Continuous biosensing and real-time metabolic monitoring in obesity, diabetes, and diabetic kidney disease: implications for precision diabetes and kidney care

Abstract Diabetic kidney disease (DKD), a major complication of obesity and type 2 diabetes mellitus, is a leading cause of chronic kidney disease and kidney failure worldwide. Optimal management requires timely assessment of glycaemic status, metabolic instability, and cardiorenal risk; however, traditional monitoring tools such as glycated haemoglobin (HbA1c), serum creatinine, and albuminuria provide only intermittent assessments, while HbA1c becomes progressively less reliable in advanced CKD because anaemia, altered erythrocyte turnover, iron therapy, erythropoiesis-stimulating treatment, transfusion, and related factors can distort its relationship with mean glucose. Recent advances in biosensor technologies enable continuous, real-time monitoring of glucose, ketones, and other metabolic and kidney-relevant biomarkers, creating new opportunities for precision diabetes and kidney care. In this Review, we discuss established and emerging platforms, including continuous glucose monitoring (CGM), continuous ketone monitoring (CKM), wearable sweat biosensors, microneedle-based devices, and implantable biosensors. We distinguish clinically established applications from early translational technologies and highlight their potential roles in hypoglycaemia detection, metabolic safety during sodium-glucose cotransporter 2 inhibitor therapy, and individualized treatment. Integration with digital health and artificial intelligence may further support dynamic risk assessment, although CKD-specific validation, clinically actionable thresholds, regulatory approval, interoperability, reimbursement, and equitable implementation remain important barriers.