Non-invasive, transdermal, path-selective and specific glucose monitoring via a graphene-based platform

Is Raman the best strategy towards the development of non-invasive continuous glucose monitoring devices for diabetes management?

Diabetes has no well-established cure; thus, its management is critical for avoiding severe health complications involving multiple organs. This requires frequent glycaemia monitoring, and the gold standards for this are fingerstick tests. During the last decades, several blood-withdrawal-free platforms have been being studied to replace this test and to improve significantly the quality of life of people with diabetes (PWD). Devices estimating glycaemia level targeting blood or biofluids such as tears, saliva, breath and sweat, are gaining attention; however, most are not reliable, user-friendly and/or cheap. Given the complexity of the topic and the rise of diabetes, a careful analysis is essential to track scientific and industrial progresses in developing diabetes management systems. Here, we summarize the emerging blood glucose level (BGL) measurement methods and report some examples of devices which have been under development in the last decades, discussing the reasons for them not reaching the market or not being really non-invasive and continuous. After discussing more in depth the history of Raman spectroscopy-based researches and devices for BGL measurements, we will examine if this technique could have the potential for the development of a user-friendly, miniaturized, non-invasive and continuous blood glucose-monitoring device, which can operate reliably, without inter-patient variability, over sustained periods.

Silk-Based Electrochemical Sensor for the Detection of Glucose in Sweat

The development of reliable glucose sensors for noninvasive monitoring is highly desirable and essential for diabetes detection. As a testing sample, sweat is voluminous and is easy to collect compared to blood. However, the application of sweat glucose sensors is generally limited because of their low stability and sensitivity compared to commercial glucometers. In this manuscript, a silk nanofibril (SNF)/reduced graphene oxide (RGO)/glucose oxidase (GOx) composite was developed as the working electrode of the sweat glucose sensor. The SNF/RGO/GOx composite was prepared via a facile two-step process, which involved the self-assembly of SNF from silk fibroin while reducing graphene oxide to RGO and immobilizing GOx on SNF. The SNF/RGO/GOx glucose sensor exhibited a low limit of detection (300 nM) and high sensitivity (18.0 μA/mM) in the sweat glucose range, covering both healthy people and diabetic patients (0-100 μM). Moreover, the SNF/RGO/GOx glucose sensors showed a long stability for at least 4 weeks. Finally, the SNF/RGO/GOx glucose sensor was applied to test the actual sweat samples from two volunteers and two sweating methods (by dry sauna and exercise). The results indicate the glucose data tested by the SNF/RGO/GOx glucose sensor were reliable, which correlated well to the data obtained from the commercial glucometer. Therefore, the SNF/RGO/GOx glucose sensor developed in this study may have a great potential for glucose control in personalized healthcare monitoring and chronic disease management.

The modern pharmacological approach to diabetes: innovative methods of monitoring and insulin treatment

INTRODUCTION

Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterised by a high blood sugar level over a prolonged period of time. In order to maintain this blood glucose value in normal parameters, a careful monitoring of it and insulin administration are necessary.

AREAS COVERED

Thus, to facilitate this procedure, new blood glucose monitoring systems have been studied. The smart lens, the nano tattoo, non-invasive sensors based on reverse ionthophoresis and glucose oxidase - based continuous blood glucose monitoring systems, are the methods described in this study. Of course, not only is blood glucose monitoring important, but also the lifestyle of a drug or the way a drug is administered, especially in the cae of insulin. How insulin is administered is also a topic that we address in this article. In an attempt to promote compliance with the administration, we have discussed about new forms of administering insulin such as: oral, intranasal, administration on the oral mucosa and last but not least, transdermal administration.

EXPERT OPINION

Further, the attention of specialists should be directed to devices based on sensors, with a role in the interruption of insulin administration, in case of detection of hypoglycemia or the additional dose of insulin, if hyperglycemia is detected.

The era of nano-bionic: 2D materials for wearable and implantable body sensors

Nano-bionics have the potential of revolutionizing modern medicine. Among nano-bionic devices, body sensors allow to monitor in real-time the health of patients, to achieve personalized medicine, and even to restore or enhance human functions. The advent of two-dimensional (2D) materials is facilitating the manufacturing of miniaturized and ultrathin bioelectronics, that can be easily integrated in the human body. Their unique electronic properties allow to efficiently transduce physical and chemical stimuli into electric current. Their flexibility and nanometric thickness facilitate the adaption and adhesion to human body. The low opacity permits to obtain transparent devices. The good cellular adhesion and reduced cytotoxicity are advantageous for the integration of the devices in vivo. Herein we review the latest and more significant examples of 2D material-based sensors for health monitoring, describing their architectures, sensing mechanisms, advantages and, as well, the challenges and drawbacks that hampers their translation into commercial clinical devices.

Recent Advances in Intelligent Wearable Medical Devices Integrating Biosensing and Drug Delivery

The primary roles of precision medicine are to perform real-time examination, administer on-demand medication, and apply instruments continuously. However, most current therapeutic systems implement these processes separately, leading to treatment interruption and limited recovery in patients. Personalized healthcare and smart medical treatment have greatly promoted research on and development of biosensing and drug-delivery integrated systems, with intelligent wearable medical devices (IWMDs) as typical systems, which have received increasing attention because of their non-invasive and customizable nature. Here, the latest progress in research on IWMDs is reviewed, including their mechanisms of integrating biosensing and on-demand drug delivery. The current challenges and future development directions of IWMDs are also discussed.

