Glucose Monitors
and Glucose
Sensing
Applications for the
21st Century and Beyond
The Quest for the Closed Loop
Why Glucose Sensing??
• More “real time” assessment
• Ability to detect hypoglycemia and hyperglycemia at
“odd” times
• Better administration and correlation of insulin
dosages—less guessing
• May uncover eating disorders and other issues
related to stress, diet and exercise
• Patient compliance with monitoring an issue– many
do not like to “poke” fingers or other sites so often.
Pain and discomfort, lack of blood obtained, lost
strips, etc.
Why Glucose Sensing??
• Goal– Closing the Loop
• An artificial pancreas
• Provide accurate and specific data to control glucose
levels – many individuals keep blood glucoses higher
than optimal to avoid hypoglycemia
• Fear of hypoglycemia in the middle of the night– not
waking up
• “Take the worry” out of diabetes treatment – Type 1
patients in particular; parents, children and
physicians
Optimal Conditions for Glucose
Measurement
• Immediate availability of results and
measurements
• High frequency of measurements
– Measurements every 2-5 minutes would be ideal
– Ability to detect rapid rise or decline is necessity
• Need quick signal stability after initiation or
placement
• Stability over prolonged period of time (>3
days necessary)
Case for Glucose Sensing – Recent
Studies
• 23 patients participated – hospitalized and
ambulatory
• Both Type 1 and Type 2 individuals
• Study lasted 72 hours (key time limit)
• 75 capillary samples were obtained
• Microdialysis subcutaneous monitoring system used
– microdialysis catheter; extracorporeal electrochemical
sensor
– signal needed to be corrected for fluid transportation – 31
minutes (lag time)
Diabetes Care 24: 1696, 2001 Jungheim et al
Results of Study and Conclusions
• Studies showed no limitations to patients activity and
only mild skin irritation
• Difference between SCGM and capillary glucose was
~ 7-9 % over the full range (meter differences can be
as much as 10 – 15 %)
• Hypoglycemia was detected with SCGM but was
missed 58-71% of the time by spot capillary
measurements. This despite 5-7 or more
measurements per day
• No decay in sensitivity over the 72 hour period
• SCGM could be useful in glucose control & therapy
Glucose Monitor Development
Race for the Closed Loop
System, Painless,
Continuous and the “Gold”
Types of Monitors in Development
• Minimally invasive interstitial devices
• Transcutaneous optical devices
• Electrochemical sensing devices
– subcutaneous
– Implantable
• Implantable optical sensors
Physiology of Interstitial Fluid
• Extracellular fluid and flows through the
capillary walls
• Glucose levels in interstitial fluid ≠ blood
glucose
• Lag time could be ~ 10 to 20 minutes
• Perspiration, oils and other environmental
factors (lotions, etc.) can dilute the
measurements and adversely affect the
results as sample size is small
Interstitial Glucose Sensor
Glucowatch Biographer 2
Cygnus Corp: www.glucowatch.com
Glucowatch Schematic
Advantages and Limitations of
Glucowatch System
Advantages
• Non-invasive
• Detects trends and patterns
in glucose levels
– readings every 10 minutes
with up to 6/hour = 72
readings/monitoring session
• Alerts patients to rapids
changes in glucose levels
• Less painful??
• Computer download capable
• ? Ability to determine insulin
or medication adjustmens
Limitations
• 2 hour “warm-up period
• Calibration is needed with
each sensor use
• Skin irritation with sensor
and adhesive
• Skipped readings possible
with rapid changes in
temperature, perspiration
and if system is bumped or
dislodged
– If several readings in a row
are skipped, the system
must be recalibrated
Use of Glucowatch Biographer 2
• Intended for use in adults and children to
detect trends and patterns in glucose levels
• To detect and assess hyperglycemic and
hypoglycemic patterns to help facilitate
adjustments in therapy
• To be used as an adjunctive device, to
supplement, not replace, information obtained
from traditional and standard home glucose
monitoring devices!
Glucowatch Biographer 2
• Draws out interstitial fluid by reverse electroionophesis
• Glucose interacts with Glucose Oxidase Membrane to form
hydrogen peroxide which interacts with biosensor producing low
electric current which is measured and analyzed
• Glucowatch 2
– Cost $599 to $799
– Rebates can save $200 to $300
• Auto sensor
–
–
–
–
Disposable transdermal pad
Changed every 14-15 hours
~$4 each (2 needed) for each recording session
Concerns with calibration time, risk of infection and irritation
Glucose Collection with the GlucoWatch® G2™
Biographer Uses Reverse Iontophoresis
• Only small compounds pass
through the skin.
CATHODE
ANODE
– No proteins (e.g., hemoglobin)
in the extract
• Glucose is collected at the
cathode.
– Interfering species (ascorbate
and urate) collected at anode
Cl-, (ascorbate, urate)
Na+, neutral species
(i.e., glucose)
• The charge and size
exclusion properties of
reverse iontophoretic
extraction will lead to a very
“clean” sample.
Data on file, Cygnus Inc. 2002.
