Recent progress in analytical instrumentation for glycemic control in diabetic and critically ill patients

Hydrogel optical fibers for continuous glucose monitoring

Continuous glucose monitoring facilitates the stringent control of blood glucose concentration in diabetic and intensive care patients. Optical fibers have emerged as an attractive platform; however, their practical applications are hindered due to lack of biocompatible fiber materials, complex and non-practical readout approaches, slow response, and time-consuming fabrication processes. Here, we demonstrate the quantification of glucose by smartphone-integrated fiber optics that overcomes existing technical limitations. Simultaneously, a glucose-responsive hydrogel was imprinted with an asymmetric microlens array and was attached to a multimode silica fiber's tip during photopolymerization, and subsequent interrogated for glucose sensing under physiological conditions. A smartphone and an optical power meter were employed to record the output signals. The functionalized fiber showed a high sensitivity (2.6 μW mM^-1), rapid response, and a high glucose selectivity in the physiological glucose range. In addition, the fiber attained the glucose complexation equilibrium within 15 min. The lactate interference was also examined and it was found minimal ∼0.1% in the physiological range. A biocompatible hydrogel made of polyethylene glycol diacrylate was utilized to fabricate a flexible hydrogel fiber to replace the silica fiber, and the fiber's tip was functionalized with the glucose-sensitive hydrogel during the ultraviolet light curing process. The biocompatible fiber was quickly fabricated by the molding, the readout approach was facile and practical, and the response to glucose was comparable to the functionalized silica fiber. The fabricated optical fiber sensors may have applications in wearable and implantable point-of-care and intensive-care continuous monitoring systems.

Diabetes Mellitus and Sepsis: A Challenging Association

Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. This inappropriate response to micro-organism invasion is characterized by an overwhelmed systemic inflammatory response and cardiovascular collapse that culminate in high mortality and morbidity in critical care units. The occurrence of sepsis in diabetes mellitus (DM) patients has become more frequent, as the prevalence of DM has increased dramatically worldwide. These two important diseases represent a global public health concern and highlight the importance of increasing our knowledge of the key elements of the immune response related to both conditions. In this context, it is well established that the cells taking part in the innate and adaptive immune responses in diabetic patients have compromised function. These altered responses favor micro-organism growth, a process that contributes to sepsis progression. The present review provides an update on the characteristics of the immune system in diabetic and septic subjects. We also explore the beneficial effects of insulin on the immune response in a glycemic control-dependent and independent manner.

Compatibility of Nitric Oxide Release with Implantable Enzymatic Glucose Sensors Based on Osmium (III/II) Mediated Electrochemistry

The compatibility of nitric oxide (NO) release coatings with implantable enzymatic glucose sensors based on osmium (III/II) mediated electrochemical detection is examined for the first time. NO-releasing osmium-mediated glucose sensors are prepared using a S-nitrosothiol impregnated outer tubing and are tested in vitro in both phosphate buffer (pH 7.4) and whole porcine blood. It is demonstrated that after 3 days of continuous NO release at or above physiological levels, there are no negative effects on the osmium mediated electrochemical currents. Indeed, such sensors maintain their functionality, sensitivity, and accuracy for detecting glucose levels in blood. The results suggest that improved performance of both intravascular and, potentially, subcutaneous Os(III/II) mediated glucose sensors may be realized by taking advantage of NO's well-known anticlotting, anti-inflammatory, and antimicrobial properties.

Electrospinning applications from diagnosis to treatment of diabetes

Modern applications of electrospinning.

Real-Time Monitoring of Critical Care Analytes in the Bloodstream with Chemical Sensors: Progress and Challenges

We review approaches and challenges in developing chemical sensor-based methods to accurately and continuously monitor levels of key analytes in blood related directly to the status of critically ill hospitalized patients. Electrochemical and optical sensor-based technologies have been pursued to measure important critical care species in blood [i.e., oxygen, carbon dioxide, pH, electrolytes (K(+), Na(+), Cl(-), etc.), glucose, and lactate] in real-time or near real-time. The two main configurations examined to date for achieving this goal have been intravascular catheter sensors and patient attached ex vivo sensors with intermittent blood sampling via an attached indwelling catheter. We discuss the status of these configurations and the main issues affecting the accuracy of the measurements, including cell adhesion and thrombus formation on the surface of the sensors, sensor drift, sensor selectivity, etc. Recent approaches to mitigate these nagging performance issues that have prevented these technologies from clinical use are also discussed.