Recent Developments and Future Perspective on Electrochemical Glucose Sensors Based on 2D Materials

Diabetes is a health disorder that necessitates constant blood glucose monitoring. The industry is always interested in creating novel glucose sensor devices because of the great demand for low-cost, quick, and precise means of monitoring blood glucose levels. Electrochemical glucose sensors, among others, have been developed and are now frequently used in clinical research. Nonetheless, despite the substantial obstacles, these electrochemical glucose sensors face numerous challenges. Because of their excellent stability, vast surface area, and low cost, various types of 2D materials have been employed to produce enzymatic and nonenzymatic glucose sensing applications. This review article looks at both enzymatic and nonenzymatic glucose sensors made from 2D materials. On the other hand, we concentrated on discussing the complexities of many significant papers addressing the construction of sensors and the usage of prepared sensors so that readers might grasp the concepts underlying such devices and related detection strategies. We also discuss several tuning approaches for improving electrochemical glucose sensor performance, as well as current breakthroughs and future plans in wearable and flexible electrochemical glucose sensors based on 2D materials as well as photoelectrochemical sensors.

An ultra-compact and wireless tag for battery-free sweat glucose monitoring

Glucose monitoring before, during, and after exercise is essential for people with diabetes as exercise increases the risk of activity-induced hyper- and hypo-glycemic events. The situation is even more challenging for athletes with diabetes as they have impaired metabolic control compared to sedentary individuals. In this regard, a compact and noninvasive wearable glucose monitoring device that can be easily worn is critical to enabling glucose monitoring. This report presents an ultra-compact glucose tag with a footprint and weight of 1.2 cm² and 0.13 g, respectively, for sweat analysis. The device comprises a near field communication (NFC) chip, antenna, electrochemical sensor, and microfluidic channels implemented in different material layers. The device has a flexible and conformal structure and can be easily attached to different body parts. The battery-less operation of the device was enabled by NFC-based wireless power transmission and the compact antenna. Femtosecond laser ablation was employed to fabricate a highly compact and flexible NFC antenna. The proposed device demonstrated excellent operating characteristics with a limit of detection (LOD), limit of quantification (LOQ), and sensitivity of 24 μM, 74 μM, and 1.27 μA cm^-2 mM^-1, respectively. The response of the proposed sensor in sweat glucose detection and quantification was validated by nuclear magnetic resonance spectroscopy (NMR). Also, the device's capability in attachment to the body, sweat collection, and glucose measurement was demonstrated through in vitro and in vivo experiments, and satisfactory results were obtained.

An integrated wearable microneedle array for the continuous monitoring of multiple biomarkers in interstitial fluid

Implementations of wearable microneedle-based arrays of sensors for the monitoring of multiple biomarkers in interstitial fluid have lacked system integration and evidence of robust analytical performance. Here we report the development and testing of a fully integrated wearable array of microneedles for the wireless and continuous real-time sensing of two metabolites (lactate and glucose, or alcohol and glucose) in the interstitial fluid of volunteers performing common daily activities. The device works with a custom smartphone app for data capture and visualization, comprises reusable electronics and a disposable microneedle array, and is optimized for system integration, cost-effective fabrication via advanced micromachining, easier assembly, biocompatibility, pain-free skin penetration and enhanced sensitivity. Single-analyte and dual-analyte measurements correlated well with the corresponding gold-standard measurements in blood or breath. Further validation of the technology in large populations with concurrent validation of sensor readouts through centralized laboratory tests should determine the robustness and utility of real-time simultaneous monitoring of several biomarkers in interstitial fluid.

Recent Advancement in Biofluid-Based Glucose Sensors Using Invasive, Minimally Invasive, and Non-Invasive Technologies: A Review

Biosensors have potentially revolutionized the biomedical field. Their portability, cost-effectiveness, and ease of operation have made the market for these biosensors to grow rapidly. Diabetes mellitus is the condition of having high glucose content in the body, and it has become one of the very common conditions that is leading to deaths worldwide. Although it still has no cure or prevention, if monitored and treated with appropriate medication, the complications can be hindered and mitigated. Glucose content in the body can be detected using various biological fluids, namely blood, sweat, urine, interstitial fluids, tears, breath, and saliva. In the past decade, there has been an influx of potential biosensor technologies for continuous glucose level estimation. This literature review provides a comprehensive update on the recent advances in the field of biofluid-based sensors for glucose level detection in terms of methods, methodology and materials used.

Recent Advances in Electronic Skins with Multiple-Stimuli-Responsive and Self-Healing Abilities

Wearable electronic skin (e-skin) has provided a revolutionized way to intelligently sense environmental stimuli, which shows prospective applications in health monitoring, artificial intelligence and prosthetics fields. Drawn inspiration from biological skins, developing e-skin with multiple stimuli perception and self-healing abilities not only enrich their bionic multifunctionality, but also greatly improve their sensory performance and functional stability. In this review, we highlight recent important developments in the material structure design strategy to imitate the fascinating functionalities of biological skins, including molecular synthesis, physical structure design, and special biomimicry engineering. Moreover, their specific structure-property relationships, multifunctional application, and existing challenges are also critically analyzed with representative examples. Furthermore, a summary and perspective on future directions and challenges of biomimetic electronic skins regarding function construction will be briefly discussed. We believe that this review will provide valuable guidance for readers to fabricate superior e-skin materials or devices with skin-like multifunctionalities and disparate characteristics.

