Comprehensive Review on Wearable Sweat-Glucose Sensors for Continuous Glucose Monitoring

The incidence of diabetes is increasing at an alarming rate, and regular glucose monitoring is critical in order to manage diabetes. Currently, glucose in the body is measured by an invasive method of blood sugar testing. Blood glucose (BG) monitoring devices measure the amount of sugar in a small sample of blood, usually drawn from pricking the fingertip, and placed on a disposable test strip. Therefore, there is a need for non-invasive continuous glucose monitoring, which is possible using a sweat sensor-based approach. As sweat sensors have garnered much interest in recent years, this study attempts to summarize recent developments in non-invasive continuous glucose monitoring using sweat sensors based on different approaches with an emphasis on the devices that can potentially be integrated into a wearable platform. Numerous research entities have been developing wearable sensors for continuous blood glucose monitoring, however, there are no commercially viable, non-invasive glucose monitors on the market at the moment. This review article provides the state-of-the-art in sweat glucose monitoring, particularly keeping in sight the prospect of its commercialization. The challenges relating to sweat collection, sweat sample degradation, person to person sweat amount variation, various detection methods, and their glucose detection sensitivity, and also the commercial viability are thoroughly covered.

Clinical and economic benefits of continuous blood glucose monitoring devices

The main intervention to reduce the macro-and microvascular complications of diabetes mellitus (DM) remains to achieve better long-term glycemic control. We have discussed the clinical and economic advantages of using continuous glucose monitoring (CGM) devices for type 1 DM and type 2 DM (T1DM and T2DM) based on data from relevant studies in the literature. Our findings show that using these modalities is associated with remarkable outcomes, including reduced HbA1c levels and enhanced glycemic control among patients with T1DM and T2DM. This can enhance the quality of care and life for diabetic patients and intervene against the development of serious complications and hypoglycemia-related adverse events. The cost of routinely using these devices might seem relatively high. However, the estimated cost benefits are usually higher as they can significantly reduce hospitalization rates due to hypoglycemia and the frequency of diabetic therapy malpractices, which are frequently encountered. However, not many studies have reported these outcomes, indicating the need to conduct future relevant studies.

Lifestyle Modification Therapy in Diabetes Disease: A Review Article

Introduction: Diabetes mellitus (DM) is a metabolic disease characterized by high blood glucose levels (hyperglycemia) resulting from disturbances in insulin secretion, insulin action or both. Insulin is a hormone produced by pancreatic beta cells, which is needed to utilize glucose from digested food. Comprehensive care is taken to treat patients with either prediabetes or diabetes. Diabetes management includes lifestyle interventions along with pharmacologic therapy and routine blood glucose monitoring. So that a decrease in blood glucose can occur and can be stable for a long time. Discussion:Lifestyle modification is an economical treatment that saves costs to prevent or delay the onset of diabetes. On the other hand, nutritional management provided by a dietitian is also recommended. Moderate weight loss goals are an important component of diabetes prevention and treatment, as large body weight can increase blood glucose levels, and can also have an increasing impact on blood pressure and cholesterol levels. Weight loss can be achieved through a balanced diet, with total control of calories and free carbohydrates. However, for diabetic patients following a low-carbohydrate diet, they should be informed about possible side effects such as hypoglycemia, headaches and constipation. Other studies have suggested the consumption of complex dietary fiber and whole grains to improve blood sugar control. Greater adherence to diet combined with light physical activity was associated with a lower likelihood of diabetes after adjusting for various factors. Conclusion:Lifestyle modification is a fairly cost-effective treatment to prevent or delay the onset of diabetes, with a risk reduction of about 58% in 3 years. It is strongly recommended by the ADA that patients with IGT, IFG or HbA1C levels of 5.7-6.4% be counseled on lifestyle changes such as diet and exercise. On the other hand, nutritional management provided by a dietitian is also recommended.

Problems of blood glucose self-monitoring in patients with diabetes mellitus

Glycemic self-monitoring is essential in the treatment of diabetes mellitus. Compliance with the recommendations for selfmonitoring of glycemia is an important condition for the prevention of diabetes complications. The article provides a review of the problems associated with blood glucose self-monitoring faced by diabetic patients and doctors. These include low frequency of blood glucose self-monitoring, technical errors in glucose measurements, errors in keeping a diary and errors in using measurement data to diabetes control. The blood glucose monitoring system, which includes the glucometer, test strips, application, сloud for data storage can be used for blood glucose self-monitoring in patients with diabetes mellitus. The article discusses the features and advantages of the blood glucose monitoring system. The advantages of the glucometer are the no сoding technology and the following options: аpplication of additional amount of blood to the test strip; adding meal marks, testing as the measurement results compare with targets and informing about it; storage a large number of measurement results. In addition to the standard blood glucose measurement, the glucose meter and the application offer many features to improve blood glucose self-monitoring that can help to improve diabetes management: automatic transferring measurement results to smartphone or tablet; saving notes in logbook; display of glucose trends and testing as they compare with targets; offering quick and valuable tips for critical high/low glucose values.

