Continuous glucose monitoring systems - Current status and future perspectives of the flagship technologies in biosensor research -

Calibration algorithms for continuous glucose monitoring systems based on interstitial fluid sensing

Continuous glucose monitoring (CGM) is of great importance to the treatment and prevention of diabetes. As a proven commercial technology, electrochemical glucose sensor based on interstitial fluid (ISF) sensing has high sensitivity and wide detection range. Therefore, it has good promotion prospects in noninvasive or minimally-invasive CGM system. However, since there are concentration differences and time lag between glucose in plasma and ISF, the accuracy of this type of sensors are still limited. Typical calibration algorithms rely on simple linear regression which do not account for the variability of the sensitivity of sensors. To enhance the accuracy and stability of CGM based on ISF, optimization of calibration algorithm for sensors is indispensable. While there have been considerable researches on improving calibration algorithms for CGM, they have still received less attention. This article reviews the problem of typical calibration and presents the outstanding calibration algorithms in recent years. Finally, combined with existing research and emerging sensing technologies, this paper makes an outlook on the future calibration algorithms for CGM sensors.

An integrated wearable differential microneedle array for continuous glucose monitoring in interstitial fluids

Monitoring biomarkers in human interstitial fluids (ISF) using microneedle sensors has been extensively studied. However, most of the previous studies were limited to simple in vitro demonstrations and lacked system integration and analytical performance. Here we report a miniaturized, high-precision, fully integrated wearable electrochemical microneedle sensing device that works with a customized smartphone application to wirelessly and in real-time monitor glucose in human ISF. A microneedle array fabrication method is proposed which enables multiple individually addressable, regionally separated sensing electrodes on a single microneedle system. As a demonstration, a glucose sensor and a differential sensor are integrated in a single sensing patch. The differential sensing electrodes can eliminate common-mode interference signals, thus significantly improving the detection accuracy. The basic mechanism of microneedle penetration into the skin was analyzed using the finite element method (FEM). By optimizing the structure of the microneedle, the puncture efficiency was improved while the puncture force was reduced. The electrochemical properties, biocompatibility, and system stability of the microneedle sensing device were characterized before human application. The test results were closely correlated with the gold standard (blood). The platform can be used not only for glucose detection, but also for various ISF biomarkers, and it expands the potential of microneedle technology in wearable sensing.

Wearable Aptalyzer Integrates Microneedle and Electrochemical Sensing for In Vivo Monitoring of Glucose and Lactate in Live Animals

Continuous monitoring of clinically relevant biomarkers within the interstitial fluid (ISF) using microneedle (MN)-based assays, has the potential to transform healthcare. This study introduces the Wearable Aptalyzer, an integrated system fabricated by combining biocompatible hydrogel MN arrays for ISF extraction with an electrochemical aptamer-based biosensor for in situ monitoring of blood analytes. The use of aptamers enables continuous monitoring of a wide range of analytes, beyond what is possible with enzymatic monitoring. The Wearable Aptalyzer is used for real-time and multiplexed monitoring of glucose and lactate in ISF. Validation experiments using live mice and rat models of type 1 diabetes demonstrate strong correlation between the measurements collected from the Wearable Aptalyzer in ISF and those obtained from gold-standard techniques for blood glucose and lactate, for each analyte alone and in combination. The Wearable Aptalyzer effectively addresses the limitations inherent in enzymatic detection methods as well as solid MN biosensors and the need for reliable and multiplexed bioanalytical monitoring in vivo.

Fabrication of Multiple-Channel Electrochemical Microneedle Electrode Array via Separated Functionalization and Assembly Method

Real-time monitoring of physiological indicators inside the body is pivotal for contemporary diagnostics and treatments. Implantable electrodes can not only track specific biomarkers but also facilitate therapeutic interventions. By modifying biometric components, implantable electrodes enable in situ metabolite detection in living tissues, notably beneficial in invasive glucose monitoring, which effectively alleviates the self-blood-glucose-managing burden for patients. However, the development of implantable electrochemical electrodes, especially multi-channel sensing devices, still faces challenges: (1) The complexity of direct preparation hinders functionalized or multi-parameter sensing on a small scale. (2) The fine structure of individual electrodes results in low spatial resolution for sensor functionalization. (3) There is limited conductivity due to simple device structures and weakly conductive electrode materials (such as silicon or polymers). To address these challenges, we developed multiple-channel electrochemical microneedle electrode arrays (MCEMEAs) via a separated functionalization and assembly process. Two-dimensional microneedle (2dMN)-based and one-dimensional microneedle (1dMN)-based electrodes were prepared by laser patterning, which were then modified as sensing electrodes by electrochemical deposition and glucose oxidase decoration to achieve separated functionalization and reduce mutual interference. The electrodes were then assembled into 2dMN- and 1dMN-based multi-channel electrochemical arrays (MCEAs), respectively, to avoid damaging functionalized coatings. In vitro and in vivo results demonstrated that the as-prepared MCEAs exhibit excellent transdermal capability, detection sensitivity, selectivity, and reproducibility, which was capable of real-time, in situ glucose concentration monitoring.

Exploratory insights into prefrontal cortex activity in continuous glucose monitoring: findings from a portable wearable functional near-infrared spectroscopy system

The escalating global prevalence of diabetes highlights an urgent need for advancements in continuous glucose monitoring (CGM) technologies that are non-invasive, accurate, and user-friendly. Here, we introduce a groundbreaking portable wearable functional near-infrared spectroscopy (fNIRS) system designed to monitor glucose levels by assessing prefrontal cortex (PFC) activity. Our study delineates the development and application of this novel fNIRS system, emphasizing its potential to revolutionize diabetes management by providing a non-invasive, real-time monitoring solution. Fifteen healthy university students participated in a controlled study, where we monitored their PFC activity and blood glucose levels under fasting and glucose-loaded conditions. Our findings reveal a significant correlation between PFC activity, as measured by our fNIRS system, and blood glucose levels, suggesting the feasibility of fNIRS technology for CGM. The portable nature of our system overcomes the mobility limitations of traditional setups, enabling continuous, real-time monitoring in everyday settings. We identified 10 critical features related to blood glucose levels from extensive fNIRS data and successfully correlated PFC function with blood glucose levels by constructing predictive models. Results show a positive association between fNIRS data and blood glucose levels, with the PFC exhibiting a clear response to blood glucose. Furthermore, the improved regressive rule principal component analysis (PCA) method outperforms traditional PCA in model prediction. We propose a model validation approach based on leave-one-out cross-validation, demonstrating the unique advantages of K-nearest neighbor (KNN) models. Comparative analysis with existing CGM methods reveals that our paper's KNN model exhibits lower RMSE and MARD at 0.11 and 8.96%, respectively, and the fNIRS data were highly significant positive correlation with actual blood glucose levels (r = 0.995, p < 0.000). This study provides valuable insights into the relationship between metabolic states and brain activity, laying the foundation for innovative CGM solutions. Our portable wearable fNIRS system represents a significant advancement in effective diabetes management, offering a promising alternative to current technologies and paving the way for future advancements in health monitoring and personalized medicine.

