Delays in Minimally Invasive Continuous Glucose Monitoring Devices: A Review of Current Technology
Open accessAbstract
Through the use of enzymatic sensors—inserted subcutaneously in the abdomen or ex vivo by means of microdialysis fluid extraction—real-time minimally invasive continuous glucose monitoring (CGM) devices estimate blood glucose by measuring a patient's interstitial fluid (ISF) glucose concentration. Signals acquired from the interstitial space are subsequently calibrated with capillary blood glucose samples, a method that has raised certain questions regarding the effects of physiological time lags and of the duration of processing delays built into these devices. The time delay between a blood glucose reading and the value displayed by a continuous glucose monitor consists of the sum of the time lag between ISF and plasma glucose, in addition to the inherent electrochemical sensor delay due to the reaction process and any front-end signal-processing delays required to produce smooth traces. Presented is a review of commercially available, minimally invasive continuous glucose monitors with manufacturer-reported device delays. The data acquisition process for the Medtronic MiniMed (Northridge, CA) continuous glucose monitoring system—CGMS® Gold—and the Guardian® RT monitor is described with associated delays incurred for each processing step. Filter responses for each algorithm are examined using in vitro hypoglycemic and hyperglycemic clamps, as well as with an analysis of fast glucose excursions from a typical meal response. Results demonstrate that the digital filters used by each algorithm do not cause adverse effects to fast physiologic glucose excursions, although nonphysiologic signal characteristics can produce greater delays.
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The continuous glucose monitoring system was validated against plasma glucose.
“The Medtronic Guardian® REAL-Time has been validated against plasma glucose [49] and is widely used in clinical settings [50], [51].”
From Impact of Five Nights of Sleep Restriction on Glucose Metabolism, Leptin and Testosterone in Young Adult Men (2012) · cites this paper as [49]
The Abstract says CGM signals are calibrated with capillary blood glucose samples, and the Discussion names the Guardian REAL-Time while discussing sensor delays. Neither passage reports that the Guardian REAL-Time was validated against plasma glucose; searches for that comparison found no such result in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measuredThe lag time between blood and subcutaneous tissue glucose concentrations causes further inaccuracies for CGM devices.
“The lag time between blood and subcutaneous tissue glucose concentrations cause further inaccuracies for CGM devices.79–80”
From Biocompatible Materials for Continuous Glucose Monitoring Devices (2013) · cites this paper as [79]
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- Authors
- Keenan, D. B., Mastrototaro, J. J., Voskanyan, G., & Steil, G. M.
- Affiliations
- Medtronic (United States) (US)
- Boston Children's Hospital (US)
- Corresponding author
- Keenan, D. Barry
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2009-09
- Volume
- 3
- Issue
- 5
- Pages
- 1207-1214
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC2769894
- OpenAlex
- W2127835324
- Cited by
- 198
- References
- 27
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 2 · 2023: 8 · 2022: 11 · 2021: 13 · 2020: 15 · 2019: 11 · 2018: 17 · 2017: 18 · 2016: 10 · 2015: 9 · 2014: 13 · 2013: 22 · 2012: 12
- FWCI
- 6.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrochemical sensors and biosensors
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- continuous glucose monitoring, interstitial glucose, sensor calibration, digital filters, hypoglycemic clamp, hyperglycemic clamp, meal response, diabetes management
- MeSH terms
- Algorithms, Blood Glucose, Diagnosis, Computer-Assisted, Dietary Carbohydrates, Equipment Design, Humans, Predictive Value of Tests, Signal Processing, Computer-Assisted, Time Factors, Blood Glucose Self-Monitoring, Reproducibility of Results, Artifacts, Diagnostic Equipment, Extracellular Fluid, Electrochemical Techniques
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