VIDEO: Recent developments in sensors for diabetes monitoring

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From a straight technology standpoint, we're seeing some really interesting, novel, effective, accurate sensors. A sensor is a little wire that goes in the skin, and you can measure glucose continuously with one, and that's called the continuous glucose monitor. More and more people with type 1 diabetes are using these. Now we're starting to see people with type 2 use them, especially if they're on insulin. And there's a popular movement for people who don't even have diabetes who are interested in what's their blood sugar. They're using them also, and people can get access to these devices. I recently wrote an article about the use of continuous glucose monitoring (CGM) in people who don't have diabetes. I posted it on LinkedIn. I had 42,000 views. That's the most views I've ever had of any article. So that really indicated that there's quite an interest in this. I think as more people use these continuous glucose monitors, we'll have a better idea of what happens to blood sugar in different people at different times of day with different foods and different activities. And eventually, continuous glucose monitors are just going to be used by everybody with diabetes, I would say. They're very popular in the US, not as popular in other countries because they're a little expensive. They're more expensive than blood glucose testing, and there are countries where they can barely afford blood glucose testing, so those countries have not adopted much CGM, but the price of CGM, continuous glucose monitoring, is coming down, and there's nothing like it.

At UCSF Diabetes Clinic, where I teach, very often, if we have a patient and we can't figure out what they need, the first thing we do is say, "We'll put on a continuous glucose monitor so we can understand that your pattern of blood sugar. Then we can decide on a good treatment for you." Another approach with a sensor that's being developed but has a lot of promise would be a non-invasive glucose monitor. Whereas a continuous glucose monitor involves in some way putting some type of a wire under the skin, which doesn't hurt, but it's in the skin. There's demand for a type of a device that would be a box with the type of light that you could put your arm on it, or you could wear it as a wristwatch. In some way, this light would be reflecting through your skin, and the reflection back would be proportionate to your blood sugar level. And there are a number of companies that are working on that. So far, none of them have been cleared by the FDA. They just haven't been accurate enough. There's several that have been cleared in Europe, but they still are having essentially no sales from those products. So it's a challenging problem to find a way of identifying a wavelength of light and separating the reflection you get back of glucose from other molecules in the skin. But there are many companies working on it, and I think that as the lasers we have become better and they can be more focused on one wavelength and as the computer algorithms we have get better so that we can really extract all the information from the reflections, eventually we will have a product that can measure glucose non-invasively. Whether it's a wristwatch or whether it's a box or a headband or a waistband, I think we'll see something.

Another type of sensor which is being developed, and people are interested in this, is a continuous ketone monitor. If a person is not taking any insulin, they're at risk of a complication called ketoacidosis. It's a very serious problem. People have to be hospitalized for this. There's some risk even of death. It's a low risk, but it's a serious problem. And if people knew that they were at risk, that their ketone levels were starting to rise, then they would go to the doctor or the emergency room before it gets so bad that they have to be hospitalized. And there's been one article a couple years ago about a promising continuous ketone monitor, and some other companies who haven't written articles about it are interested in developing one themselves. So I'm hoping that we see one of those on the market soon. It's a little more difficult to build than a continuous glucose monitor because a continuous glucose monitor starts with a certain amount of glucose in the blood. Everybody has glucose in their blood. They have sort of a medium amount in the blood. It can get too high, it can get too low, but it's often in the medium level. But ketones, a normal level is really zero. You're allowed to have a small amount, but it's harder to build a device where a typical result is zero. So if you're building a continuous ketone monitor, you have to find people who have ketones in the blood for some reason and then test your device on them.