Hospitals Of The Future

In vivo glucose sensing for diabetes management: progress towards non-invasive monitoring

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7220.1289 (Published 13 November 1999) Cite this as: BMJ 1999;319:1289
  1. John Pickup, reader (j.pickup@umds.ac.uk)a,
  2. Lydia McCartney, research fellowa,
  3. Olaf Rolinski, research fellowb,
  4. David Birch, professor of photophysicsb
  1. a Department of Chemical Pathology, Guy's, King's College, and St Thomas's School of Medicine, Guy's Hospital, London SE1 9RT
  2. b Department of Physics and Applied Physics, University of Strathclyde, Glasgow G4 0NG
  1. Correspondence to: Correspondence to: John Pickup

    A device for continuous in vivo monitoring of glucose concentration in people with diabetes has been a clinical and research priority for many years but now has an urgency which is probably unquestioned in diabetes care. The purpose of this article is to explain recent advances in technology that are bringing glucose sensors closer to routine use and to highlight some of the remaining problems Important new technologies include artificial receptors for glucose, tissue fluid sampling techniques, and new approaches to non-invasive sensing, such as fluorescence lifetime measurements.

    This is a selective overview that concentrates on research of the past five years, which we have assembled largely through personal experience and research in the specialty and from recent international workshops and meetings.

    Summary points

    One of the main reasons for developing in vivo glucose sensors is the detection of hypoglycaemia in people with insulin dependent (type 1) diabetes

    Until recently, research and development largely focused on needle-type glucose sensors (enzyme electrodes) implanted in the subcutaneous tissue. Problems of calibration and drift have delayed clinical application, but one device for trend monitoring is now being commercialised and is entering practice

    Several new approaches will accelerate development of in vivo glucose sensors, including totally implanted sensors with more robust artificial glucose receptors. These might be interrogated from outside the body by measurement of changes in near infrared fluorescence intensity or decay lifetime

    Tissue fluid sampling and extraction techniques—such as microdialysis and reverse iontophoresis—enable glucose to be measured outside the body under more controlled conditions but need further development

    Non-invasive glucose sensing will maximise acceptance by patients and overcome biocompatibility problems of implants. Near infrared spectroscopy has been most investigated but the precision needs to be improved for eventual clinical application

    The need for in vivo glucose monitoring

    The main reason for developing in vivo glucose sensors is for the detection of …

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