The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey

Abstract

Background: Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter-glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters.

Objective: The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management.

Methods: A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts.

Results: On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices.

Conclusions: Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions.

Keywords: big data; consumer health informatics; mobile health; survey; type 1 diabetes; wearable sensors.

Figure 1

Different types of wearable technology by ForbesOste (license: CC BY-NC-ND 2.0).

Figure 2

Article selection methodology according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. T1D: type 1 diabetes.

Figure 3

Physiological functions found that are affected by type 1 diabetes (T1D) and the number of relevant studies. This graph refers only to the studies that compared T1D with healthy cohorts. BP: blood pressure; BS: Baroreflex Sensitivity; ECG: electrocardiogram; ESC: electrochemical skin conductance; HR: heart rate; HRV: heart rate variability; SpO₂: oxygen saturation.

Figure 4

Identified areas of potential impact of wearable devices on the acute glycemic management of type 1 diabetes. The numbers indicate the number of relevant studies found for each physiological signal. ECG: electrocardiogram; ESC: electrochemical skin conductance; HR: heart rate; HRV: heart rate variability; NIR: near-infrared; SpO₂: oxygen saturation; ST: skin temperature.

Figure 5

Identified areas of potential impact for wearable devices related to long-term type 1 diabetes complications. The numbers indicate the number of relevant studies found for each physiological signal. BP: blood pressure; CAN: cardiac autonomic neuropathy; ECG: electrocardiogram; ESC: electrochemical skin conductance; HR: heart rate; HRV: heart rate variability.