Continuous Glucose Monitoring Alarms in Adults with Type 1 Diabetes: User Characteristics and the Impact of Hypoglycemia and Hyperglycemia Alarm Thresholds on Glycemic Control

Background: Few studies have evaluated the implications of the alarm thresholds of continuous glucose monitoring (CGM) systems for individuals with diabetes. The present study aimed to investigate the influence of hypoglycemia and hyperglycemia alarm thresholds on glycemic control in adults with type 1 diabetes (T1DM) and the characteristics of patients who use these alarms more frequently. Methods: This observational cross-sectional study included 873 users of the FreeStyle Libre 2 system (501 men, median age 48 years, range 18-90 years) with T1DM from a single center. We investigated the role of demographic and metabolic factors on the use of alarms and the impact of hypoglycemia and hyperglycemia alarms and their thresholds on glycemic control. Results: Alarm users were older than nonusers (median age 49 vs. 43 years, respectively; P < 0.001). The hypoglycemia alarms were set by 76.1% of women and by 69.1% of men (P = 0.022). The hypoglycemia alarms reduced hypoglycemia features and glucose variability, although at the expense of shorter time in range. The higher the hypoglycemia alarm threshold, the greater these effects. The hyperglycemia alarms were effective in reducing hyperglycemia and lowering the glucose management indicator, although at the expense of a greater tendency to hypoglycemia. The lower the hyperglycemia alarm threshold, the greater these effects. Conclusions: CGM alarms contribute to better glycemic control. However, hypoglycemia and hyperglycemia alarms have advantages and disadvantages. Adults with T1DM should explore, under medical supervision, which alarm thresholds will best help them achieve their individual glycemic goals.

Comparing Equil patch versus traditional catheter insulin pump in type 2 diabetes using continuous glucose monitoring metrics and profiles

AIMS

It is not clear whether there are differences in glycemic control between the Equil patch and the MMT-712 insulin pump. Our objective was to compare two types of insulin pumps in the treatment of type 2 diabetes mellitus (T2DM), using continuous glucose monitoring (CGM) metrics and profiles.

METHODS

This was a randomized case-crossover clinical trial. Participants were hospitalized and randomly allocated to two groups and underwent two types of insulin pump treatments (group A: Equil patch-Medtronic MMT-712 insulin pump; group B: Medtronic MMT-712-Equil patch insulin pump) separated by a 1-day washout period. Glycemic control was achieved after 7-8 days of insulin pump therapy. Each patient received CGM for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, the Equil patch insulin pump treatment was switched to Medtronic MMT-712 insulin pump treatment at the same basal and bolus insulin doses or vice versa. CGM metrics and profiles including glycemic variability (GV), time in range (TIR, 3.9-10.0 mmol/L), time below range (TBR, <3.9 mmol/L), time above range (TAR, >10.0 mmol/L), and postprandial glucose excursions, as well as incidence of hypoglycemia.

RESULTS

Forty-six T2DM patients completed the study. There was no significant difference in parameters of daily GV and postprandial glucose excursions between the Equil patch insulin pump treatment and the Medtronic insulin pump treatment. Similarly, there was no between-treatment difference in TIR, TBR, and TAR, as well as the incidence of hypoglycemia.

CONCLUSION

The Equil patch insulin pump was similar to the traditional MMT-712 insulin pump in terms of glycemic control. Equil patch insulin pump is a reliable tool for glycemic management of diabetes mellitus.

The transition from genomics to phenomics in personalized population health

Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data-driven personalized approach that reflects their genetics, behaviour and environment, we can start to address these challenges. This assessment includes longitudinal phenome measures, such as the blood proteome and metabolome, gut microbiome composition and function, and lifestyle and behaviour through wearables and questionnaires. Here, we review ongoing large-scale genomics and longitudinal phenomics efforts and the powerful insights they provide into wellness. We describe our vision for the transformation of the current health care from disease-oriented to data-driven, wellness-oriented and personalized population health.

Technological Advances of Wearable Device for Continuous Monitoring of In Vivo Glucose

Managing diabetes is a chronic challenge today, requiring monitoring and timely insulin injections to maintain stable blood glucose levels. Traditional clinical testing relies on fingertip or venous blood collection, which has facilitated the emergence of continuous glucose monitoring (CGM) technology to address data limitations. Continuous glucose monitoring technology is recognized for tracking long-term blood glucose fluctuations, and its development, particularly in wearable devices, has given rise to compact and portable continuous glucose monitoring devices, which facilitates the measurement of blood glucose and adjustment of medication. This review introduces the development of wearable CGM-based technologies, including noninvasive methods using body fluids and invasive methods using implantable electrodes. The advantages and disadvantages of these approaches are discussed as well as the use of microneedle arrays in minimally invasive CGM. Microneedle arrays allow for painless transdermal puncture and are expected to facilitate the development of wearable CGM devices. Finally, we discuss the challenges and opportunities and look forward to the biomedical applications and future directions of wearable CGM-based technologies in biological research.

Discordance between Glucose Management Indicator and Glycated Hemoglobin in a Pediatric Cohort with Type 1 Diabetes: A Real-World Study

The introduction of continuous glucose monitoring (CGM) systems in clinical practice has allowed a more detailed picture of the intra- and interdaily glycemic fluctuations of individuals with type 1 diabetes (T1D). However, CGM-measured glucose control indicators may be occasionally inaccurate. This study aims to assess the discrepancy between the glucose management indicator (GMI) and glycated hemoglobin (HbA1c) (ΔGMI-HbA1c) within a cohort of children and adolescents with T1D, exploring its correlation with other CGM metrics and blood count parameters. In this single-center, cross-sectional study, we gathered demographic and clinical data, including blood count parameters, HbA1c values, and CGM metrics, from 128 pediatric subjects with T1D (43% female; mean age, 13.4 ± 3.6 years). Our findings revealed higher levels of the coefficient of variation (CV) (p < 0.001) and time above range > 250 mg/dL (p = 0.033) among subjects with ΔGMI-HbA1c > 0.3%. No association was observed between blood count parameters and ΔGMI-HbA1c. In conclusion, despite the advancements and the widespread adoption of CGM systems, HbA1c remains an essential parameter for the assessment of glycemic control, especially in individuals with suboptimal metabolic control and extreme glycemic variability.

