Already in use for monitoring patients with various types of cardiovascular disease, one of the most promising applications of smart textiles is their development for noninvasive glucose monitoring.

The ability to provide patients with diabetes the same ease of use and flexibility that has shown to increase cardiac patients’ adherence to monitoring regimes could offer the same type of benefit in diabetes.

Also, for patients with diabetes who have comorbidities, these textiles could allow the collection and integration of a variety of data directly into a patient’s electronic health record (EHR) at the clinician’s level.

At the intersection of biomedical electronics and traditional textiles, these garment-device hybrids have the potential to change the way that both patients with diabetes and physicians manage the condition and overcome some of the limitations of today’s continuous glucose monitors (CGMs).

“While smart textiles are still in early development and not yet as precise as current glucose monitors, they represent an exciting step toward more seamless, noninvasive monitoring,” said Disha Narang, MD, an endocrinologist and the director of Obesity Medicine at Endeavor Health, a nine-hospital system headquartered in Evanston, Illinois. “If accuracy continues to improve, this technology could make glucose checks more convenient and integrated into daily life, especially for people who want continuous insights without extra devices.”

Current Challenges of Continuous Glucose Monitoring 

For decades, the standard for blood glucose monitoring has been the finger-prick method, which is accurate but also inconvenient, painful, and frequently a source of anxiety for individuals with diabetes, especially children. The discomfort and hassle of repeated pricking can lead to poor adherence to a monitoring schedule, resulting in suboptimal blood sugar control and an increased risk for long-term complications.

This 2001 study showed that a lack of compliance with home blood glucose monitoring correlated strongly with hospitalization relating to various complications, largely due to the “inconvenience and anxiety of constantly performing finger pricking.”

More recently, CGMs have offered a significant improvement. While still invasive, they are minimally so: these devices use a tiny sensor inserted under the skin to measure glucose in the interstitial fluid. While CGMs have reduced the need for frequent finger pricks, they still require regular replacement of the sensor, which can be uncomfortable to the point that a 2023 study published in Diabetes Technology & Therapeutics showed that of 851 participants, 28% of those with CGMs reported skin reactions, and 3% stopped wearing their sensor due to reactions.

Narang said that stopping of sensor use can be attributed simply to the grind involved in ongoing glucose measurement, an area in which monitoring systems that would fit more easily into the user’s daily routine, like smart garments, could make a considerable difference.

“As an endocrinologist, I think smart textiles could reduce diabetes burnout for patients by making glucose monitoring more seamless and less intrusive,” she said.

However, Narang cautioned that such gains would have to be achieved without sacrificing the accuracy offered by today’s CGMs.

“What matters most is turning that continuous stream of data into actionable trends — like identifying patterns around meals, activity, or sleep — so I can adjust therapy in real time without overwhelming patients or providers.”

This is already happening with glucose monitors, Narang said, “However, we do need to verify that we will be getting accurate feedback (from smart garments), and that will require more testing and FDA approval.”

Where Smart Garment Development Stands Now

The development of smart garments for glucose monitoring relies on a complex confluence of advanced textile engineering, sensor technology, and data analytics. Currently in the developmental stage only, these garments are engineered with integrated fabrics that can interact with the body to gather biological data, and work using a variety of microneedle patches or biosensors embedded directly into the fabric.

This study published in the November 3, 2022, issue of Biosensors details several strategies for the use of technology embedded in textiles for glucose monitoring using an individual’s sweat, urine, or tears. With respect to smart garments, the measurement of sweat is the most applicable, highly studied pursuit.

One approach involves the use of flexible, screen-printed electrodes that can be seamlessly integrated into the fabric; the challenge lies in the fact that sweat glucose levels do not always directly correlate with blood glucose levels, and external factors like temperature and hydration can affect the readings. Researchers are working to overcome this by developing sophisticated algorithms that can calibrate sweat glucose data against a known blood glucose value and adjust for other variables.

One institution at the forefront of smart garment research in the area of continuous glucose monitoring is Penn State University, in teams being led by Huanyu “Larry” Cheng, PhD, an associate professor of engineering science and mechanics at the school. Cheng said that noninvasive continuous glucose monitoring sensors are the “holy grail” for applied materials scientists.

“Compared with other disease populations, diabetes is a much larger number of patients…so a lot of people are just more interested in diabetes over other diseases with smaller populations. And of course, interest has sparked the development for the sensor — but of course, despite maybe a few decades of effort, it’s still not available,” Cheng said.

If their work leads to a viable products for diabetes, he said it could then be adapted for other diseases.