Commercial and Scientific Solutions for Blood Glucose Monitoring—A Review

Diabetes is a chronic and, according to the state of the art, an incurable disease. Therefore, to treat diabetes, regular blood glucose monitoring is crucial since it is mandatory to mitigate the risk and incidence of hyperglycemia and hypoglycemia. Nowadays, it is common to use blood glucose meters or continuous glucose monitoring via stinging the skin, which is classified as invasive monitoring. In recent decades, non-invasive monitoring has been regarded as a dominant research field. In this paper, electrochemical and electromagnetic non-invasive blood glucose monitoring approaches will be discussed. Thereby, scientific sensor systems are compared to commercial devices by validating the sensor principle and investigating their performance utilizing the Clarke error grid. Additionally, the opportunities to enhance the overall accuracy and stability of non-invasive glucose sensing and even predict blood glucose development to avoid hyperglycemia and hypoglycemia using post-processing and sensor fusion are presented. Overall, the scientific approaches show a comparable accuracy in the Clarke error grid to that of the commercial ones. However, they are in different stages of development and, therefore, need improvement regarding parameter optimization, temperature dependency, or testing with blood under real conditions. Moreover, the size of scientific sensing solutions must be further reduced for a wearable monitoring system.

Diabetes and COVID-19 Vaccination

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

Indole as a new tentative marker in exhaled breath for non-invasive blood glucose monitoring of diabetic subjects

Blood glucose monitoring (BGM) is the most important part of diabetes management. In classical BGM, glucose measurement by test strips involves invasive finger pricking. We present results of a clinical study that focused on a non-invasive approach based on volatile organic compounds (VOCs) in exhaled breath. Main objective was the discovery of markers for prediction of blood glucose levels (BGL) in diabetic patients. Exhaled breath was measured repeatedly in 60 diabetic patients (30 type 1, 30 type 2) in fasting state and after a standardized meal. Proton Transfer Reaction Time of Flight Mass Spectrometry (PTR-ToF-MS) was used to sample breath every 15 minutes for a total of six hours. BGLs were tested in parallel via BGM test strips. VOC signals were plotted against glucose trends for each subject to identify correlations. Exhaled indole (a bacterial metabolite of tryptophan) showed significant mean correlation to BGL (with negative trend) and significant individual correlation in 36 patients. The type of diabetes did not affect this result. Additional experiments of one healthy male subject by ingestion of lactulose and 13C-labeled glucose (n=3) revealed that exhaled indole does not directly originate from food digestion by intestinal microbiota. As indole has been linked to human glucose metabolism, it might be a tentative marker in breath for non-invasive BGM. Clinical studies with greater diversity are required for confirmation of such results and further investigation of metabolic pathways.

Hyperglycaemia in COVID-19: improving recognition and management in a single centre

Background: Hyperglycaemia is a recognised complication of COVID-19 disease and is associated with increased morbidity and mortality. Effects are noted in individuals with and without diabetes and potentiated by the use of recognised COVID-19 treatments such as corticosteroids. Early glycaemic control in the inpatient with COVID-19 disease impacts significantly on outcomes. Methods: A three-phase improvement project evaluated the recognition and management of hyperglycaemia in 120 adult inpatients with COVID-19 disease over a 4-month period. A local guideline and a separate acute care ‘bundle’ were implemented to improve performance. The main outcomes of the project were evaluated in a repeated cross- sectional design; assessing the performance of regular capillary blood glucose monitoring and appropriate treatment of hyperglycaemia where indicated. Results: Prior to intervention, 78.6% of patients had appropriate capillary blood glucose monitoring and no patients were deemed to receive appropriate treatment. Following interventions, 83–100% of patients had appropriate monitoring and 75–100% received appropriate treatment. Conclusions: In this setting, implementation of a guideline and a care bundle contributed towards improved recognition and management of hyperglycaemia in patients with COVID-19 disease. Future study could assess the impact of interventions on a larger scale whilst investigating variation in the subtype of diabetes, patient sex and other demographics on outcomes such as length of stay, morbidity and mortality.