Metabolic tumor profiling with pH, oxygen, and glucose chemosensors on a quantum dot scaffold

Acidity, hypoxia, and glucose levels characterize the tumor microenvironment rendering pH, pO2, and pGlucose, respectively, important indicators of tumor health. To this end, understanding how these parameters change can be a powerful tool for the development of novel and effective therapeutics. We have designed optical chemosensors that feature a quantum dot and an analyte-responsive dye. These noninvasive chemosensors permit pH, oxygen, and glucose to be monitored dynamically within the tumor microenvironment by using multiphoton imaging.

Carbon nanotubes as optical biomedical sensors

Biosensors are important tools in biomedical research. Moreover, they are becoming an essential part of modern healthcare. In the future, biosensor development will become even more crucial due to the demand for personalized-medicine, point-of care devices and cheaper diagnostic tools. Substantial advances in sensor technology are often fueled by the advent of new materials. Therefore, nanomaterials have motivated a large body of research and such materials have been implemented into biosensor devices. Among these new materials carbon nanotubes (CNTs) are especially promising building blocks for biosensors due to their unique electronic and optical properties. Carbon nanotubes are rolled-up cylinders of carbon monolayers (graphene). They can be chemically modified in such a way that biologically relevant molecules can be detected with high sensitivity and selectivity. In this review article we will discuss how carbon nanotubes can be used to create biosensors. We review the latest advancements of optical carbon nanotube based biosensors with a special focus on near-infrared (NIR)-fluorescence, Raman-scattering and fluorescence quenching.

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

OBJECTIVE

To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point.

METHODS

Where available, the literature was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to assess the impact of insulin infusions on outcome for general intensive care unit patients and those in specific subsets of neurologic injury, traumatic injury, and cardiovascular surgery. Elements that contribute to safe and effective insulin infusion therapy were determined through literature review and expert opinion. The majority of the literature supporting the use of insulin infusion therapy for critically ill patients lacks adequate strength to support more than weak recommendations, termed suggestions, such that the difference between desirable and undesirable effect of a given intervention is not always clear.

RECOMMENDATIONS

The article is focused on a suggested glycemic control end point such that a blood glucose ≥ 150 mg/dL triggers interventions to maintain blood glucose below that level and absolutely <180 mg/dL. There is a slight reduction in mortality with this treatment end point for general intensive care unit patients and reductions in morbidity for perioperative patients, postoperative cardiac surgery patients, post-traumatic injury patients, and neurologic injury patients. We suggest that the insulin regimen and monitoring system be designed to avoid and detect hypoglycemia (blood glucose ≤ 70 mg/dL) and to minimize glycemic variability.Important processes of care for insulin therapy include use of a reliable insulin infusion protocol, frequent blood glucose monitoring, and avoidance of finger-stick glucose testing through the use of arterial or venous glucose samples. The essential components of an insulin infusion system include use of a validated insulin titration program, availability of appropriate staffing resources, accurate monitoring technology, and standardized approaches to infusion preparation, provision of consistent carbohydrate calories and nutritional support, and dextrose replacement for hypoglycemia prevention and treatment. Quality improvement of glycemic management programs should include analysis of hypoglycemia rates, run charts of glucose values <150 and 180 mg/dL. The literature is inadequate to support recommendations regarding glycemic control in pediatric patients.

CONCLUSIONS

While the benefits of tight glycemic control have not been definitive, there are patients who will receive insulin infusion therapy, and the suggestions in this article provide the structure for safe and effective use of this therapy.

Real-time clinical monitoring of biomolecules

Continuous monitoring of clinical biomarkers offers the exciting possibility of new therapies that use biomarker levels to guide treatment in real time. This review explores recent progress toward this goal. We initially consider measurements in body fluids by a range of analytical methods. We then discuss direct tissue measurements performed by implanted sensors; sampling techniques, including microdialysis and ultrafiltration; and noninvasive methods. A future directions section considers analytical methods at the cusp of clinical use.