The Automatic Monitoring Process
with the GlucoWatch® G2™ Biographer *
A “RUNNING AVERAGE” PROVIDES READINGS EVERY 10 MINUTES
†3
min
Internal
measure
‡7
min
†3
min
‡7
127
mg/dL
Displayed
reading
TIME
3:10 pm
* Following a 2 hour warm-up and calibration
† 3 min glucose collection
‡ 7 min glucose measurement
min
†3
min
‡7
min
†3
min
‡7
min
109
mg/dL
101
mg/dL
112
mg/dL
118
mg/dL
105
mg/dL
107
mg/dL
3:20 pm
3:30 pm
3:40 pm
Data on file, Cygnus Inc. 2002.
GlucoWatch® Biographer
Home Study – Clarke Error Grid Analysis
Slope = 0.95, Intercept = 12.6 mg/dL, r = 0.80
ZONE
Biographer
Readings
2996 paired points
A
60%
B
34%
C
1%
D
4%
E
0.1%
400
A
350
Biographer Readings (mg/dL)
E
C
300
250
(A) Accurate. Biographer within 20% of finger-stick
test result (or both below 70 mg/dL)
B
200
150
(B) Acceptable. Difference greater than 20% but
Biographer would not lead to bad decision
D
D
B
(C) Might cause an over-correction of normal
glucose levels. Finger-stick blood glucose test
result in the normal range, but Biographer reading is
high or low.
100
50
(D) Failure to detect a high or low glucose level.
Biographer reading in the normal range, but fingerstick blood glucose test result is high or low
E
C
0
0
One
100
®
Touch Profile ®
200
®
Glucose
300
®
Readings
*
One Touch
Profile
400
(mg/dL)
* One Touch® Profile® – Johnson and Johnson, New Brunswick New Jersey
(E) Treatment error could occur. Biographer
reading low when finger-stick blood glucose is high
or Biographer reading high when finger-stick is low.
Data on file, Cygnus Inc. 2002.
Studies of Glucowatch vs. Meters
• Differences between interstitial fluid and blood
glucose
• Time lag: 17.2 minutes ± 7 minutes with Glucowatch
• Time lag: 13 minutes with most blood glucose meters
• With glucose increasing, changes were less as
measured by Glucowatch as compared with blood
• With glucose decreasing, changes were greater as
measured by Glucowatch as compared with blood or
meters
• Conclusion: possible false hyperglycemia and false
hypoglycemia if taken unilaterally
Kulcu et al:
ADA Meeting
2002
SpectRx Glucose Sensing System
•
•
•
•
•
•
•
Transdermal Biophotonic System
Fluid is collected through micropores
Laser system used on the outer layer of skin
Measured in a patch which contains a glucose sensor
Clinical trials are ongoing
Is not FDA approved at this time
Still similar to Glucowatch in that it provides
information on trends and not necessarily real-time
for treatment adjustments
SpectRx website: www.spectrx.com
SpectRx Glucose Sensing System
Laser device on the skin surface
Patch with sensor system embedded
www.spectrx.com
Preliminary data with SpectRx ISF
System
www.spectrx.com
Preliminary data with SpectRx ISF
System
Pendragon Glucose Sensing System
• Uses electromagnetic
waves
• Attached to lower
forearm similar to the
Glucowatch
• Performs
measurements every
minute but averaging
occurs
Pendragon Glucose Sensing System
Recent Study with PENDRA
• 15 individuals without diabetes
• Changes in microcirculation of the arms resulted in
varying glucose values
• Temperature changes, other environmental issues
had to address via a complex calibration procedure
• Conclusions:
– Need to “fix” device appropriately to arm to avoid
possible variations
– Needs extensive physician and patient training to
operate
– Needs further studies prior to any extensive use in the
clinical setting
Diabetes Technology and Therapeutics 6:435, 2004
Electrochemical Glucose Sensors
CGMS
TGMS
DexCOM
Continuous Glucose Monitoring
System--CGMS
• Basic Premise: Glucose + Oxygen = Gluconic Acid +
H2O2
• Reaction is submitted to an electrical current which is
proportional to the glucose concentration which is
measured
• Enzymatic or Electrochemical Sensors are implanted
in the subcutaneous tissue (under the skin)
• Similar to the catheters used in insulin pump therapy
• Short term use at present; reliability just 48 to 72
hours
Medtronic (MiniMed) CGMS System
Two Views of CGMS
Mechanism of Action of CGMS
Enzymatic Reaction is measured by sensor in IF through skin
CGMS System
• Sensor is percutaneous an ~1mm in diameter
• Measures an “average” glucose value every 5
minutes and is stored in the monitor
• “Hard” wired system; worn externally
• Requires calibration at 4-5 times per day, otherwise
data is not able to be downloaded
• Able to enter events on the monitor to assist with
interpretation of results
• 3 day use only at this time
• Not “real time”—requires return to physician office for
download and interpretation
CGMS System
• Problems with encapsulation tissue which can cause
errors in data collection
• Anything implanted in the body over time becomes
covered with a protein layer initially and then a collagen
like layer
• Encapsulation tissue is to protect the body from foreign
objects which may be perceived as harmful and to isolate
the object chemically (ie.—broken port in pulmonary
artery)
• This chemical isolation could decrease the sensitivity and
response time of electrochemical subcutaneous systems
such as CGMS
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002




