Investigating the Efficacy of Using Hand Tremors for Early Detection of Hypoglycemic Events: A Scoping Literature Review

Abstract

Diabetes is a prevalent condition affecting millions of patients globally. Some diabetic patients suffer from a deadly condition called Hypoglycemia (sudden drop in blood glucose levels). Continuous Glucose Monitors (CGMs) have been the most pervasive tool used to track blood glucose levels but these tools are invasive and costly. While early detection of hypoglycemia has been studied, current approaches do not leverage tremors; which are a primary symptom of hypoglycemia. A scoping review was conducted to understand the relationship between tremors and hypoglycemia, and to document any efforts that utilized tremor signatures non-invasively to detect hypoglycemic events. Findings suggest that hypoglycemic tremors are a medium frequency tremor, more resistant to hypoglycemic impairment than other symptoms, and have not been fully explored yet. This paper also documents the work in progress to utilize a novel wearable device that predicts the onsets of hypoglycemia using hand tremor sensing.

Diabetes Management Experience and the State of Hypoglycemia: National Online Survey Study (Preprint)

“…A nationwide survey of 212 patients with type 1 diabetes was conducted to investigate noticeability of hypoglycemic tremors as well as perceived frequency and severity of such tremors among patients. Our findings suggest that while tremors are perceived to be less noticeable, frequent, or severe than other hypoglycemic symptoms such as sweating, changes in body temperature, and headache, in line with the literature [19,21], such hypoglycemic tremors occur at moderate frequency and are being noticed by most patients. Indeed, our study shows that more than 50% of the respondents encountered hypoglycemic events at least once a week.…”

“…In a previous review, we reported that tremors and trembling have been found to be very common among patients with diabetes [19]. In another study surveying elderly subjects, trembling was reported in 71% of patients with diabetes [21].…”

“…However, the availability of alternatives, particularly for detection and monitoring of hypoglycemia, has been very limited. A few noninvasive devices such as HypoMon, GlucoWatch G2, and Diabetes Sentry made it to the market but exhibited a high incidence of false alarms and were sensitive to environmental conditions [19]. Those that could not be commercialized were prototypes with significant wearability issues [19].…”

“…A few noninvasive devices such as HypoMon, GlucoWatch G2, and Diabetes Sentry made it to the market but exhibited a high incidence of false alarms and were sensitive to environmental conditions [19]. Those that could not be commercialized were prototypes with significant wearability issues [19]. One study even claimed that noninvasive options were incapable of competing with invasive methods in terms of accuracy [20].…”

A Wearable, Low-cost Hand Tremor Sensor for Detecting Hypoglycemic Events in Diabetic Patients

“…With environmental factors greatly influencing the skin conductance and body temperature, these parameters are not accurate predictors of hypoglycemia [6]. Furthermore, our literature search revealed very few studies using hypoglycemic tremors or utilized technology to correlate tremors with the onset of hypoglycemia [7]. One study attempted to detect hypoglycemia through tremors as a continuous movement for more than 30 seconds in the wrist without specific analysis of the tremor characteristics.…”