Recent advances in continuous glucose monitoring

Continuous glucose monitoring, providing more detailed information on gluco se excursions than single spot measurements, should help to improve the the rapy in diabetic patients and is also required for feedback-controlled insu lin delivery. At the Institute for Diabetes-Technology in Ulm, founded by E F Pfeiffer, a portable glucose sensor for continuous tissue glucose monitor ing has been developed. The combination of microdialysis and enzymatic ampe rometric glucose measurement implemented in this device marked a break-thro ugh in achieving reliable and precise continuous tissue glucose monitoring. In several studies, we have demonstrated that continuous subcutaneous gluc ose monitoring for up to 72 hours is feasible under 'in-house' and 'daily l ife' conditions in diabetic patients. The measured tissue glucose concentra tions correlated closely to glucose control measurements in venous and capi llary blood. A reliable continuous glucose monitoring device is a prerequis ite for the development of an artificial pancreas. Our group developed an a lgorithm for subcutaneous application of the fast acting insulin analogon l ispro. In experiments performed over 7 and 24 hours good metabolic control was achieved by algorithm-based insulin application. In addition, the algor ithm was able to maintain acceptable metabolic control during and after mod erate physical exercise. Further work is needed to optimize continuous tiss ue glucose monitoring systems and to develop a closed loop system for insul in application based on continuously measured tissue glucose concentrations .