Current advancements and prospects of enzymatic and non-enzymatic electrochemical glucose sensors

This review discusses the most current developments and future perspectives in enzymatic and non-enzymatic glucose sensors, which have notably evolved over the preceding quadrennial period. Furthermore, a thorough exploration encompassed the sensor's intricate fabrication processes, the diverse range of materials employed, the underlying principles of detection, and an in-depth assessment of the sensors' efficacy in detecting glucose levels within essential bodily fluids such as human blood serums, urine, saliva, and interstitial fluids. It is worth noting that the accurate quantification of glucose concentrations within human blood has been effectively achieved by utilizing classical enzymatic sensors harmoniously integrated with optical and electrochemical transduction mechanisms. Monitoring glucose levels in various mediums has attracted exceptional attention from industrial to academic researchers for diabetes management, food quality control, clinical medicine, and bioprocess inspection. There has been an enormous demand for the creation of novel glucose sensors over the past ten years. Research has primarily concentrated on succeeding biocompatible and enhanced sensing abilities related to the present technologies, offering innovative avenues for more effective glucose sensors. Recent developments in wearable optical and electrochemical sensors with low cost, high stability, point-of-care testing, and online tracking of glucose concentration levels in biological fluids can aid in managing and controlling diabetes globally. New nanomaterials and biomolecules that can be used in electrochemical sensor systems to identify glucose concentration levels are developed thanks to advances in nanoscience and nanotechnology. Both enzymatic and non-enzymatic glucose electrochemical sensors have garnered much interest recently and have made significant strides in detecting glucose levels. In this review, we summarise several categories of non-enzymatic glucose sensor materials, including composites, non-precious transition metals and their metal oxides, hydroxides, precious metals and their alloys, carbon-based materials, conducting polymers, metal-organic framework (MOF)-based electrocatalysts, and wearable device-based glucose sensors deeply.

Advances in Non-Electrochemical Sensing of Human Sweat Biomarkers: From Sweat Sampling to Signal Reading

Sweat, commonly referred to as the ultrafiltrate of blood plasma, is an essential physiological fluid in the human body. It contains a wide range of metabolites, electrolytes, and other biologically significant markers that are closely linked to human health. Compared to other bodily fluids, such as blood, sweat offers distinct advantages in terms of ease of collection and non-invasive detection. In recent years, considerable attention has been focused on wearable sweat sensors due to their potential for continuous monitoring of biomarkers. Electrochemical methods have been extensively used for in situ sweat biomarker analysis, as thoroughly reviewed by various researchers. This comprehensive review aims to provide an overview of recent advances in non-electrochemical methods for analyzing sweat, including colorimetric methods, fluorescence techniques, surface-enhanced Raman spectroscopy, and more. The review covers multiple aspects of non-electrochemical sweat analysis, encompassing sweat sampling methodologies, detection techniques, signal processing, and diverse applications. Furthermore, it highlights the current bottlenecks and challenges faced by non-electrochemical sensors, such as limitations and interference issues. Finally, the review concludes by offering insights into the prospects for non-electrochemical sensing technologies. By providing a valuable reference and inspiring researchers engaged in the field of sweat sensor development, this paper aspires to foster the creation of innovative and practical advancements in this domain.

Development of enzyme-inorganic hybrid nanoflower-modified electrodes and a smartphone-controlled electrochemical analyzer for point-of-care testing of salivary amylase in saliva

Quantitation of salivary alpha-amylase (sAA) plays a significant role in not only theoretical studies but also clinical practice. This study reports a quantitative point-of-care testing (POCT) system for sAA quantitation anywhere, anytime and by anyone, which consists of customized electrodes and a smartphone-controlled electrochemical analyzer. Organic-inorganic hybrid nanoflowers (NFs) encapsulating α-glucosidase (AG) and glucose dehydrogenase (GDH) have been synthesized and modified onto screen-printed electrodes (SPCEs) to fabricate the customized electrodes. The SPCEs integrated with the smartphone-controlled electrochemical analyzer exhibit good analytical performance for sAA with a low detection limit of 5.02 U mL-1 and a wide dynamic range of 100-2000 U mL-1 using chronoamperometry. The reported POCT system has been successfully demonstrated for quantitation of sAA in clinical saliva samples, and the quantitation results correlated well with those of the Bernfeld method which is extensively used in clinics. More importantly, this study reveals the great potential of sAA as an early warning indicator of abnormal glucose metabolism in obese individuals. Considering the non-invasive saliva sampling process as well as the easy-to-use and cost-effectiveness features of this quantitative POCT system, quantitation of salivary sAA at home by laypersons might become an appealing choice for obese individuals to monitor their glucose metabolism status anytime.

In-human testing of a non-invasive continuous low-energy microwave glucose sensor with advanced machine learning capabilities

Continuous glucose monitoring schemes that avoid finger pricking are of utmost importance to enhance the comfort and lifestyle of diabetic patients. To this aim, we propose a microwave planar sensing platform as a potent sensing technology that extends its applications to biomedical analytes. In this paper, a compact planar resonator-based sensor is introduced for noncontact sensing of glucose. Furthermore, in vivo and in-vitro tests using a microfluidic channel system and in clinical trial settings demonstrate its reliable operation. The proposed sensor offers real-time response and a high linear correlation (R2 ∼ 0.913) between the measured sensor response and the blood glucose level (GL). The sensor is also enhanced with machine learning to predict the variation of body glucose levels for non-diabetic and diabetic patients. This addition is instrumental in triggering preemptive measures in cases of unusual glucose level trends. In addition, it allows for the detection of common artifacts of the sensor as anomalies so that they can be removed from the measured data. The proposed system is designed to noninvasively monitor interstitial glucose levels in humans, introducing the opportunity to create a customized wearable apparatus with the ability to learn.

