Cited by 5Non-Invasive Vital Sign MonitoringDiabetes Management and ResearchContext-Aware Activity Recognition Systems

Variability of the Skin Temperature from Wrist-Worn Device for Definition of Novel Digital Biomarkers of Glycemia

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Piersanti, Agnese, Littero, Martina, Del Giudice, Libera Lucia, Marcantoni, Ilaria, Burattini, Laura, Tura, Andrea, Morettini, Micaela·2025·Sensors

Abstract

This study exploited the skin temperature signal derived from a wrist-worn wearable device to define potential digital biomarkers for glycemia levels. Characterization of the skin temperature signal measured through the Empatica E4 device was obtained in 16 subjects (data taken from a dataset freely available on PhysioNet) by deriving standard metrics and a set of novel metrics describing both the current and the retrospective behavior of the signal. For each subject and for each metric, values that correspond to when glycemia was inside the tight range (70–140 mg/dL) were compared through the Wilcoxon rank-sum test against those above or below the range. For hypoglycemia characterization (below range), retrospective behavior of skin temperature described by the metric CVT SD (standard deviation of the series of coefficient of variation) proved to be the most effective both in daytime and nighttime (100% and 50% of the analyzed subjects, respectively). On the other side, for hyperglycemia characterization (above range), differences were observed between daytime and nighttime, with current behavior of skin temperature, described by M2T (deviation from the reference value of 32 °C), being the most informative during daytime, whereas retrospective behavior, described by SDT hhmm (standard deviation of the series of means), showed the highest effectiveness during nighttime. Proposed variability features outperformed standard metrics, and in future studies, their integration with other digital biomarkers of glycemia could improve the performance of applications devoted to non-invasive detection of glycemic events.

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  • Changes in statistical measures of distal body temperature can be used for identifying hypoglycemic events and predicting blood glucose concentration.

    “These works analyzed how changes in statistical measures of distal body temperature can be used for identifying hypoglycemic events and prediction blood glucose concentration29–32.”

    From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [32]

    The Results report that wrist skin-temperature metrics differed significantly during hypoglycemic conditions, supporting their potential to identify such events. The Conclusions describe possible use in non-invasive glycemia assessment, but this study did not demonstrate prediction of blood glucose concentration; the Discussion (4.3) calls for further evaluation of hypoglycemia detection. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Commonly used features are supported by prior work to be relevant to the effects of DM.

    “commonly used features supported by prior work to be relevant to the effects of DM31–33,35–38,45,49”

    From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [32]

    The Introduction (p. unavailable) reports prior evidence linking skin temperature to glycemic variation, and Discussion §4.2 says earlier studies used standard statistical temperature features. But the paper describes its engineered features as novel and studied people at risk of diabetes, not people with overt diabetes; it does not establish those features as commonly used measures of the effects of DM. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Prior work chiefly assessed statistical aggregation functions of wearable data streams (primary features), which are nonspecific to the effects of DM within data streams that are constantly fluctuating in natural settings.

    “Third, prior work chiefly assessed statistical aggregation functions of wearable data streams (primary features)5,26–32, which are nonspecific to the effects of DM within data streams that are constantly fluctuating in natural settings.”

    From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [32]

    The Discussion (§4.2; page unavailable) says previous studies using the same dataset relied on raw skin-temperature signals or standard statistical features such as the mean and standard deviation. Section 4.1 finds those standard metrics only partially effective at capturing glycemic changes. This supports the point about prior use and limitations of aggregation features, but does not establish that prior wearable-data work generally used such features or that they are wholly nonspecific to diabetes effects. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Neither prior literature was able to test their efficacy in large, real-world cohorts representing a practical assessment.

    “Though interesting, neither literature was able to test their efficacy in large, real-world cohorts representing a practical assessment.”

    From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [32]

    The Discussion (section 4.3, page unavailable) says this study evaluated hypoglycemia metrics in only six of fifteen subjects and calls for larger populations and further evaluation for real applications. That supports the lack of a large-cohort practical assessment for this study, but the passage does not establish the same limitation for both pieces of prior literature described in the claim. (LLM, conf=0.78)

    Experimental — accuracy not yet measured
  • Skin temperature collected from wrist-worn wearables has been assessed for changes with hyperglycemic events in cohorts ranging from 10 to 20 individuals.

    “Skin temperature was additionally collected from wrist-worn wearables was assessed for changes with hyperglycemic events in cohorts ranging from 10 to 20 individuals29–32.”

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Cites

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Research works printed but not linked: 2

  1. [1]Mathew T.K. Zubair M. Tadi P. Blood Glucose Monitoring StatPearls Publishing Treasure Island, FL, USA 2024 32310436
  2. [60]Yousef H. Ramezanpour Ahangar E. Varacallo M. Physiology, Thermal Regulation StatPearls Publishing Treasure Island, FL, USA 2024 29763018

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Authors
Piersanti, A., Littero, M., Del Giudice, L. L., Marcantoni, I., Burattini, L., Tura, A., & Morettini, M.
Affiliations
  • Marche Polytechnic University (IT)
  • Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
  • CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127 Padova, Italy
Corresponding author
Morettini, Micaela
Venue
Sensors
Publisher
MDPI AG
Published
2025-06-28
Volume
25
Issue
13
Pages
4038
ISSN
1424-8220 (ISSN-L)
OpenAlex
W4411802676
Cited by
5
References
59
Citations by year
2026: 5
FWCI
1.21
Type
journal article
Language
en
Open access
Locations
  • Sensors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
Keywords
skin temperature, digital biomarkers, glycemia, hypoglycemia, hyperglycemia, wearable devices, Empatica E4, coefficient of variation, non-invasive glucose monitoring
MeSH terms
Wearable Electronic Devices, Adult, Blood Glucose, Female, Humans, Hyperglycemia, Hypoglycemia, Male, Middle Aged, Skin Temperature, Wrist, Biomarkers

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