Self monitoring of glucoses
several times per day will leave
“gaps”– large excursions can
occur without patient
knowledge
Hypothesis: to test the
reproducibility of the CGMS in
“real-life setting”
CGMS may be a tool that could
alleviate this difficulty
System measures glucose
concentration every 5 minutes
for a 72 hour period






Preliminary Study – performed
in Type 2 patients
~ 150 separate glucose tracings
Included healthy volunteers and
patients on only metformin
Correlated with frequent blood
glucose measurements
Noted exceeding high incidence
of hypoglycemic events with no
symptoms and not confirmed by
simultaneous blood glucose
measurements
Correlation coefficient –r=0.74
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002
“Real Life Study” was undertaken to determine accuracy
and reproducibility of tracings utilizing the CGMS device
 11 patients involved in the study
 6 had Type 1 diabetes
 3 had Type 2 diabetes
 2 “healthy” volunteers with no history of DM
 10 male, 1 female
 Placed on two glucose sensor devices simultaneously for a
3 day period with usual “normal” activity

CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002
Protocol – Sensors were attached according to the
manufacturer’s instructions
 Sensors were placed in the abdominal SQ tissue 4-5 cm to
the right or left of the umbilicus
 Calibration and Initialization were performed and 1 hour
was elapsed before first capillary glucose
 Meal times were recorded
 Capillary glucoses were done immediately post meals,
during the night and early AM
 Capillary glucoses were entered into the monitor within 5
minutes of determination

CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002EA




Download was done upon completion and analysis was
performed immediately
Anonymity was preserved
Each day was divided into 8 time intervals according to the
meal times of the patient
Classifications:
–
–
–
–
A: Satisfactory
B: if all glucose values are between 80 –150
C: glucose > 150 during >1 hr., too low
D: glucose < 70 during >30 minutes or impossible to evaluate due
to technical reasons
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002

D Classification was further subclassified:
– D1: Low concordance between sensor and glucometer r < 0.8 or
the difference is too high (28%)
– D2: Insufficient number of meter glucose values entered for
calibration
– D3: Strong midnight shift: usual sensor glucose values post
midnight. Usually secondary to insufficient number of calibration
values.

