Technol Ther. 2016;18(S2):S2-3-S2-13. doi:10.1089/dia.2015.0417
- Lodwig V, Heinemann L. Continuous Glucose Monitoring with Glucose Sensors: Calibration and Assessment Criteria. Diabetes Technol Ther. 2003;5(4):572-586. doi:10.1089/152091503322250596
- Gao W, Emaminejad S, Nyein HYY, et al. Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis. Nature. 2016;529(7587):509-514. doi:10.1038/nature16521
- Jina A, Tierney MJ, Tamada JA, et al. Design, Development, and Evaluation of a Novel Microneedle Array-based Continuous Glucose Monitor. J Diabetes Sci Technol. 2014;8(3):483-487. doi:10.1177/1932296814526191
- Kim J, Valdés-Ramírez G, Bandodkar AJ, et al. Non-invasive mouthguard biosensor for continuous salivary monitoring of metabolites. The Analyst. 2014;139(7):1632-1636. doi:10.1039/C3AN02359A
- Senior M. Novartis signs up for Google smart lens. Nat Biotechnol. 2014;32(9):856. doi:10.1038/nbt0914-856
- Sempionatto JR, Nakagawa T, Pavinatto A, et al. Eyeglasses based wireless electrolyte and metabolite sensor platform. Lab Chip. 2017;17(10):1834-1842. doi:10.1039/C7LC0019