Emerging Diabetes Technologies: Continuous Glucose Monitors/Artificial Pancreases

• Published in: Journal of the Indian Institute of Science 2023-01, Vol.103 (1), p.205-230
• Main Authors: Almurashi, Abdulhalim M., Rodriguez, Erika, Garg, Satish K.
• Format: Article
• Language: English
• Subjects: Chemistry and Materials Science; Chemistry/Food Science; Engineering; Materials Science; Physics; Review; Review Article
• ISSN: 0970-4140; 0019-4964
• DOI: 10.1007/s41745-022-00348-3

Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGM CGM : A device that measures glucose values in the subcutaneous space via a sensor and is transmitted to a receiver/smartphone. s), insulin-delivery devices, and hybrid closed loop systems Hybrid Closed Loop (HCL) Systems: An insulin pump able to deliver variable insulin dosages based on CGM values using an algorithm. . Now most CGMs (Medtronic-Guardian, Dexcom-G6, and Abbott-Libre-2) have MARD values of  20%. In addition, the majority of the new CGMs do not require calibrations, and the latest CGMs last for 10–14 days. An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. Recently, the FDA approved Libre 3 which provides real-time glucose values every minute. Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. The newer CGMs that are likely to be launched in the next few months in the USA include the 10–11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it is down to 2–3 min; however, in many instances, it is still 15–20 min, especially when the rate of change of glucose is > 2 mg/min. We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care.