Single-walled carbon nanotube-based near-infrared optical glucose sensors toward in vivo continuous glucose monitoring

This article reviews research efforts on developing single-walled carbon nanotube (SWNT)-based near-infrared (NIR) optical glucose sensors toward long-term in vivo continuous glucose monitoring (CGM). We first discuss the unique optical properties of SWNTs and compare SWNTs with traditional organic and nanoparticle fluorophores regarding in vivo glucose-sensing applications. We then present our development of SWNT-based glucose sensors that use glucose-binding proteins and boronic acids as a high-affinity molecular receptor for glucose and transduce binding events on the receptors to modulate SWNT fluorescence. Finally, we discuss opportunities and challenges in translating the emerging technology of SWNT-based NIR optical glucose sensors into in vivo CGM for practical clinical use.

Determinants of the accuracy of continuous glucose monitoring in non-critically ill patients with heart failure or severe hyperglycemia

BACKGROUND

The accuracy of continuous glucose monitoring (CGM) in non-critically ill hospitalized patients with heart failure or severe hyperglycemia (SH) is unknown.

METHODS

Hospitalized patients with congestive heart failure (CHF) exacerbation (receiving IV or subcutaneous insulin) or SH requiring insulin infusion were compared to outpatients referred for retrospective CGM.

RESULTS

Forty-three patients with CHF, 15 patients with SH, and 88 outpatients yielded 470, 164, and 2150 meter-sensor pairs, respectively. Admission glucose differed (188 versus 509 mg/dl in CHF and SH, p < .001) but not the first sensor glucose (p = .35). In continuous glucose error grid analysis, 67-78% of pairs during hypoglycemia were in zones A+B (p = .63), compared with 98-100% in euglycemia (p < .001) and 98%, 92%, and 99% (p = .001) during hyperglycemia for the CHF, SH, and outpatient groups, respectively. Mean absolute relative difference (MARD) was lower in the CHF versus the SH group in glucose strata above 100 mg/dl, but there was no difference between the CHF and outpatient groups. Linear regression models showed that CHF versus outpatient, SH versus CHF, and coefficient of variation were significant predictors of higher MARD. Among subjects with CHF, MARD was not associated with brain natriuretic peptide or change in plasma volume, but it was significantly higher in subjects randomized to IV insulin (p = .04).

CONCLUSIONS

The results suggest that SH and glycemic variability are more important determinants of CGM accuracy than known CHF status alone in hospitalized patients.

Boronic acid library for selective, reversible near-infrared fluorescence quenching of surfactant suspended single-walled carbon nanotubes in response to glucose

We describe the high-throughput screening of a library of 30 boronic acid derivatives to form complexes with sodium cholate suspended single-walled carbon nanotubes (SWNTs) to screen for their ability to reversibly report glucose binding via a change in SWNT fluorescence. The screening identifies 4-cyanophenylboronic acid which uniquely causes a reversible wavelength red shift in SWNT emission. The results also identify 4-chlorophenylboronic acid which demonstrates a turn-on fluorescence response when complexed with SWNTs upon glucose binding in the physiological range of glucose concentration. The mechanism of fluorescence modulation in both of these cases is revealed to be a photoinduced excited-state electron transfer that can be disrupted by boronate ion formation upon glucose binding. The results allow for the elucidation of design rules for such sensors, as we find that glucose recognition and transduction is enabled by para-substituted, electron-withdrawing phenyl boronic acids that are sufficiently hydrophobic to adsorb to the nanotube surface.

In vivo, transcutaneous glucose sensing using surface-enhanced spatially offset Raman spectroscopy: multiple rats, improved hypoglycemic accuracy, low incident power, and continuous monitoring for greater than 17 days

This paper presents the latest progress on quantitative, in vivo, transcutaneous glucose sensing using surface enhanced spatially offset Raman spectroscopy (SESORS). Silver film over nanosphere (AgFON) surfaces were functionalized with a mixed self-assembled monolayer (SAM) and implanted subcutaneously in Sprague-Dawley rats. The glucose concentration was monitored in the interstitial fluid of six separate rats. The results demonstrated excellent accuracy and consistency. Remarkably, the root-mean-square error of calibration (RMSEC) (3.6 mg/dL) and the root-mean-square error of prediction (RMSEP) (13.7 mg/dL) for low glucose concentration (<80 mg/dL) is lower than the current International Organization Standard (ISO/DIS 15197) requirements. Additionally, our sensor demonstrated functionality up 17 days after implantation, including 12 days under the laser safety level for human skin exposure with only one time calibration. Therefore, our SERS based sensor shows promise for the challenge of reliable continuous glucose sensing systems for optimal glycemic control.