Cheng’s team created flexible, wearable laser-induced nonenzymatic glucose sensors based on graphene foam or fibers. Their work was originally published in a study in the December 1, 2021, issue of Biosensors and Bioelectronics. Cheng has continued his work on the material in the intervening years, so that this nanocomposite can now detect specific glucose levels in sweat for 3 weeks while simultaneously monitoring body temperature and pH levels, as published as a study in the December 22, 2023, issue of the journal Advanced Functional Materials. There it showed a sensitivity of 91% over the trial period and the researchers said it would be low in cost to produce.

In related research published in the September 2025 issue of Composites Part B: Engineering, Cheng and his team integrated the graphene nanocomposites with molecularly-imprinted polymers specific to the detection of vitamin B6, and Prussian blue as a “signal booster.” The study showed this new combination to be highly effective even at low detection limits, with the idea of redirecting this system for potential glucose detection.

Elsewhere at Penn State, a team developed a material that is self-powering using a technique called electrospinning. In a study published in the May 16, 2025, issue of the Journal of Applied Physics, colead authors Guanchun Rui, PhD, a visiting postdoctoral student in the Department of Electrical Engineering and the Materials Research Institute; Patrick Mather, PhD, professor of chemical engineering and dean of the Schreyer Honors College; and Qiming Zhang, PhD, professor of electrical engineering, presented results detailing the fiber’s thermal stability, light weight, and flexibility. The results could lead to a fabric that is low-cost and scalable for use in the production of smart garments — and could potentially be used, among other things, in concert with the technology Cheng is developing nearby.

While the Biosensors study discusses other methods of glucose detection — for example, the use of spectroscopy, a technique that analyzes the interaction of light with a substance — Cheng feels strongly that glucose measurement through sweat detection is the most effective technique to pursue.

“Sweat detection based on electrochemical sensing will be a bit more robust because you don't need to worry about the optical setup that can be changing or fluctuating based on the fluctuation or the environmental factor or noise, and it’s really robust in different exercise, different activities,” Cheng said. “So I think this will be a bit more robust over the optical-based method for sure.”

Overcoming Challenges

As Narang said, the primary challenge most clinicians mention is accuracy: Any noninvasive glucose monitoring device must be accurate both in terms of the measurement it takes and with respect to how that measurement compares to the gold-standard of blood glucose monitoring via finger-prick testing. Cheng said there are two ways that sweat testing measurements are “translated” in order to be understood in context with blood glucose testing.

It can take anywhere from 9 or 10 minutes up to 30 minutes to diffuse from the blood vessel onto the sweat surface, Cheng said.

Second, the magnitude of the signal measured from the sweat will be smaller than from the blood vessel because the sweat generation will contain a lot of water, which can dilute the concentration of glucose and affect the reading.

“That’s why we typically have to make sure the glucose sensor is more sensitive to a smaller concentration of the glucose,” Cheng said.

The readings must also be reliable at all temperatures, during motion or inactivity, with varying amounts of sweat, and under all sorts of other conditions.

Beyond that, for these smart garments to make a widespread impact, they must be easy to wear and practical — for example, looking at smart garments for monitoring used by individuals with cardiovascular disease, it’s likely that washability will be a key factor, as is integration with patients’ EHRs at the provider level.

Data security will also be a critical concern. Access, including insurance coverage, is likely to be a factor, as is cost effectiveness. But safety remains at the forefront of Narang’s concerns.

“The biggest safety concerns with long-term wear of smart textiles are skin irritation from constant contact, sensor durability with repeated sweat and washing, and the risk of data drift as sensors degrade,” she said. “Any device we use clinically must prove it can remain safe, hygienic, and accurate over time.”

Once safety, accuracy, and reliability have been established, then comes the giant hurdle of regulatory approval. Cheng said that beginning this process is not too far in the future.

“For the direct submission to FDA, I think from the initial prototype we have available and doing maybe a small pilot study on some healthy individuals and the patient population, we can get that submitted in a year or so.”

The Potential Impact Is Sizeable, But When Will They Get Here?

The implications of smart garments for glucose monitoring are far-reaching. For individuals with Type 1 diabetes, a smart shirt, armband, or even socks could provide a continuous feedback loop in real time. These wearables could constantly monitor a user’s glucose levels and transmit the data to their smartphone, with an app that could then provide alerts for high or low blood sugar, track trends over time, and potentially even be integrated with an insulin pump for automated delivery. For individuals with Type 2 diabetes, similar garments could be integrated with an app to provide feedback on lifestyle management and improve understanding of what diet and exercise do to blood sugar as it’s happening.

After FDA approval, Cheng said it could take a while to get to production levels of the garments.

“After that stage, potential translation from the lab scale into the market would depend on a lot of factors, (including) the resources for scaling up and reproducible fabrication in an FDA-approved facility or through other ways of collaboration, and that, of course, will go beyond what we typically have been working on,” he said. “I hope we’ll get more resources to get it into the people’s hands faster. As a scientist, and more important, as an engineer, we think that’s really something we want to see — beyond the paper publication.”