Smart sensing flexible sutures for glucose monitoring in house sparrows

There is a need for flexible chemical sensors for the ecological and physiological research of avian species such as house sparrows (Passer domesticus). Current methods in this field are invasive and require multiple physical interactions with the birds. Emerging research in flexible bioelectronics can enable realization of implantable devices that are mechanically compliant with the underlying tissues for continuous real-time sensing in situ. However, challenges still remain in forming an intimate flexible interface. One of the promising flexible bioelectronic platforms for tissue-embedded sensing is based on functionalizing surgical sutures or threads. Threads have three-dimensional flexibility, high surface-area-to-volume ratio, inherent wicking properties, and are easily functionalizable using reel-to-reel dip coating. Threads are ideal as they are lightweight, therefore, would not interfere with flight motion and would only require minimal interaction with the bird. However, the challenge remains in achieving a highly conductive yet flexible electrode for electrochemical sensing using materials such as gold. In this study, we address this issue through novel gold deposition directly on thread substrate followed by enzyme immobilization to realize flexible electrochemical glucose biosensors on medical-grade sutures. These sensors were calibrated and tested in a range that is wide enough to include the expected range of glucose concentration in house sparrows (0-8.55 mM). Glucose monitoring in house sparrows will provide insights into energy metabolism and regulation during stress responses. In addition, the stability, repeatability, and selectivity of the sensor were tested with final validation in a real bird. Our innovative gold-coated, thread-based flexible electrochemical glucose sensor can also be used in other small and large animals. This can also be extended to monitoring other metabolites in future.

Evidence and Diabetes Technology: A Catch-22?

Diabetes technology is a dynamically evolving field. Sometimes the pace of evaluation of new diabetes technologies does not keep pace with its dynamic development. This leads to a dilemma: either the evaluation lags behind the developing technologies or diabetes technologies are used without sufficient evaluation. This situation is known as the Catch 22 dilemma. The aim of this paper is a discussion of ideas for a timely assessment, taking account of the speed of technological development and the need for evidence and safety improvement.

Smart Contact Lenses-A Step towards Non-Invasive Continuous Eye Health Monitoring

According to the age-old adage, while eyes are often considered the gateway to the soul, they might also provide insights into a more pragmatic aspect of our health: blood sugar levels. This potential breakthrough could be realized through the development of smart contact lenses (SCLs). Although contact lenses were first developed for eyesight correction, new uses have recently become available. In the near future, it might be possible to monitor a variety of ocular and systemic disorders using contact lens sensors. Within the realm of glaucoma, SCLs present a novel prospect, offering a potentially superior avenue compared to traditional management techniques. These lenses introduce the possibility of non-invasive and continuous monitoring of intraocular pressure (IOP) while also enabling the personalized administration of medication as and when needed. This convergence holds great promise for advancing glaucoma care. In this review, recent developments in SCLs, including their potential applications, such as IOP and glucose monitoring, are briefly discussed.

Monitoring saliva compositions for non-invasive detection of diabetes using a colorimetric-based multiple sensor

The increasing population of diabetic patients, especially in developing countries, has posed a serious risk to the health sector, so that the lack of timely diagnosis and treatment process of diabetes can lead to threatening complications for the human lifestyle. Here, a multiple sensor was fabricated on a paper substrate for rapid detection and controlling the progress of the diabetes disease. The proposed sensor utilized the sensing ability of porphyrazines, pH-sensitive dyes and silver nanoparticles in order to detect the differences in saliva composition of diabetic and non-diabetic patients. A unique color map (sensor response) was obtained for each studied group, which can be monitored by a scanner. Moreover, a good correlation was observed between the colorimetric response resulting from the analysis of salivary composition and the fasting blood glucose (FBG) value measured by standard laboratory instruments. It was also possible to classify participants into two groups, including patients caused by diabetes and those were non-diabetic persons with a total accuracy of 88.9%. Statistical evaluations show that the multiple sensor can be employed as an effective and non-invasive device for continuous monitoring of diabetes, substantially in the elderly.

Continuous monitoring of multiple biomarkers with an ultrasensitive 3D-structured wearable biosensor

Chronic diseases call for routine management of frequent monitoring of specific biomarkers. Traditional in vitro diagnostics technologies suffer from complex sampling processes and long detection intervals, which cannot meet the need of continuous monitoring. Wearable devices taking advantage of compact size, rapid detection process, and small sample consumption are promising to take the place of endpoint detection, providing more comprehensive information about human health. Here, we proposed a fully integrated wearable system with an ultrasensitive 3D-structured biosensor for real-time monitoring of multiple metabolites. The 3D-structured biosensor shows wide linear ranges of 400-1,400 μM and 0.1-8 mM and high sensitivities of 460.5 and 283.09 μA/(mM·cm2) for lactate and glucose detection, respectively. We have conducted in vivo animal experiments, and the proposed wearable biosensor demonstrated high consistency with established methods. We envision that this system could provide a real-time wearable detection platform for multiple biomarker detection.

Cyclodextrin Host-Guest Recognition in Glucose-Monitoring Sensors

Diabetes mellitus is a prevalent chronic health condition that has caused millions of deaths worldwide. Monitoring blood glucose levels is crucial in diabetes management, aiding in clinical decision making and reducing the incidence of hypoglycemic episodes, thereby decreasing morbidity and mortality rates. Despite advancements in glucose monitoring (GM), the development of noninvasive, rapid, accurate, sensitive, selective, and stable systems for continuous monitoring remains a challenge. Addressing these challenges is critical to improving the clinical utility of GM technologies in diabetes management. In this concept, cyclodextrins (CDs) can be instrumental in the development of GM systems due to their high supramolecular recognition capabilities based on the host-guest interaction. The introduction of CDs into GM systems not only impacts the sensitivity, selectivity, and detection limit of the monitoring process but also improves biocompatibility and stability. These findings motivated the current review to provide a comprehensive summary of CD-based blood glucose sensors and their chemistry of glucose detection, efficiency, and accuracy. We categorize CD-based sensors into four groups based on their modification strategies, including CD-modified boronic acid, CD-modified mediators, CD-modified nanoparticles, and CD-modified functionalized polymers. These findings shed light on the potential of CD-based sensors as a promising tool for continuous GM in diabetes mellitus management.

Immobilization of Enzyme Electrochemical Biosensors and Their Application to Food Bioprocess Monitoring

Electrochemical biosensors based on immobilized enzymes are among the most popular and commercially successful biosensors. The literature in this field suggests that modification of electrodes with nanomaterials is an excellent method for enzyme immobilization, which can greatly improve the stability and sensitivity of the sensor. However, the poor stability, weak reproducibility, and limited lifetime of the enzyme itself still limit the requirements for the development of enzyme electrochemical biosensors for food production process monitoring. Therefore, constructing sensing technologies based on enzyme electrochemical biosensors remains a great challenge. This article outlines the construction principles of four generations of enzyme electrochemical biosensors and discusses the applications of single-enzyme systems, multi-enzyme systems, and nano-enzyme systems developed based on these principles. The article further describes methods to improve enzyme immobilization by combining different types of nanomaterials such as metals and their oxides, graphene-related materials, metal-organic frameworks, carbon nanotubes, and conducting polymers. In addition, the article highlights the challenges and future trends of enzyme electrochemical biosensors, providing theoretical support and future perspectives for further research and development of high-performance enzyme chemical biosensors.