Skin Patchable Sensor Surveillance for Continuous Glucose Monitoring

Diabetes mellitus is a physiological and metabolic disorder affecting millions of people worldwide, associated with global morbidity, mortality, and financial expenses. Long-term complications can be avoided by frequent, continuous self-monitoring of blood glucose. Therefore, this review summarizes the current state-of-art glycemic control regimes involving measurement approaches and basic concepts. Following an introduction to the significance of continuous glucose sensing, we have tracked the evolution of glucose monitoring devices from minimally invasive to non-invasive methods to present an overview of the spectrum of continuous glucose monitoring (CGM) technologies. The conveniences, accuracy, and cost-effectiveness of the real-time CGM systems (rt-CGMs) are the factors considered for discussion. Transdermal biosensing and drug delivery routes have recently emerged as an innovative approach to substitute hypodermal needles. This work reviews skin-patchable glucose monitoring sensors for the first time, providing specifics of all the major findings in the past 6 years. Skin patch sensors and their progressive form, i.e., microneedle (MN) array sensory and delivery systems, are elaborated, covering self-powered, enzymatic, and non-enzymatic devices. The critical aspects reviewed are material design and assembly techniques focusing on flexibility, sensitivity, selectivity, biocompatibility, and user-end comfort. The review highlights the advantages of patchable MNs' multi-sensor technology designed to maintain precise blood glucose levels and administer diabetes drugs or insulin through a "sense and act" feedback loop. Subsequently, the limitations and potential challenges encountered from the MN array as rt-CGMs are listed. Furthermore, the current statuses of working prototype glucose-responsive "closed-loop" insulin delivery systems are discussed. Finally, the expected future developments and outlooks in clinical applications are discussed.

Highly sensitive gas sensor based on a parity-time-symmetric system

Achieving extremely high sensitivity is an important indicator in the development of novel and stable gas concentration sensors. In this paper, we present a gas concentration sensor with parity-time symmetry for high sensitivity at low concentrations. The proposed sensor can detect toxic gases, such as benzene, bromine, and acetone, by probing the faint changing of the permittivity. Furthermore, the level of the sensitivity can be adjusted by the resistance segment, which is realized by various metallic formations. Our proposed structure provides a novel idea for the development of future gas concentration sensors, showing an exciting prospect for gas sensing technologies.

Graphene-enabled wearable sensors for healthcare monitoring

Wearable sensors in healthcare monitoring have recently found widespread applications in biomedical fields for their non- or minimal-invasive, user-friendly and easy-accessible features. Sensing materials is one of the major challenges to achieve these superiorities of wearable sensors for healthcare monitoring, while graphene-based materials with many favorable properties have shown great efficiency in sensing various biochemical and biophysical signals. In this paper, we review state-of-the-art advances in the development and modification of graphene-based materials (i.e., graphene, graphene oxide and reduced graphene oxide) for fabricating advanced wearable sensors with 1D (fibers), 2D (films) and 3D (foams/aerogels/hydrogels) macroscopic structures. We summarize the structural design guidelines, sensing mechanisms, applications and evolution of the graphene-based materials as wearable sensors for healthcare monitoring of biophysical signals (e.g., mechanical, thermal and electrophysiological signals) and biochemical signals from various body fluids and exhaled gases. Finally, existing challenges and future prospects are presented in this area.

A touch-actuated glucose sensor fully integrated with microneedle array and reverse iontophoresis for diabetes monitoring

The development of non-invasive biosensor for monitoring glucose in interstitial fluid (ISF) is still challenging, because ISF extraction through classical reverse iontophoresis (RI) is limited by low extraction flux and consistency. Here, we developed a touch-actuated biosensor for monitoring glucose in ISF. The biosensor is composed of three main components: 1) the solid microneedle array (MA) for painless skin penetration; 2) the RI unit for ISF extraction through the MA-created microchannels; and 3) the sensing unit for glucose monitoring. The sensing strategy of this biosensor is "skin penetration-RI extraction-electrochemical detection". Compared with RI extraction only, the reported skin penetration-RI extraction sampling strategy obviously increased the glucose extraction flux by ∼1.6 times not only in vitro but also in vivo. Moreover, we developed a wearable glucose monitoring system by incorporating this touch-actuated biosensor, a wireless electrochemical detector, and a smartphone application. In vivo experiments using healthy and diabetic rats revealed a high correlation between the results measured by the reported wearable system and commercially blood glucometer. This sampling strategy which combined skin penetration and RI extraction paves the way to develop wearable platforms for not only glucose monitoring but also various ISF biomarkers without the need of painful finger-stick blood sampling.

Recent Advances in Wearable Optical Sensor Automation Powered by Battery versus Skin-like Battery-Free Devices for Personal Healthcare-A Review

Currently, old-style personal Medicare techniques rely mostly on traditional methods, such as cumbersome tools and complicated processes, which can be time consuming and inconvenient in some circumstances. Furthermore, such old methods need the use of heavy equipment, blood draws, and traditional bench-top testing procedures. Invasive ways of acquiring test samples can potentially cause patient discomfort and anguish. Wearable sensors, on the other hand, may be attached to numerous body areas to capture diverse biochemical and physiological characteristics as a developing analytical tool. Physical, chemical, and biological data transferred via the skin are used to monitor health in various circumstances. Wearable sensors can assess the aberrant conditions of the physical or chemical components of the human body in real time, exposing the body state in time, thanks to unintrusive sampling and high accuracy. Most commercially available wearable gadgets are mechanically hard components attached to bands and worn on the wrist, with form factors ultimately constrained by the size and weight of the batteries required for the power supply. Basic physiological signals comprise a lot of health-related data. The estimation of critical physiological characteristics, such as pulse inconstancy or variability using photoplethysmography (PPG) and oxygen saturation in arterial blood using pulse oximetry, is possible by utilizing an analysis of the pulsatile component of the bloodstream. Wearable gadgets with “skin-like” qualities are a new type of automation that is only starting to make its way out of research labs and into pre-commercial prototypes. Flexible skin-like sensing devices have accomplished several functionalities previously inaccessible for typical sensing devices due to their deformability, lightness, portability, and flexibility. In this paper, we studied the recent advancement in battery-powered wearable sensors established on optical phenomena and skin-like battery-free sensors, which brings a breakthrough in wearable sensing automation.