Evaluations were analyzed by two different observers
independently and concordance rates were determined
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002

Mean sensor not recording glucose values
– 46 classified in the “D” group and not use of sensor: 60.4 ± 16.9
hours each patient

432 single time intervals were initially evaluated
 78 (18%) were discarded for technical reasons
– 32 due to interpretable

139 paired sets of data were available for sensor-sensor
comparison.
– 92 from Type 1 patients
– 30 from Type 2 patients
– 17 from non-diabetes volunteers
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002





Concordance was seen in only 65% of the time
periods
25% noted glucose levels too high in one sensor
and satisfactory in the other
9% noted glucose levels too low with satisfactory
levels in the other
1 case noted: sensor 1 showed hyperglycemia,
sensor 2 showed hypoglycemia
No difference between patients with DM and non
DM
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002

Conclusions:
– Accuracy and reproducibility is lower than
previously thought
– Differences were greatest between the 125 and
225 mg/dl range – most important area in
treatment of patients with diabetes mellitus
– Correlation between two simultaneous sensors
was lower than that of capillary vs. sensor (r =
0.84 vs. 0.90)
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002

Conclusions:
– 35% clinically important discrepancies between
two simultaneous sensor tracings
– Could result in incorrect clinical advice in 17%
of patient cases
–  RESULTS OBTAINED IN “REAL LIFE”
SITUATIONS MUST BE INTERPRETED IN
INDIVIDUAL CLINICAL TERMS
CGMS– Reproducibility Study
Metzger, M. et al: Diabetes Care 25:1185, July 2002

Development of a reliable device for continuous
glucose monitoring is of outmost importance in
the treatment of diabetes
 Future endeavors in this area must be rigorously
evaluated in “real life” situations before release
to the general public
 Rebuttal from Medtronic —concerns in the above
study: software used was earlier version, device
was used for more than planned or approved
Additional Studies--2003









Armstrong and King: ADA Meeting 2003
11 subjects: 2 No Diabetes, 6 Type 1, 3 Type 2
Measured Glucoses with 1 Touch Ultra 7 times per day
Wore 2 sensors (CGMS) concurrently for 3 days
Mean Sensor life: 67 hours
Used updated software
Found accuracy with newer software ~94%
Most of differences between modalities within 10%
Sensor-sensor differences less than previous study
Rebuttal to Metzger Findings

Expectations did not coincide with CGMS intended use
 Study did not use Clarke error grid but was one of
subjective assessment
 Study did use updated software (Solutions 3.0)
 Results are similar to those reported in the postmarketing studies (Diabetes Technology and
Therapeutics, 2000)
 CGMS is intended to “supplement, not replace, blood
glucose information using standard monitoring devices”
 CGMS, when used with home monitoring devices and
HbA1C values can help optimize clinical management
Mastrototaro and Gross; Diabetes Care 26:256 2003
Rebuttal to Metzger Findings

Solutions 3.0 software resolves most of the 18% rate of
technical problems encountered in the study
– Correction of the midnight shift
– Improvement in the accuracy and reproducibility of
the downloads
– Improvement in the agreement between sensor and
meter values
Mastrototaro and Gross; Diabetes Care 26:256 2003
Rebuttal to Metzger Findings