Polyvinylpyrrolidone/TiO2 composites' preparation via sol-gel procedure furthered with non-enzymatic glucose sensing and antibacterial effectiveness

An amperometric non-enzymatic glucose sensing based on polyvinylpyrrolidone and titanium dioxide nanocomposites (PVP-TiO2 NCs) fabricated over stainless-steel (SS) electrode was experimented. The electrode was fabricated of PVP-TiO2 NCs onto SS surface through drop casting coating. The NCs and the electrode were analyzed using Fourier transform infrared (FTIR) and UV-visible (UV-Vis) spectroscopy, X-ray diffraction spectra (XRD), X-ray photoelectron spectra (XPS), particle analyzer, scanning electron microscopy (SEM), EDS and transmission electron microscopy (TEM) and Brunauer-Emmett-Teller (BET) analysis for surface. For electrochemical investigation, cyclic voltammetry, electrochemical impedance spectra, including Nyquist plots and Bode plots, and chronoamperometry were adopted. PVP-TiO2/SS-modified electrode manifested high sensitivity of 360.13 µA/mM.cm2, lower detection limit of 756.8 µM and 0 to 13 mM linear range with regression coefficient of R2 = 0.992. The electrode exhibited high stability with good anti-interference tendency against fructose, uric acid, ascorbic acid and sucrose. The modified electrode also performed well in real sample glucose detection. Further, PVP-TiO2 NCs performed appreciably toward antibacterial studies against some Gram-positive and Gram-negative deleterious bacteria, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Shigella flexneri microbes.

Perceptions of Continuous Glucose Monitoring Systems in the T1D Exchange Diabetes Registry: Satisfaction, Concerns, and Areas for Future Improvement

Manufacturers continue to improve performance and usability of continuous glucose monitoring (CGM) systems. As CGM becomes a standard of care, especially for people on insulin therapy, it is important to routinely gauge how satisfied people with diabetes are with this technology. This article describes survey feedback from a large cohort of people with diabetes using older and current CGM systems and highlights areas of current satisfaction, concern, and future system improvement.

Wearable Insulin Biosensors for Diabetes Management: Advances and Challenges

We present a critical review of the current progress in wearable insulin biosensors. For over 40 years, glucose biosensors have been used for diabetes management. Measurement of blood glucose is an indirect method for calculating the insulin administration dosage, which is critical for insulin-dependent diabetic patients. Research and development efforts aiming towards continuous-insulin-monitoring biosensors in combination with existing glucose biosensors are expected to offer a more accurate estimation of insulin sensitivity, regulate insulin dosage and facilitate progress towards development of a reliable artificial pancreas, as an ultimate goal in diabetes management and personalised medicine. Conventional laboratory analytical techniques for insulin detection are expensive and time-consuming and lack a real-time monitoring capability. On the other hand, biosensors offer point-of-care testing, continuous monitoring, miniaturisation, high specificity and sensitivity, rapid response time, ease of use and low costs. Current research, future developments and challenges in insulin biosensor technology are reviewed and assessed. Different insulin biosensor categories such as aptamer-based, molecularly imprinted polymer (MIP)-based, label-free and other types are presented among the latest developments in the field. This multidisciplinary field requires engagement between scientists, engineers, clinicians and industry for addressing the challenges for a commercial, reliable, real-time-monitoring wearable insulin biosensor.

Wearable Microfluidics for Continuous Assay

The development of wearable devices provides approaches for the realization of self-health care. Easily carried wearable devices allow individual health monitoring at any place whenever necessary. There are various interesting monitoring targets, including body motion, organ pressure, and biomarkers. An efficient use of space in one small device is a promising resolution to increase the functions of wearable devices. Through integration of a microfluidic system into wearable devices, embedding complicated structures in one design becomes possible and can enable multifunction analyses within a limited device volume. This article reviews the reported microfluidic wearable devices, introduces applications to different biofluids, discusses characteristics of the design strategies and sensing principles, and highlights the attractive configurations of each device. This review seeks to provide a detailed summary of recent advanced microfluidic wearable devices. The overview of advanced key components is the basis for the development of future microfluidic wearable devices.

Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management

Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.

Stimuli-bioresponsive hydrogels as new generation materials for implantable, wearable, and disposable biosensors for medical diagnostics: Principles, opportunities, and challenges

Hydrogels are excellent water-swollen polymeric materials for use in wearable, implantable, and disposable biosensors. Hydrogels have unique properties such as low cost, ease of preparation, transparency, rapid response to external conditions, biocompatibility and self-adhesion to the skin, flexibility, and strain sensitivity, making them ideal for use in biosensor platforms. This review provides a detailed overview of advanced applications of stimuli-responsive hydrogels in biosensor platforms, from hydrogel synthesis and functionalization for bioreceptor immobilization to several important diagnostic applications. Emphasis is placed on recent advances in the fabrication of ultrasensitive fluorescent and electrically conductive hydrogels and their applications in wearable, implantable, and disposable biosensors for quantitative measurements. Design, modification, and assembly techniques of fluorescent, ionically conductive, and electrically conductive hydrogels to improve performance will be addressed. The advantages and performance improvements of immobilizing bioreceptors (e.g., antibodies, enzymes, and aptamers), and incorporating fluorescent and electrically conductive nanomaterials are described, as are their limitations. Potential applications of hydrogels in implantable, wearable, disposable portable biosensors for quantitative detection of the various bioanalytes (ions, molecules, drugs, proteins, and biomarkers) are discussed. Finally, the global market for hydrogel-based biosensors and future challenges and prospects are discussed in detail.

Leveraging the future of diagnosis and management of diabetes: From old indexes to new technologies

BACKGROUND

Diabetes is a heterogeneous and multifactorial disease. However, glycemia and glycated hemoglobin have been the focus of diabetes diagnosis and management for the last decades. As diabetes management goes far beyond glucose control, it has become clear that assessment of other biochemical parameters gives a much wider view of the metabolic state of each individual, enabling a precision medicine approach.