Intravascular glucose/lactate sensors prepared with nitric oxide releasing poly(lactide-co-glycolide)-based coatings for enhanced biocompatibility

Intravenous amperometric needle-type enzymatic glucose/lactate sensors intended for continuous monitoring are prepared with a novel nitric oxide (NO) releasing layer to improve device hemocompatibility. To create an underlying NO release coating, the sensors with immobilized enzymes (either glucose oxidase or lactate oxidase) are prepared with a thin layer of poly(lactide-co-glycolide) (PLGA) loaded with lipophilic diazeniumdiolate species that slowly release NO via a proton driven reaction. An outer thin layer (ca. 30 μm) of PurSil (polyurethane/dimethylsiloxane copolymer) limits the flux of glucose and lactate to the inner layer of enzyme, to provide the desired linear amperometric response. A 30 μm coating of PLGA containing 33 wt% of the appropriate NO donor (N-diazeniumdiolated dibutylhexanediamine, DBHD/N₂O₂) can release NO at a physiologically relevant rate > 1 × 10⁻¹⁰mol min⁻¹ cm⁻² for at least 7 days without influencing the analytical performance of the glucose/lactate sensors. In vitro, the sensors exhibit relatively stable amperometric response over a one-week period with high selectivity over interferences (e.g., ascorbic acid) required for blood monitoring applications. Glucose sensors implanted in the veins of rabbits for 8h exhibit significantly enhanced hemocompatibility for the NO release sensors vs. corresponding controls (without NO release in same animals), with greatly reduced thrombus formation on their surfaces. Further, the analytical performance of the NO release glucose sensors are superior to controls placed in the veins of the same animals, with a greater accuracy in measuring blood glucose levels as evaluated using a Clarke error grid type analysis.

Direct measurements of blood glucose concentration in the presence of saccharide interferences using slope and bias orthogonal signal correction and Fourier transform near-infrared spectroscopy

Saccharide interferences such as Dextran, Galactose, etc. have a great potential to interfere with near infrared (NIR) glucose analysis since they have a similar spectroscopic fingerprint and are present physiologically at large relative concentrations. These can lead to grossly inappropriate interpretation of patient glucose levels and resultant treatment in critical care and hospital settings. This study describes a methodology to reduce this effect on glucose analysis using an NIR Fourier transform spectroscopy method combined with a multivariate calibration technique (PLS) using preprocessing by orthogonal signal correction (OSC). A mathematical approach based on the use of a single calibration based bias and slope correction was applied in addition to a standard OSC was investigated. This approach is combined with a factorial interferent calibration design to accommodate for interference effects. We named this approach as a slope and bias OSC (sbOSC). sbOSC differs from OSC in the way it handles the prediction. In sbOSC, statistics on slope and bias obtained from a set of calibration samples are then used as a validation parameter in the prediction set. Healthy human volunteer blood with different glucose (80 to 200 mg/dL) and hematocrit (24 to 48 vol.%) levels containing high expected levels of inteferents have been measured with a transmittance near-infrared Fourier transform spectrometer operates in the broadband spectral range of 1.25-2.5 μm (4000-8000 cm(-1)). The effect of six interferents compounds used in intensive care and operating rooms, namely Dextran, Fructose, Galactose, Maltose, Mannitol, and Xylose, were tested on blood glucose. A maximum interference effect (MIE) parameter was used to rank the significance for the individual interferent type on measurement error relative to the total NIR whole blood glucose measurement error. For comparison, a YSI (Yellow Springs Instrument) laboratory reference glucose analyzer and NIR data were collected at the same time as paired samples. MIE results obtained by sbOSC were compared with several standard spectral preprocessing approaches and show a substantial reduced effect of saccharide interferences. NIR glucose measurement results are substantially improved when comparing standard error of prediction from validation samples; and resulting MIE values are small.

Prediction of glucose concentration in post-cardiothoracic surgery patients using continuous glucose monitoring

OBJECTIVE

This study evaluated the predictive capability of simple linear extrapolation of continuous glucose data in postsurgical patients undergoing intensive care.

