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The efficacy of pharmaceutical treatments can be greatly enhanced by physiological feedback from the patient using biosensors, though this is often invasive or infeasible. By adapting microelectromechanical systems (MEMS) technology to miniaturize such biosensors, previously inaccessible signals can be obtained, often from inside the patient. This is enabled by the device's extremely small footprint which minimizes both power consumption and implantation trauma, as well as the transport time for chemical analytes, in turn decreasing the sensor's response time. MEMS fabrication also allows mass production which can be easily scaled without sacrificing its high reproducibility and reliability, and allows seamless integration with control circuitry and telemetry which is already produced using the same materials and fabrication steps. By integrating these systems with drug delivery devices, many of which are also MEMS-based, closed loop drug delivery can be achieved. This paper surveys the types of signal transduction devices available for biosensing—primarily electrochemical, optical, and mechanical—looking at their implementation via MEMS technology. The impact of MEMS technology on the challenges of biosensor development, particularly safety, power consumption, degradation, fouling, and foreign body response, are also discussed.