METHODS

In this review, we summarize and discuss indexes that have been used in epidemiological studies and in the clinical practice.

RESULTS

Indexes of insulin secretion, sensitivity/resistance and metabolism have been developed and validated over the years to account also with insulin, C-peptide, triglycerides or even anthropometric measures. Nevertheless, each one has their own objective and consequently, advantages and disadvantages for specific cases. Thus, we discuss how new technologies, namely new sensors but also new softwares/applications, can improve the diagnosis and management of diabetes, both for healthcare professionals but also for caretakers and, importantly, to promote the empowerment of people living with diabetes.

CONCLUSIONS

In long-term, the solution for a better diabetes management would be a platform that allows to integrate all sorts of relevant information for the person with diabetes and for the healthcare practitioners, namely glucose, insulin and C-peptide or, in case of need, other parameters/indexes at home, sometimes more than once a day. This solution would allow a better and simpler disease management, more adequate therapeutics thereby improving patients' quality of life and reducing associated costs.

Minimally invasive electrochemical continuous glucose monitoring sensors: Recent progress and perspective

Diabetes and its complications are seriously threatening the health and well-being of hundreds of millions of people. Glucose levels are essential indicators of the health conditions of diabetics. Over the past decade, concerted efforts in various fields have led to significant advances in glucose monitoring technology. In particular, the rapid development of continuous glucose monitoring (CGM) based on electrochemical sensing principles has great potential to overcome the limitations of self-monitoring blood glucose (SMBG) in continuously tracking glucose trends, evaluating diabetes treatment options, and improving the quality of life of diabetics. However, the applications of minimally invasive electrochemical CGM sensors are still limited owing to the following aspects: i) invasiveness, ii) short lifespan, iii) biocompatibility, and iv) calibration and prediction. In recent years, the performance of minimally invasive electrochemical CGM systems (CGMSs) has been significantly improved owing to breakthrough developments in new materials and key technologies. In this review, we summarize the history of commercial CGMSs, the development of sensing principles, and the research progress of minimally invasive electrochemical CGM sensors in reducing the invasiveness of implanted probes, maintaining enzyme activity, and improving the biocompatibility of the sensor interface. In addition, this review also introduces calibration algorithms and prediction algorithms applied to CGMSs and describes the application of machine learning algorithms for glucose prediction.

Technology Roadmap for Flexible Sensors

Humans rely increasingly on sensors to address grand challenges and to improve quality of life in the era of digitalization and big data. For ubiquitous sensing, flexible sensors are developed to overcome the limitations of conventional rigid counterparts. Despite rapid advancement in bench-side research over the last decade, the market adoption of flexible sensors remains limited. To ease and to expedite their deployment, here, we identify bottlenecks hindering the maturation of flexible sensors and propose promising solutions. We first analyze challenges in achieving satisfactory sensing performance for real-world applications and then summarize issues in compatible sensor-biology interfaces, followed by brief discussions on powering and connecting sensor networks. Issues en route to commercialization and for sustainable growth of the sector are also analyzed, highlighting environmental concerns and emphasizing nontechnical issues such as business, regulatory, and ethical considerations. Additionally, we look at future intelligent flexible sensors. In proposing a comprehensive roadmap, we hope to steer research efforts towards common goals and to guide coordinated development strategies from disparate communities. Through such collaborative efforts, scientific breakthroughs can be made sooner and capitalized for the betterment of humanity.

Clinical Accuracy of a Glucose Oxidase-Based Blood Glucose Test-Strip Across Extremes of Oxygen Partial Pressure

BACKGROUND

Glucose oxidase (GOx)-based blood glucose monitors (BGMs) are influenced by the partial pressure of oxygen (Po2) within the applied sample. Limited in-clinic data exists regarding the quantitative effect of Po2 in unmanipulated capillary fingertip blood samples across physiologically representative glucose and Po2 ranges.

METHOD

Clinical accuracy data were collected as part of a BGM manufacturer's ongoing post-market surveillance program for a commercially available GOx-based BGM test-strip. The data set comprised 29 901 paired BGM-comparator readings and corresponding Po2 values from 5 428 blood samples from a panel of 975 subjects.

RESULTS

A linear regression-calculated bias range of 5.22% (+0.72% [low Po2: 45 mm Hg] to -4.5% [high Po2: 105 mm Hg]); biases calculated as absolute at <100 mg/dL glucose was found. Below the nominal Po2 of 75 mm Hg, a linear regression bias of +3.14% was calculated at low Po2, while negligible impact on bias (regression slope: +0.002%) was observed at higher than nominal levels (>75 mm Hg). When evaluating BGM performance under corner conditions of low (<70 mg/dL) and high (>180 mg/dL) glucose, combined with low and high Po2, linear regression biases ranged from +1.52% to -5.32% within this small group of subjects and with no readings recorded at <70 mg/dL glucose at low and high Po2.

CONCLUSIONS

Data from this large-scale clinical study, performed on unmanipulated fingertip capillary bloods from a diverse diabetes population, indicate Po2 sensitivity of the BGM to be markedly lower than published studies, which are mainly laboratory-based, requiring artificial manipulation of oxygen levels in aliquots of venous blood.

Non-invasive method for blood glucose monitoring using ECG signal

Introduction: Tight glucose monitoring is crucial for diabetic patients by using a Continuous Glucose Monitor (CGM). The existing CGMs measure the Blood Glucose Concentration (BGC) from the interstitial fluid. These technologies are quite expensive, and most of them are invasive. Previous studies have demonstrated that hypoglycemia and hyperglycemia episodes affect the electrophysiology of the heart. However, they did not determine a cohort relationship between BGC and ECG parameters.

Material and method: In this work, we propose a new method for determining the BGC using surface ECG signals. Recurrent Convolutional Neural Networks (RCNN) were applied to segment the ECG signals. Then, the extracted features were employed to determine the BGC using two mathematical equations. This method has been tested on 04 patients over multiple days from the D1namo dataset, using surface ECG signals instead of intracardiac signal.

Results: We were able to segment the ECG signals with an accuracy of 94% using the RCNN algorithm. According to the results, the proposed method was able to estimate the BGC with a Mean Absolute Error (MAE) of 0.0539, and a Mean Squared Error (MSE) of 0.1604. In addition, the linear relationship between BGC and ECG features has been confirmed in this paper.

Conclusion: In this paper, we propose the potential use of ECG features to determine the BGC. Additionally, we confirmed the linear relationship between BGC and ECG features. That fact will open new perspectives for further research, namely physiological models. Furthermore, the findings point to the possible application of ECG wearable devices for non-invasive continuous blood glucose monitoring via machine learning.