CONCLUSIONS:
Results should be weighed against the
encouraging results and conclusions from
previous and evolving reports and research
 ◙ Appears that this is a work in progress and
should not be utilized as the sole clinical
indicator! – should not be used at present as the
only source for change in treatment regimens
 -Speakers judgment after reviewing literature
Sample CGMS Reports
Daily Report of Blood Glucoses
Sample CGMS Reports
Modal Time Reports– Can be varied individually
Sample CGMS Reports
Composite 3 day report for comparison
Additional Studies Involving Children
• Accuracy of Glucowatch 2 system and CGMS in
detecting hypoglycemia
• Multi-center study
• Involved the Children in Diabetes Research Network
• 91 children enrolled
• Ages 3-17
• Patients were enrolled in a CRC-clinical research
center for 24 hours
Diabetes Care 27:722-726 2004
Glucowatch 2 vs. CGMS
• Patients used CGMS and Glucowatch 2 during each
admission
• 1/3 patients started CGMS 48 hours prior to
admission
• 1/3 patients started CGMS 24 hours prior to
admission
• 1/3 patients started CGMS on the day of admission
• Each patient used 2 sensors for the G-watch 2 during
the study– 2 hour overlap
• 1 Touch Ultra meter used as calibration and control
Glucowatch 2 vs. CGMS
• Samples: every hour during the day
every 30 minutes during the night
• Hypoglycemia induction test: samples obtained every
5 minutes for 90 minutes
• Adjustment of values for lag time: time involved in
sampling the interstitial fluid measuring glucose as
compared with blood
– Glucowatch 2 Biographer– 17.5 minutes
– CGMS – 2.5 minutes
Glucowatch 2 vs. CGMS
Results of Study
• Glucowatch 2
Biographer
– ~ 23 % of values
were within
reference range
when glucoses were
< 60 mg%
– 51% false alarms
were detected with
use
• CGMS System
– Both modified and
original sensors
noted < 50%
detection within
reference range (36
and 48 %)
– 58% to 60% false
alarms were
detected with use
Study Conclusions
• Neither Glucowatch 2 nor CGMS is accurate in reporting
glucose values in the hypoglycemic range
• Accuracy of both devices is better when reference glucose
levels are >100 mg/dl
• Neither device is appropriate at this time for real time
detection
• Both systems are more likely to be of value in adjusting
bolus and basal insulin doses in patients with consistently
elevated glucoses and A1C levels
• The accuracy of these early generation sensors is similar
to the early generation meters (circa 1970s-early 1980s)
Modified Home Use of CGMS—
Guardian System
Guardian Home System
• Sensor can be set to “alarm” at certain levels both
high and low
• Monitor can be placed up to 6 feet away; does not
have to be worn
• Monitor can store up to 21 days of data
• Can be downloaded to personal computer
• Still needs calibration similar to CGMS system
• Alerts or alarms need to be verified with “finger stick”
glucose
• Cost is not set at present (~ $800- $1500 anticipated)
Anticipated Sample Guardian Report
Reports similar to CGMS System
www.minimed.com
Paradigm 522 System– Patient Use
• Consists of Glucose Sensor, Radio Transmitter and
Pump receiver
• Abstract presented at ADA 2004 (Orlando)
• 9 Patients involved; Ages 10-21, Type 1 DM
• Used CSII
• Did 4 Blood Glucoses/day via HGM
• Wore 7 sensors during the 3 week trial
• A1C levels decreased 0.3%
• Glucoses decreased average 20 mg%
• Work in progress; Not available yet!!!
Implantable Subcutaneous Systems
Enzyme electrode system
Electrochemical device
DexCom Subcutaneous Sensor System
Implantable Sensor device
Pager monitoring system
DexCom Subcutaneous Sensor System
• Special bioprotective layer prevents foreign body
reaction with sensor
• Can measure glucoses ranging from 40 mg/dl to
700 mg/dl (2.2-38.9 mmol/L)
• Recalibration every 20 days
• 160 – 180 day lifespan for sensor
• Still need to do HGM 2-3 times/day to initiate
glucose algorithm
• Easily implanted in subcutaneous tissue
• Can be accomplished as outpatient procedure
Diabetes Care 27:734, 2004
Endocrinology Clinics NA 33:175, 2004
Therasense Navigator System
• Interstitial System
• Wireless system
• Needs calibration 1-2
times per day
• Readings every 1-2
minutes conceptualized
• High and low glucose
alarms to be
incorporated
• Currently experimental
• Company not
distributing info at this
time
Near Infrared Spectroscopy
Non-invasive techniques
Sensys Medical Systems
Endocrinology Clinics of NA 33: 163-173 2004
Sensys Medical Systems