Oxygen-Sensitive Probe and Hydrogel for Optical Imaging and Photodynamic Antimicrobial Chemotherapy of Chronic Wounds

A small molecular probe (Ir-fliq) and a macromolecular optical probe (Ir-fliq-PVP) based on iridium complex are designed for hypoxia imaging and antibacterial chemotherapy in this work. The existence of both...

Reverse Iontophoretic Extraction of Skin Cancer-Related Biomarkers

Non-invasive methods for early diagnosis of skin cancer are highly valued. One possible approach is to monitor relevant biomarkers such as tryptophan (Trp) and kynurenine (Kyn), on the skin surface. The primary aim of this in vitro investigation was, therefore, to examine whether reverse iontophoresis (RI) can enhance the extraction of Trp and Kyn, and to demonstrate how the Trp/Kyn ratio acquired from the skin surface reflects that in the epidermal tissue. The study also explored whether the pH of the receiver medium impacted on extraction efficiency, and assessed the suitability of a bicontinuous cubic liquid crystal as an alternative to a simple buffer solution for this purpose. RI substantially enhanced the extraction of Trp and Kyn, in particular towards the cathode. The Trp/Kyn ratio obtained on the surface matched that in the viable skin. Increasing the receiver solution pH from 4 to 9 improved extraction of both analytes, but did not significantly change the Trp/Kyn ratio. RI extraction of Trp and Kyn into the cubic liquid crystal was comparable to that achieved with simple aqueous receiver solutions. We conclude that RI offers a potential for non-invasive sampling of low-molecular weight biomarkers and further investigations in vivo are therefore warranted.

Soft Bioelectronics Based on Nanomaterials

Recent advances in nanostructured materials and unconventional device designs have transformed the bioelectronics from a rigid and bulky form into a soft and ultrathin form and brought enormous advantages to the bioelectronics. For example, mechanical deformability of the soft bioelectronics and thus its conformal contact onto soft curved organs such as brain, heart, and skin have allowed researchers to measure high-quality biosignals, deliver real-time feedback treatments, and lower long-term side-effects in vivo. Here, we review various materials, fabrication methods, and device strategies for flexible and stretchable electronics, especially focusing on soft biointegrated electronics using nanomaterials and their composites. First, we summarize top-down material processing and bottom-up synthesis methods of various nanomaterials. Next, we discuss state-of-the-art technologies for intrinsically stretchable nanocomposites composed of nanostructured materials incorporated in elastomers or hydrogels. We also briefly discuss unconventional device design strategies for soft bioelectronics. Then individual device components for soft bioelectronics, such as biosensing, data storage, display, therapeutic stimulation, and power supply devices, are introduced. Afterward, representative application examples of the soft bioelectronics are described. A brief summary with a discussion on remaining challenges concludes the review.

Wearable Motion Smartsensors Self-Powered by Core-Shell Au@Pt Methanol Fuel Cells

A wearable self-powered sensor is a promising frontier in recent flexible electronic devices. In this work, a wearable fuel cell (FC)-type self-powering motion smartsensor has been fabricated, particularly in choosing methanol vapor as a target fuel for the first time. The core-shell structure of Pt@Au/N-rGO and the porous carbon network act as methanol oxidation and oxygen reduction reaction catalysts, with a highly conductive alkaline hydrogel as a solid-state electrolyte. As a result, a wearable FC for a self-powered sensing system demonstrates excellent sensing performance toward 2-20% (v/v) methanol vapor with a maximum power density of 2.26 μW cm^-1 and good mechanical behaviors during the bending or twisting process. Significantly, this wearable FC device could power strain sensors of human motion, and real-time signals can be easily remotely detected via a cellphone. With attractive biocompatibility and self-powering performance, wearable FCs for a self-powering system would provide new opportunities for next-generation flexible smartsensing electronics and initiate a developed self-powering platform in future practical application of wearable smart monitoring.

The Application of Wearable Glucose Sensors in Point-of-Care Testing

Diabetes and its complications have become a worldwide concern that influences human health negatively and even leads to death. The real-time and convenient glucose detection in biofluids is urgently needed. Traditional glucose testing is detecting glucose in blood and is invasive, which cannot be continuous and results in discomfort for the users. Consequently, wearable glucose sensors toward continuous point-of-care glucose testing in biofluids have attracted great attention, and the trend of glucose testing is from invasive to non-invasive. In this review, the wearable point-of-care glucose sensors for the detection of different biofluids including blood, sweat, saliva, tears, and interstitial fluid are discussed, and the future trend of development is prospected.

