Introduction to Cybersecurity Vulnerabilities in Connected Medical Devices

The integration of Continuous Glucose Monitors (CGMs) into Automated Insulin Delivery (AID) systems has significantly elevated the importance of cybersecurity, transforming it from a privacy concern to a critical patient safety issue [1]. This shift is largely due to the potential for cyber attacks to directly impact patient health. The primary vulnerabilities in these systems can be attributed to Bluetooth Low Energy (BLE) implementation flaws, which include eavesdropping, Man-in-the-Middle (MitM) attacks, and Replay attacks [2].

Analysis of Key Vulnerabilities

The cybersecurity vulnerabilities in connected medical devices can be categorized into several key areas:

• Integrity Attacks: One of the most lethal vectors involves spoofing high glucose values, which can cause connected insulin pumps to administer an overdose of insulin to the patient [3]. This type of attack highlights the critical need for robust security measures to protect the integrity of the data transmitted between devices.
• Denial of Service (DoS): Attacks aimed at exhausting the battery of medical devices can force them offline, thereby disrupting the continuity of therapy [4]. This underscores the importance of designing devices with security features that prevent such disruptions.
• Mobile Risks: The process of reverse-engineering smartphone apps used in conjunction with medical devices can expose API keys and proprietary protocols [5]. This vulnerability necessitates the implementation of secure coding practices and regular security audits for mobile applications.

Mitigation Strategies

To address these vulnerabilities, regulatory bodies such as the FDA have begun to mandate Software Bill of Materials (SBOM) and cryptographic agility [6]. Manufacturers, including Dexcom and Abbott, are adopting enhanced security measures such as application-layer encryption and Out-of-Band (OOB) pairing via NFC to secure the wireless link between devices [7]. These measures are crucial steps towards ensuring the security and reliability of connected medical devices.

Conclusion

In conclusion, the cybersecurity of connected medical devices is a multifaceted issue that requires a comprehensive approach. By understanding the key vulnerabilities and implementing effective mitigation strategies, we can significantly enhance the security of these devices and protect patient safety. Further research and collaboration between manufacturers, regulatory bodies, and cybersecurity experts are essential for staying ahead of emerging threats and ensuring the integrity of connected medical devices.