• Measures glucose non-invasively via NIR
spectroscopy
• Device weighs less than 1.5 pounds
• Fiber-optic head secured to the forearm
• Still needs HGM for calibration
• Various components such as sweat, fat, etc. can
interfere with efficacy
• Can use either volar or dorsal aspects of the forearm
• Uses a rechargeable battery
• Studies ongoing with patient use
Open-flow Microperfusion Systems
ADICOL ProjectDisetronic/Roche
Advanced Insulin Infusion with a
Control Loop
ADICOL Project –Disetronic / Roche
• Inserted into the
subcutaneous adipose
tissue
• Double lumen catheter
• Acquires glucose
readings every 30
minutes
• Goal – subcutaneous
glucose sensing/insulin
delivery system
ADICOL Project –Disetronic / Roche
Large bore catheter
Readings only
every 30 minutes
Small study sample
with patient use
Infrared Spectroscopy
Animas Corporation
Continuous Glucose
Monitoring System
Infrared Spectroscopy
• Infrared light is absorbed by molecules
• Each molecule has its own spectra (absorption
characteristic)—similar to its own footprint
• Theoretically-by measuring the absorbed light vs.
wavelength, one could delineate the species and
concentration
• In reality– this is difficult
– Water absorbs most IR light
– Blood scatters light
– Different species overlap in their spectra or footprint
Spectra of Water, Hemoglobin, Blood &
Glucose
Absorbance
0.042
2.2
0.040
2.0
0.038
0.036
Water
1.8
0.034
1.6
0.032
0.030
Hemoglobin
1.4
Absorbance
0.028
0.026
0.024
0.022
0.020
1.2
1.0
0.8
0.018
0.016
0.6
0.014
0.4
0.012
0.010
0.2
0.008
0.0
0.006
0.004
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
2.2
2.3
1.2
1.3
1.4
1.5
1.6
Wavelength (microns)
1.8
1.9
2.0
2.1
2.2
2.0
2.1
2.2
2.3
mic(microns)
Wavelength
Absorbance
2.6
0.062
2.4
0.060
Blood
2.2
Glucose
0.058
2.0
1.8
0.054
1.6
Absorbance
0.056
0.052
0.050
1.4
1.2
0.048
1.0
0.046
0.8
0.044
0.6
0.042
0.4
0.040
0.2
0.038
1.2
1.7
0.0
1.3
1.4
1.5
1.6
1.7
1.8
Wavelength (microns)
1.9
2.0
2.1
2.2
2.3
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
mic (microns)
Wavelength
2.3
Sketch of Animas Sensor
Implanted Extravascular Sensor Head
Early Animas Sensor Head
Concentration(mg/dl), using Optical Means
Correlation (r2=.94) between optical
and conventional means (500 people)
450
400
350
300
250
200
150
100
50
0
0
50
100
150
200
250
300
350
Concentration (mg/dl) Determined by Glucometer
400
450
In vivo Measurements in Dog:
Glucometer and Sensor Head vs. Time
Glucose Concentration (mg/dl)
350
300
Glucometer
Sensor
250
200
150
100
50
0
Time
Animas Continuous System
• Has designed and built short term prototype and
demonstrated stability in animals
• Need to miniaturize system
– Laser diodes under development
– Telemetry developed
– Electronics being modified and mostly developed
• Clinical trials in humans projected to start 2005 or
2006. Projected as early Phase 2 studies with
sites to be determined. No pediatric patients to
be involved!
Advantages of
Animas Monitor
 Provides continuous reading of blood glucose without
patient intervention
 Measures glucose in blood as opposed to some other body
fluid, e.g. interstitial fluid, ocular fluid
 The encapsulation/ fibrin tissue has no effect on monitor
accuracy
 Provides direct access to blood, obviating loss and
interference associated with light transmission through
intervening tissues.
 Sensor stays implanted for at least 5 years, limited by
battery life. No percutaneous wires or cables are utilized.
What is the Goal of These
Technologies?
Development of a Closed
Loop System– The
Artificial Pancreas
*Put the Endocrinologist into
Early or Permanent Retirement
Have We Achieved
Goal???
Not Yet!!
What Has Been Accomplished?
• New Technology to determine patterns and facilitate
changes in therapy
• Prototypes for long term glucose monitoring
• More awareness by patients and families regarding
the importance of intensive therapy and “tight” control
of blood glucoses
• “Consumer driven” research for an artificial pancreas
• More physicians are implementing intensive therapy
with technology now available to compliment the
treatment
Final Thoughts
• No system at present is appropriate for a closed loop
system
• No system developed at present can replace the
“finger stick” monitor for “real time” glucose values
and treatment decisions
• Presently, there are 50+ companies or individuals
attempting to develop a continuous glucose
monitoring system
• EVENTUALLY, THAT DAY WILL
ARRIVE!! WHEN, ONE ONLY KNOWS!