Blood glucose estimation based on ECG signal

Successful self-management of diabetes requires Continuous Glucose Monitors (CGMs). These CGMs have several limitations such as being invasive, expensive and limited in terms of use. Many techniques, in vain, have been proposed to overcome these limitations. Nowadays, with the help of the Internet of Medical Things (IoMT) technologies, researchers are working to find alternative solutions. They succeed to predict hypoglycemia and hyperglycemia peaks using Electrocardiogram (ECG) signals. However, they failed to use it to estimate the Blood Glucose Concentration (BGC) directly and in real time. Three patients with 08 days of measurements from the D1namo dataset contributed to the study. A new technique has been proposed to estimate the BGC curves based on ECG signals. We used a convolutional neural network to segment the different regions of ECG signals as well as we extracted ECG features that were required for the next step. Then, five regression models have been employed to estimate BGC using as input sixth ECG parameters. We were able to segment the ECG signals with an accuracy of 94% using the convolutional neural network algorithm. The best performance among all simulated models was provided by Exponential Gaussian Process Regression (GPR) with Root Mean Squared Error (RMSE) values of 0.32, 0.41, 0.67 and R-squared (R²) values of 98%, 80%, and 70% for patients 01, 02 and 03 respectively. The method indicates the potential use of ECG wearable devices as non-invasive for continuous blood glucose monitoring, which is affordable and durable.

Progress on the influence of non-enzymatic electrodes characteristics on the response to glucose detection: a review (2016–2022)

Glucose sensing devices have experienced significant progress in the last years in response to the demand for cost-effective monitoring. Thus, research efforts have been focused on achieving reliable, selective, and sensitive sensors able to monitor the glucose level in different biofluids. The development of enzyme-based devices is challenged by poor stability, time-consuming, and complex purification procedures, facts that have given rise to the synthesis of enzyme-free sensors. Recent advances focus on the use of different components: metal-organic frameworks (MOFs), carbon nanomaterials, or metal oxides. Motivated by this topic, several reviews have been published addressing the sensor materials and synthesis methods, gathering relevant information for the development of new nanostructures. However, the abundant information has not concluded yet in commercial devices and is not useful from an engineering point of view. The dependence of the electrode response on its physico-chemical nature, which would determine the selection and optimization of the materials and synthesis method, remains an open question. Thus, this review aims to critically analyze from an engineering vision the existing information on non-enzymatic glucose electrodes; the analysis is performed linking the response in terms of sensitivity when interferences are present, stability, and response under physiological conditions to the electrode characteristics.

Single-Molecule Optical Biosensing: Recent Advances and Future Challenges

In recent years, the sensitivity and specificity of optical sensors has improved tremendously due to improvements in biochemical functionalization protocols and optical detection systems. As a result, single-molecule sensitivity has been reported in a range of biosensing assay formats. In this Perspective, we summarize optical sensors that achieve single-molecule sensitivity in direct label-free assays, sandwich assays, and competitive assays. We describe the advantages and disadvantages of single-molecule assays and summarize future challenges in the field including their optical miniaturization and integration, multimodal sensing capabilities, accessible time scales, and compatibility with real-life matrices such as biological fluids. We conclude by highlighting the possible application areas of optical single-molecule sensors that include not only healthcare but also the monitoring of the environment and industrial processes.

Accelerating the development of implantable neurochemical biosensors by using existing clinically applied depth electrodes

In this study, an implantable stereo-electroencephalography (sEEG) depth electrode was functionalised with an enzyme coating for enzyme-based biosensing of glucose and L-glutamate. This was done because personalised medicine could benefit from active real-time neurochemical monitoring on small spatial and temporal scales to further understand and treat neurological disorders. To achieve this, the sEEG depth electrode was characterised using cyclic voltammetry (CV), differential pulse voltammetry (DPV), square wave voltammetry (SWV), and electrochemical impedance spectroscopy (EIS) using several electrochemical redox mediators (potassium ferri/ferrocyanide, ruthenium hexamine chloride, and dopamine). To improve performance, the Pt sensors on the sEEG depth electrode were coated with platinum black and a crosslinked gelatin-enzyme film to enable enzymatic biosensing. This characterisation work showed that producing a useable electrode with a good electrochemical response showing the expected behaviour for a platinum electrode was possible. Coating with Pt black improved the sensitivity to H₂O₂ over unmodified electrodes and approached that of well-defined Pt macro disc electrodes. Measured current showed good dependence on concentration, and the calibration curves report good sensitivity of 29.65 nA/cm²/μM for glucose and 8.05 nA/cm²/μM for L-glutamate with a stable, repeatable, and linear response. These findings demonstrate that existing clinical electrode devices can be adapted for combined electrochemical and electrophysiological measurement in patients and obviate the need to develop new electrodes when existing clinically approved devices and the associated knowledge can be reused. This accelerates the time to use and application of in vivo and wearable biosensing for diagnosis, treatment, and personalised medicine.

Microgravity environment grown crystal structure information based engineering of direct electron transfer type glucose dehydrogenase

The heterotrimeric flavin adenine dinucleotide dependent glucose dehydrogenase is a promising enzyme for direct electron transfer (DET) principle-based glucose sensors within continuous glucose monitoring systems. We elucidate the structure of the subunit interface of this enzyme by preparing heterotrimer complex protein crystals grown under a space microgravity environment. Based on the proposed structure, we introduce inter-subunit disulfide bonds between the small and electron transfer subunits (5 pairs), as well as the catalytic and the electron transfer subunits (9 pairs). Without compromising the enzyme's catalytic efficiency, a mutant enzyme harboring Pro205Cys in the catalytic subunit, Asp383Cys and Tyr349Cys in the electron transfer subunit, and Lys155Cys in the small subunit, is determined to be the most stable of the variants. The developed engineered enzyme demonstrate a higher catalytic activity and DET ability than the wild type. This mutant retains its full activity below 70 °C as well as after incubation at 75 °C for 15 min - much higher temperatures than the current gold standard enzyme, glucose oxidase, is capable of withstanding.