Conductive Biomaterials as Bioactive Wound Dressing for Wound Healing and Skin Tissue Engineering

Conductive biomaterials based on conductive polymers, carbon nanomaterials, or conductive inorganic nanomaterials demonstrate great potential in wound healing and skin tissue engineering, owing to the similar conductivity to human skin, good antioxidant and antibacterial activities, electrically controlled drug delivery, and photothermal effect. However, a review highlights the design and application of conductive biomaterials for wound healing and skin tissue engineering is lacking. In this review, the design and fabrication methods of conductive biomaterials with various structural forms including film, nanofiber, membrane, hydrogel, sponge, foam, and acellular dermal matrix for applications in wound healing and skin tissue engineering and the corresponding mechanism in promoting the healing process were summarized. The approaches that conductive biomaterials realize their great value in healing wounds via three main strategies (electrotherapy, wound dressing, and wound assessment) were reviewed. The application of conductive biomaterials as wound dressing when facing different wounds including acute wound and chronic wound (infected wound and diabetic wound) and for wound monitoring is discussed in detail. The challenges and perspectives in designing and developing multifunctional conductive biomaterials are proposed as well.

Electrical aspects of skin as a pathway to engineering skin devices

Skin is one of the indispensable organs for life. The epidermis at the outermost surface provides a permeability barrier to infectious agents, chemicals, and excessive loss of water, while the dermis and subcutaneous tissue mechanically support the structure of the skin and appendages, including hairs and secretory glands. The integrity of the integumentary system is a key for general health, and many techniques have been developed to measure and control this protective function. In contrast, the effective skin barrier is the major obstacle for transdermal delivery and detection. Changes in the electrical properties of skin, such as impedance and ionic activity, is a practical indicator that reflects the structures and functions of the skin. For example, the impedance that reflects the hydration of the skin is measured for quantitative assessment in skincare, and the current generated across a wound is used for the evaluation and control of wound healing. Furthermore, the electrically charged structure of the skin enables transdermal drug delivery and chemical extraction. This paper provides an overview of the electrical aspects of the skin and summarizes current advances in the development of devices based on these features.

Wearable chem-biosensing devices: from basic research to commercial market

Wearable chem-biosensors have been garnering tremendous interest due to the significant potential in tailored healthcare diagnostics and therapeutics. With the development of the medical diagnostics revolution, wearable chem-biosensors as a rapidly emerging wave allow individuals to perform on-demand detection and obtain the required in-depth information. In contrast to commercial wearables, which tend to be miniaturized for measuring physical activities, the recent progressive wearable chem-biosensing device have mainly focused on non-invasive or minimally invasive monitoring biomarkers at the molecular level. Wearables is a multidisciplinary subject, and chem-biosensing is one of the most significant technologies. In this review, the currently basic academic research of wearable chem-biosensing devices and its commercial transformation were summarized and highlighted. Moreover, some representative wearable products on the market for individual health managements are presented. Strategies for the identification and sensing of biomarkers are discussed to further promote the development of wearable chem-biosensing devices. We also shared the limitations and breakthroughs of the next generation of chemo-biosensor wearables, from home use to clinical diagnosis.

2D Materials for Skin-Mountable Electronic Devices

Skin-mountable devices that can directly measure various biosignals and external stimuli and communicate the information to the users have been actively studied owing to increasing demand for wearable electronics and newer healthcare systems. Research on skin-mountable devices is mainly focused on those materials and mechanical design aspects that satisfy the device fabrication requirements on unusual substrates like skin and also for achieving good sensing capabilities and stable device operation in high-strain conditions. 2D materials that are atomically thin and possess unique electrical and optical properties offer several important features that can address the challenging needs in wearable, skin-mountable electronic devices. Herein, recent research progress on skin-mountable devices based on 2D materials that exhibit a variety of device functions including information input and output and in vitro and in vivo healthcare and diagnosis is reviewed. The challenges, potential solutions, and perspectives on trends for future work are also discussed.

Organic Bioelectronic Devices for Metabolite Sensing

Electrochemical detection of metabolites is essential for early diagnosis and continuous monitoring of a variety of health conditions. This review focuses on organic electronic material-based metabolite sensors and highlights their potential to tackle critical challenges associated with metabolite detection. We provide an overview of the distinct classes of organic electronic materials and biorecognition units used in metabolite sensors, explain the different detection strategies developed to date, and identify the advantages and drawbacks of each technology. We then benchmark state-of-the-art organic electronic metabolite sensors by categorizing them based on their application area (in vitro, body-interfaced, in vivo, and cell-interfaced). Finally, we share our perspective on using organic bioelectronic materials for metabolite sensing and address the current challenges for the devices and progress to come.

Extended Noninvasive Glucose Monitoring in the Interstitial Fluid Using an Epidermal Biosensing Patch

An effective, noninvasive glucose monitoring technology could be a pivotal factor for addressing the major unmet needs for managing diabetes mellitus (DM). Here, we describe a skin-worn, disposable, wireless electrochemical biosensor for extended noninvasive monitoring of glucose in the interstitial fluid (ISF). The wearable platform integrates three components: a screen-printed iontophoretic electrode system for ISF extraction by reverse iontophoresis (RI), a printed three-electrode amperometric glucose biosensor, and an electronic interface for control and wireless communication. Prolonged on-body glucose monitoring of up to 8 h, including clinical trials conducted in individuals with and without DM, demonstrated good correlation between glucose blood and ISF concentrations and the ability to monitor dynamically changing glucose levels upon food consumption, with no evidence of skin irritation or discomfort. Such successful extended operation addresses the challenges reported for the GlucoWatch platform by using a lower RI current density at shorter extraction times, along with a lower measurement frequency. Such a noninvasive skin-worn platform could address long-standing challenges with existing glucose monitoring platforms.

