Non-enzymatic sweat sensors for pediatric continuous glucose monitoring: a systematic review of engineering readiness and the cost-accuracy trade-off

Continuous glucose monitoring (CGM) in children with type 1 diabetes is faced with major challenges due to prohibitive price, invasiveness and lack of compliance with insulin of the currently available interstitial devices, which is particularly severe in low- and middle-income countries (LMICs). To investigate emerging solutions, we have undertaken a systematic review (2016–2025) of non-invasive, sweat-based glucose sensors and used a structured biomedical engineering model to determine the technological maturity and pediatric and global health usage of the sensors. The review of 25 peer-reviewed articles indicates a significant shift to non-enzymatic sensing schemes based on strong approaches and incorporating highly sensitive nanomaterials like MXene and scalable libraries of fabrications. An analysis of qualitative cost accuracy trade-off, formalized by new, specially developed LMIC Scalability Score, proves that whereas complex and expensive systems would reach the lowest mean absolute relative difference (MARD), simpler and highly scalable devices would reach the same performance with a MARD value under 10.5%, making them possible and low-cost variants. To this end, the essential interventions that can be done to facilitate clinical translation in the short term are the design of advanced physiological time-lag simulations and the implementation of strong, age-focused pediatric clinical trials to bridge the technology innovation and clinical practice gap.