Subcutaneously implantable electromagnetic biosensor system for continuous glucose monitoring

Continuous glucose monitoring systems (CGMS) are becoming increasingly popular in diabetes management compared to conventional methods of self-blood glucose monitoring systems. They help understanding physiological responses towards nutrition intake, physical activities in everyday life and glucose control. CGMS available in market are of two types based on their working principle. Needle type systems with few weeks lifespan (e.g., enzyme-based Freestyle Libre) and implant type system (e.g., fluorescence-based Senseonics) with few months of lifespan are commercially available. An alternate to both working methods, herein, we propose electromagnetic-based sensor that can be subcutaneously implanted and capable of tracking minute changes in dielectric permittivity owing to changes in blood glucose level (BGL). Proof-of-concept of proposed electromagnetic-based implant sensor has been validated in intravenous glucose tolerance test (IVGTT) conducted on swine and beagle in a controlled environment. Sensor interface modules, mobile applications, and glucose mapping algorithms are also developed for continuous measurement in a freely moving beagle during oral glucose tolerance test (OGTT). The results of the short-term (1 h, IVGTT) and long-term (52 h, OGTT) test are summarized in this work. A close trend is observed between sensor frequency and BGL during GTT experiments on both animal species.

Advances in Electrochemical Nano-Biosensors for Biomedical and Environmental Applications: From Current Work to Future Perspectives

Modern life quality is strongly supported by the advances made in biosensors, which has been attributed to their crucial and viable contribution in point-of-care (POC) technology developments. POC devices are exploited for the fast tracing of disease progression, rapid analysis of water, and food quality assessment. Blood glucose meters, home pregnancy strips, and COVID-19 rapid tests all represent common examples of successful biosensors. Biosensors can provide great specificity due to the incorporation of selective bio-recognition elements and portability at significantly reduced costs. Electrochemical biosensor platforms are one of the most advantageous of these platforms because they offer many merits, such as being cheap, selective, specific, rapid, and portable. Furthermore, they can be incorporated into smartphones and various analytical approaches in order to increase their sensitivity and many other properties. As a very broad and interdisciplinary area of research and development, biosensors include all disciplines and backgrounds from materials science, chemistry, physics, medicine, microbiology/biology, and engineering. Accordingly, in this state-of-the-art article, historical background alongside the long journey of biosensing construction and development, starting from the Clark oxygen electrode until reaching highly advanced wearable stretchable biosensing devices, are discussed. Consequently, selected examples among the miscellaneous applications of nanobiosensors (such as microbial detection, cancer diagnosis, toxicity analysis, food quality-control assurance, point of care, and health prognosis) are described. Eventually, future perspectives for intelligent biosensor commercialization and exploitation in real-life that is going to be supported by machine learning and artificial intelligence (AI) are stated.

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.

Nanoparticle–Hydrogel Based Sensors: Synthesis and Applications

Hydrogels are hydrophilic three-dimensional (3D) porous polymer networks that can easily stabilize various nanoparticles. Loading noble metal nanoparticles into a 3D network of hydrogels can enhance the synergy of the components. It can also be modified to prepare intelligent materials that can recognize external stimuli. The combination of noble metal nanoparticles and hydrogels to produce modified or new composite materials has attracted considerable attention as to the use of these materials in sensors. However, there is limited review literature on nanoparticle–hydrogel-based sensors. This paper presents the detailed strategies of synthesis and design of the composites, and the latest applications of nanoparticle–hydrogel materials in the sensing field. Finally, the current challenges and future development directions of nanoparticle–hydrogel-based sensors are proposed.

In Vitro Continuous 3 Months Operation of Direct Electron Transfer Type Open Circuit Potential Based Glucose Sensor: Heralding the Next CGM Sensor

BACKGROUND

While continuous glucose monitoring (CGM) systems allow precise and real-time blood glucose control, current electrochemicalbased CGM technologies inherently harbor enzyme instability issues. The direct electron transfer (DET) type open circuit potential (OCP) based enzyme sensing principle can minimize the catalytic turnover of the enzyme reaction, thereby providing longer-term operational stability in future CGM glucose sensors.

METHOD

DET-type OCP based glucose sensors were constructed using gold disk electrodes with glucose dehydrogenase capable of DET which was immobilized using a self-assembled monolayer (SAM). The single enzyme layer prepared on the gold electrode was operated in the presence of glucose, using in vitro buffer solution, continuously for over 3 months with the OCP sensor signal monitored every 10 seconds at 25°C.

RESULTS

The DET-type OCP glucose sensor was continuously operated for more than 3 months without a significant decrease of the sensor signal and sensitivity (slope). These results suggest that the DET-type OCP glucose sensor is far more stable than the sensor constructed based on the amperometric principle. The long-term stability of DET-type OCP glucose sensor is attributed to the enzyme's minimized catalytic reaction during the operation, thereby extending the lifetime of enzyme.

CONCLUSION

The DET-type OCP glucose sensor can be continuously operated for more than 3 months at 25 °C, in vitro without significant decreases in sensor signal and sensitivity. While the further investigation will be required for in vivo validation, the DET-type OCP glucose sensor is ideal for next generation CGM's, especially in long duration implantable use cases.

In Vitro Evaluation of Miniaturized Amperometric Enzyme Sensor Based on the Direct Electron Transfer Principle for Continuous Glucose Monitoring

BACKGROUND

The bacterial derived flavin adenine dinucleotide (FAD)-dependent glucose dehydrogenase (FADGDH) is the most promising enzyme for the third-generation principle-based enzyme sensor for continuous glucose monitoring (CGM). Due to the ability of the enzyme to transfer electrons directly to the electrode, recognized as direct electron transfer (DET)-type FADGDH, although no investigation has been reported about DET-type FADGDH employed on a miniaturized integrated electrode.

METHODS

The miniaturized integrated electrode was formed by sputtering gold (Au) onto a flexible film with 0.1 mm in thickness and divided into 3 parts. After an insulation layer was laminated, 3 openings for a working electrode, a counter electrode and a reference electrode were formed by dry etching. A reagent mix containing 1.2 × 10^-4 Unit of DET-type FADGDH and carbon particles was deposited. The long-term stability of sensor was evaluated by continuous operation, and its performance was also evaluated in the presence of acetaminophen and the change in oxygen partial pressure (pO₂) level.

RESULTS

The amperometric response of the sensor showed a linear response to glucose concentration up to 500 mg/dL without significant change of the response over an 11-day continuous measurement. Moreover, the effect of acetaminophen and pO₂ on the response were negligible.

CONCLUSIONS

These results indicate the superb potential of the DET-type FADGDH-based sensor with the combination of a miniaturized integrated electrode. Thus, the described miniaturized DET-type glucose sensor for CGM will be a promising tool for effective glycemic control. This will be further investigated using an in vivo study.

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.