Wearable Glucose Monitoring and Implantable Drug Delivery Systems for Diabetes Management

The global cost of diabetes care exceeds $1 trillion each year with more than $327 billion being spent in the United States alone. Despite some of the advances in diabetes care including continuous glucose monitoring systems and insulin pumps, the technology associated with managing diabetes has largely remained unchanged over the past several decades. With the rise of wearable electronics and novel functional materials, the field is well-poised for the next generation of closed-loop diabetes care. Wearable glucose sensors implanted within diverse platforms including skin or on-tooth tattoos, skin-mounted patches, eyeglasses, contact lenses, fabrics, mouthguards, and pacifiers have enabled noninvasive, unobtrusive, and real-time analysis of glucose excursions in ambulatory care settings. These wearable glucose sensors can be integrated with implantable drug delivery systems, including an insulin pump, glucose responsive insulin release implant, and islets transplantation, to form self-regulating closed-loop systems. This review article encompasses the emerging trends and latest innovations of wearable glucose monitoring and implantable insulin delivery technologies for diabetes management with a focus on their advanced materials and construction. Perspectives on the current unmet challenges of these strategies are also discussed to motivate future technological development toward improved patient care in diabetes management.

Lab under the Skin: Microneedle Based Wearable Devices

While the current smartwatches and cellphones can readily track mobility and vital signs, a new generation of wearable devices is rapidly developing to enable users to monitor their health parameters at the molecular level. Within this emerging class of wearables, microneedle-based transdermal sensors are in a prime position to play a key role in synergizing the significant advantages of dermal interstitial fluid (ISF) as a rich source of clinical indicators and painless skin pricking to allow the collection of real-time diagnostic information. While initial efforts of microneedle sensing focused on ISF extraction coupled with either on-chip analysis or off-chip instrumentation, the latest trend has been oriented toward assembling electrochemical biosensors on the tip of microneedles to allow direct continuous chemical measurements. In this context, significant advances have recently been made in exploiting microneedle-based devices for real-time monitoring of various metabolites, electrolytes, and therapeutics and toward the simultaneous multiplexed detection of key chemical markers; yet, there are several grand challenges that still exist. In this review, we outline current progress, recent trends, and new capabilities of microneedle-empowered sensors, along with the current unmet challenges and a future roadmap toward transforming the latest innovations in the field to commercial products.

Flexible Wearable Sensors for Cardiovascular Health Monitoring

Cardiovascular diseases account for the highest mortality globally, but recent advances in wearable technologies may potentially change how these illnesses are diagnosed and managed. In particular, continuous monitoring of cardiovascular vital signs for early intervention is highly desired. To this end, flexible wearable sensors that can be comfortably worn over long durations are gaining significant attention. In this review, advanced flexible wearable sensors for monitoring cardiovascular vital signals are outlined and discussed. Specifically, the functional materials, configurations, mechanisms, and recent advances of these flexible sensors for heart rate, blood pressure, blood oxygen saturation, and blood glucose monitoring are highlighted. Different mechanisms in bioelectric, mechano-electric, optoelectric, and ultrasonic wearable sensors are presented to monitor cardiovascular vital signs from different body locations. Present challenges, possible strategies, and future directions of these wearable sensors are also discussed. With rapid development, these flexible wearable sensors will potentially be applicable for both medical diagnosis and daily healthcare use in tackling cardiovascular diseases.

A Fully Integrated Closed-Loop System Based on Mesoporous Microneedles-Iontophoresis for Diabetes Treatment

A closed-loop system that can mini-invasively track blood glucose and intelligently treat diabetes is in great demand for modern medicine, yet it remains challenging to realize. Microneedles technologies have recently emerged as powerful tools for transdermal applications with inherent painlessness and biosafety. In this work, for the first time to the authors' knowledge, a fully integrated wearable closed-loop system (IWCS) based on mini-invasive microneedle platform is developed for in situ diabetic sensing and treatment. The IWCS consists of three connected modules: 1) a mesoporous microneedle-reverse iontophoretic glucose sensor; 2) a flexible printed circuit board as integrated and control; and 3) a microneedle-iontophoretic insulin delivery component. As the key component, mesoporous microneedles enable the painless penetration of stratum corneum, implementing subcutaneous substance exchange. The coupling with iontophoresis significantly enhances glucose extraction and insulin delivery and enables electrical control. This IWCS is demonstrated to accurately monitor glucose fluctuations, and responsively deliver insulin to regulate hyperglycemia in diabetic rat model. The painless microneedles and wearable design endows this IWCS as a highly promising platform to improve the therapies of diabetic patients.

Low dimensional materials for glucose sensing

Biosensors are essential components for effective healthcare management. Since biological processes occur on molecular scales, nanomaterials and nanosensors intrinsically provide the most appropriate landscapes for developing biosensors. Low-dimensional materials have the advantage of offering high surface areas, increased reactivity and unique physicochemical properties for efficient and selective biosensing. So far, nanomaterials and nanodevices have offered significant prospects for glucose sensing. Targeted glucose biosensing using such low-dimensional materials enables much more effective monitoring of blood glucose levels, thus providing significantly better predictive diabetes diagnostics and management. In this review, recent advances in using low dimensional materials for sensing glucose are summarized. Sensing fundamentals are discussed, as well as invasive, minimally-invasive and non-invasive sensing methods. The effects of morphological characteristics and size-dependent properties of low dimensional materials are explored for glucose sensing, and the key performance parameters such as selectivity, stability and sensitivity are also discussed. Finally, the challenges and future opportunities that low dimensional materials can offer for glucose sensing are outlined.

