Elsevier

Biosensors and Bioelectronics

Volume 20, Issue 10, 15 April 2005, Pages 1897-1902
Biosensors and Bioelectronics

Review
In vivo glucose monitoring: the clinical reality and the promise

https://doi.org/10.1016/j.bios.2004.08.016Get rights and content

Abstract

Glucose monitoring is an essential component of modern diabetes management. Three in vivo glucose sensors are now available for clinical use: a subcutaneously implanted amperometric enzyme electrode, a reverse iontophoresis system and a microdialysis-based device. Improvements in glucose-sensing technology continue to be sought, e.g. wired enzyme technology, viscometric affinity sensing and totally implanted glucose sensors. Non-invasive glucose sensing is the ultimate goal of glucose monitoring, but the most investigated approach, near-infrared (NIR) spectroscopy, is presently too imprecise for clinical application. Fluorescence-based glucose sensing offers several advantages and we are investigating strategies which include NIR-based fluorescence resonance energy transfer using concanavalin A/dextran; changes in the intrinsic fluorescence of hexokinase encapsulated in sol-gel; and non-invasive glucose monitoring of cells by measuring glucose-related changes in NADP(H).

Section snippets

The problem of diabetes and why glucose is monitored

Diabetes mellitus is a disease of major global importance, increasing in frequency at almost epidemic rates, such that the worldwide prevalence is predicted to at least double to about 300 million people over the next 10–15 years (King et al., 1998). Diabetes is characterised by a chronically raised blood glucose concentration (hyperglycaemia), due to a relative or absolute lack of the pancreatic hormone, insulin.

Much of the burden of the disease to the patient and to health care resources is

Currently available in vivo glucose sensors for clinical use

At the time of writing, there are three commercially available in vivo glucose sensors, which make use of different technologies.

Alternative technologies for minimally invasive sensing

Because there have been some remaining problems with first-generation glucose sensors, researchers have been encouraged to continue exploring alternative technologies for in vivo glucose monitoring. Attempts, for example, to improve subcutaneous enzyme electrodes include ‘wired enzyme technology’ (Csoregi et al., 1995, Feldman et al., 2003), currently being commercialized by TheraSense, Inc. Here, an osmium-based mediator incorporated in a polymer film shuttles electrons from glucose to glucose

Conclusions

In vivo glucose sensing has now moved from the purely experimental stage to commercially available products, which are already finding clinical use in diabetes care. The ultimate goal of completely non-invasive glucose sensing is still some way away, but many promising technologies are being investigated.

Acknowledgements

We are grateful to the Engineering and Physical Sciences Research Council, the Wellcome Trust and the Diabetes Foundation for financial support and to Prof. David Birch and Dr. Olaf Rolinski for invaluable help and discussion.

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