A soft and transparent contact lens for the wireless quantitative monitoring of intraocular pressure

Continuous detection of raised intraocular pressure (IOP) could benefit the monitoring of patients with glaucoma. Current contact lenses with embedded sensors for measuring IOP are rigid, bulky, partially block vision or are insufficiently sensitive. Here, we report the design and testing in volunteers of a soft and transparent contact lens for the quantitative monitoring of IOP in real time using a smartphone. The contact lens incorporates a strain sensor, a wireless antenna, capacitors, resistors, stretchable metal interconnects and an integrated circuit for wireless communication. In rabbits, the lens provided measurements that match those of a commercial tonometer. In ten human participants, the lens proved to be safe, and reliably provided accurate quantitative measurements of IOP without inducing inflammation.

The impact of chemical engineering and technological advances on managing diabetes: present and future concepts

Monitoring blood glucose levels for diabetic patients is critical to achieve tight glycaemic control. As none of the current antidiabetic treatments restore lost functional β-cell mass in diabetic patients, insulin injections and the use of insulin pumps are most widely used in the management of glycaemia. The use of advanced and intelligent chemical engineering, together with the incorporation of micro- and nanotechnological-based processes have lately revolutionized diabetic management. The start of this concept goes back to 1974 with the description of an electrode that repeatedly measures the level of blood glucose and triggers insulin release from an infusion pump to enter the blood stream from a small reservoir upon need. Next to the insulin pumps, other drug delivery routes, including nasal, transdermal and buccal, are currently investigated. These processes necessitate competences from chemists, engineers-alike and innovative views of pharmacologists and diabetologists. Engineered micro and nanostructures hold a unique potential when it comes to drug delivery applications required for the treatment of diabetic patients. As the technical aspects of chemistry, biology and informatics on medicine are expanding fast, time has come to step back and to evaluate the impact of technology-driven chemistry on diabetics and how the bridges from research laboratories to market products are established. In this review, the large variety of therapeutic approaches proposed in the last five years for diabetic patients are discussed in an applied context. A survey of the state of the art of closed-loop insulin delivery strategies in response to blood glucose level fluctuation is provided together with insights into the emerging key technologies for diagnosis and drug development. Chemical engineering strategies centered on preserving and regenerating functional pancreatic β-cell mass are evoked in addition as they represent a permanent solution for diabetic patients.

Diving beetle-like miniaturized plungers with reversible, rapid biofluid capturing for machine learning-based care of skin disease

Recent advances in bioinspired nano/microstructures have received attention as promising approaches with which to implement smart skin-interfacial devices for personalized health care. In situ skin diagnosis requires adaptable skin adherence and rapid capture of clinical biofluids. Here, we report a simple, all-in-one device consisting of microplungers and hydrogels that can rapidly capture biofluids and conformally attach to skin for stable, real-time monitoring of health. Inspired by the male diving beetle, the microplungers achieve repeatable, enhanced, and multidirectional adhesion to human skin in dry/wet environments, revealing the role of the cavities in these architectures. The hydrogels within the microplungers instantaneously absorb liquids from the epidermis for enhanced adhesiveness and reversibly change color for visual indication of skin pH levels. To realize advanced biomedical technologies for the diagnosis and treatment of skin, our suction-mediated device is integrated with a machine learning framework for accurate and automated colorimetric analysis of pH levels.

Wearable and Mobile Sensors for Personalized Nutrition

While wearable and mobile chemical sensors have experienced tremendous growth over the past decade, their potential for tracking and guiding nutrition has emerged only over the past three years. Currently, guidelines from doctors and dietitians represent the most common approach for maintaining optimal nutrition status. However, such recommendations rely on population averages and do not take into account individual variability in responding to nutrients. Precision nutrition has recently emerged to address the large heterogeneity in individuals' responses to diet, by tailoring nutrition based on the specific requirements of each person. It aims at preventing and managing diseases by formulating personalized dietary interventions to individuals on the basis of their metabolic profile, background, and environmental exposure. Recent advances in digital nutrition technology, including calories-counting mobile apps and wearable motion tracking devices, lack the ability of monitoring nutrition at the molecular level. The realization of effective precision nutrition requires synergy from different sensor modalities in order to make timely reliable predictions and efficient feedback. This work reviews key opportunities and challenges toward the successful realization of effective wearable and mobile nutrition monitoring platforms. Non-invasive wearable and mobile electrochemical sensors, capable of monitoring temporal chemical variations upon the intake of food and supplements, are excellent candidates to bridge the gap between digital and biochemical analyses for a successful personalized nutrition approach. By providing timely (previously unavailable) dietary information, such wearable and mobile sensors offer the guidance necessary for supporting dietary behavior change toward a managed nutritional balance. Coupling of the rapidly emerging wearable chemical sensing devices-generating enormous dynamic analytical data-with efficient data-fusion and data-mining methods that identify patterns and make predictions is expected to revolutionize dietary decision-making toward effective precision nutrition.

Development and Application of Mobile Apps for Molecular Sensing: A Review

Modern smartphone-based sensing devices are generally standalone detection platforms that can transduce signals (via the built-in USB port, audio jack, or camera), perform analysis through mobile applications (apps), and display results on the screen/user interface. The advancement toward this ultimate form of on-site chemical analysis and point-of-care diagnosis is tied closely with the evolution of mobile technology. Previous reviews in the field mainly focused on the physical platforms while overlooking the role of mobile apps in such devices. There exist three general stages throughout the development: (1) early generation telemedicine, (2) mobile phone-assisted clinical diagnosis (without apps), and (3) mobile app-based sensing devices for various analytes. This review presents the key breakthroughs during each stage, recent development, remaining challenges, and future perspectives of the field. Representative examples, spanning from the pioneering point-of-care testing to the latest devices with integrated mobile apps, are classified by their sensing mechanisms. The review also discusses the scarcity of open-source apps dedicated to molecular sensing. With the introduction of more open-source and commercial apps, the mobile app-based detection system is anticipated to dominate point-of-care diagnosis and on-site molecular sensing in our opinion.

Frontiers of graphene-based Hall-effect sensors

Hall sensors have become one of the most used magnetic sensors in recent decades, performing the vital function of providing a magnetic sense that is naturally absent in humans. Various electronic applications have evolved from circuit-integrated Hall sensors due to their low cost, simple linear magnetic field response, ability to operate in a large magnetic field range, high magnetic sensitivity and low electronic noise, in addition to many other advantages. Recent developments in the fabrication and performance of graphene Hall devices promise to open up the realm of Hall sensor applications by not only widening the horizon of current uses through performance improvements, but also driving Hall sensor electronics into entirely new areas. In this review paper we describe the evolution from the traditional selection of Hall device materials to graphene Hall devices, and explore the various applications enabled by them. This includes a summary of the selection of materials and architectures for contemporary micro-to nanoscale Hall sensors. We then turn our attention to introducing graphene and its remarkable physical properties and explore how this impacts the magnetic sensitivity and electronic noise of graphene-based Hall sensors. We summarise the current state-of-the art of research into graphene Hall probes, demonstrating their record-breaking performance. Building on this, we explore the various new application areas graphene Hall sensors are pioneering such as magnetic imaging and non-destructive testing. Finally, we look at recent encouraging results showing that graphene Hall sensors have plenty of room to improve, before then discussing future prospects for industry-level scalable fabrication.

A review of biomarkers in the context of type 1 diabetes: Biological sensing for enhanced glucose control

As wearable healthcare monitoring systems advance, there is immense potential for biological sensing to enhance the management of type 1 diabetes (T1D). The aim of this work is to describe the ongoing development of biomarker analytes in the context of T1D. Technological advances in transdermal biosensing offer remarkable opportunities to move from research laboratories to clinical point-of-care applications. In this review, a range of analytes, including glucose, insulin, glucagon, cortisol, lactate, epinephrine, and alcohol, as well as ketones such as beta-hydroxybutyrate, will be evaluated to determine the current status and research direction of those analytes specifically relevant to T1D management, using both in-vitro and on-body detection. Understanding state-of-the-art developments in biosensing technologies will aid in bridging the gap from bench-to-clinic T1D analyte measurement advancement.

The Microbiome Meets Nanotechnology: Opportunities and Challenges in Developing New Diagnostic Devices

Monitoring of the human microbiome is an emerging area of diagnostics for personalized medicine. Here, the potential of different nanomaterials and nanobiosensing technologies is reviewed for the development of novel diagnostic devices for the detection and measurement of microbiome-related biomarkers. Moreover, the current and future landscape of microbiome-based diagnostics is defined by exploring the advantages and disadvantages of current nanotechnology-based approaches, especially in the context of developing point-of-care (PoC) devices that would meet the international guidelines known as REASSURED (Real-time connectivity; Ease of specimen collection; Affordability; Sensitivity; Specificity; User-friendliness; Rapid & robust operation; Equipment-free; and Deliverability). Finally, the strategies of the latest international scientific consortia working in this field are analyzed, the current microbiome diagnostics market are reported and the principal ethical, legal, and societal issues related to microbiome R&D and innovation are discussed.

Artificial Skin Perception

Skin is the largest organ, with the functionalities of protection, regulation, and sensation. The emulation of human skin via flexible and stretchable electronics gives rise to electronic skin (e-skin), which has realized artificial sensation and other functions that cannot be achieved by conventional electronics. To date, tremendous progress has been made in data acquisition and transmission for e-skin systems, while the implementation of perception within systems, that is, sensory data processing, is still in its infancy. Integrating the perception functionality into a flexible and stretchable sensing system, namely artificial skin perception, is critical to endow current e-skin systems with higher intelligence. Here, recent progress in the design and fabrication of artificial skin perception devices and systems is summarized, and challenges and prospects are discussed. The strategies for implementing artificial skin perception utilize either conventional silicon-based circuits or novel flexible computing devices such as memristive devices and synaptic transistors, which enable artificial skin to surpass human skin, with a distributed, low-latency, and energy-efficient information-processing ability. In future, artificial skin perception would be a new enabling technology to construct next-generation intelligent electronic devices and systems for advanced applications, such as robotic surgery, rehabilitation, and prosthetics.

Reagentless biomolecular analysis using a molecular pendulum

The development of reagentless sensors that can detect molecular analytes in biological fluids could enable a broad range of applications in personalized health monitoring. However, only a limited set of molecular inputs can currently be detected using reagentless sensors. Here, we report a sensing mechanism that is compatible with the analysis of proteins that are important physiological markers of stress, allergy, cardiovascular health, inflammation and cancer. The sensing method is based on the motion of an inverted molecular pendulum that exhibits field-induced transport modulated by the presence of a bound analyte. We measure the sensor's electric field-mediated transport using the electron-transfer kinetics of an attached reporter molecule. Using time-resolved electrochemical measurements that enable unidirectional motion of our sensor, the presence of an analyte bound to our sensor complex can be tracked continuously in real time. We show that this sensing approach is compatible with making measurements in blood, saliva, urine, tears and sweat and that the sensors can collect data in situ in living animals.