METHODS

Twenty patients, both with or without an established diagnosis of diabetes mellitus, scheduled to undergo cardiothoracic surgery were included. Glucose was continuously monitored in the intensive care unit with a microdialysis-based subcutaneous glucose monitoring system. The prediction horizon (PH) with respect to a given glucose reading was calculated by extrapolating the linear trend of the glucose signal and subjected to both analytical and clinical assessment (by calculation of the average duration of consecutive positive and negative glucose signal trends, the root mean squared error [RMSE], and by insulin titration error grid [ITEG] analysis, respectively).

RESULTS

In total, 609 h of continuous glucose data from 17 patients were analyzed. The average duration of consecutive positive and negative glucose signal trends was 7.97 (3.99-19.98) min (median, interquartile range). An increase in the RMSE of 0.5 mmol/L (9 mg/dL) was associated with a PH of 37 min. A strong increase in the number of data points in the unacceptable violation zone of the ITEG was associated with a PH of approximately 20 min.

CONCLUSIONS

Our data provide evidence that simple linear extrapolation of glucose trend information obtained by continuous glucose monitoring can be used to predict the course of glycemia in critically ill patients for up to 20-30 min. This "glimpse into the future" can be used to proactively prevent the occurrence of adverse events.

Injectable hydrogel microbeads for fluorescence-based in vivo continuous glucose monitoring

Fluorescent microbeads hold great promise for in vivo continuous glucose monitoring with wireless transdermal transmission and long-lasting activity. The full potential of fluorescent microbeads has yet to be realized due to insufficient intensity for transdermal transmission and material toxicity. This paper illustrates the highly-sensitive, biostable, long-lasting, and injectable fluorescent microbeads for in vivo continuous glucose monitoring. We synthesized a fluorescent monomer composed of glucose-recognition sites, a fluorogenic site, spacers, and polymerization sites. The spacers are designed to be long and hydrophilic for increasing opportunities to bind glucose molecules; consequently, the fluorescent monomers enable high-intensive responsiveness to glucose. We then fabricated injectable-sized fluorescent polyacrylamide hydrogel beads with high uniformity and high throughput. We found that our fluorescent beads provide sufficient intensity to transdermally monitor glucose concentrations in vivo. The fluorescence intensity successfully traced the blood glucose concentration fluctuation, indicating our method has potential uses in highly-sensitive and minimally invasive continuous blood glucose monitoring.

Microdialysis based device for continuous extravascular monitoring of blood glucose

Glycemic control of intensive care patients can be beneficial for this patient group but the continuous determination of their glucose concentration is challenging. Current continuous glucose monitoring systems based on the measurement of interstitial fluid glucose concentration struggle with sensitivity losses, resulting from biofouling or inflammation reactions. Their use as decision support systems for the therapeutic treatment is moreover hampered by physiological time delays as well as gradients in glucose concentration between plasma and interstitial fluid. To overcome these drawbacks, we developed and clinically evaluated a system based on microdialysis of whole blood. Venous blood is heparinised at the tip of a double lumen catheter and pumped through a membrane based micro-fluidic device where protein-free microdialysate samples are extracted. Glucose recovery as an indicator of long term stability was studied in vitro with heparinised bovine blood and remained highly stable for 72 h. Clinical performance was tested in a clinical trial in eight healthy volunteers undergoing an oral glucose tolerance test. Glucose concentrations of the new system and the reference method correlated at a level of 0.96 and their mean relative difference was 1.9 +/- 11.2%. Clinical evaluation using Clark's Error Grid analysis revealed that the obtained glucose concentrations were accurate and clinically acceptable in 99.6% of all cases. In conclusion, results of the technical and clinical evaluation suggest that the presented device delivers microdialysate samples suitable for accurate and long term stable continuous glucose monitoring in blood.

Polymerized crystalline colloidal array sensing of high glucose concentrations

We are developing photonic crystal glucose sensing materials to continuously monitor relatively high glucose concentrations, such as found in blood. We modified our synthetic fabrication methodologies in order to increase the glucose concentration range and to increase the reproducibility of our PCCA fabrication. We have also advanced our understanding of the sensing response by developing a mechanical method to independently determine the hydrogel cross-link density. Our investigation of the sensing mechanism indicates that glucose binding depends mainly on the boronic acid concentrations and affinities. We determined the binding constant of 2-fluoro-5-aminophenyl boronic acid for glucose under physiological conditions. We have examined the dependence of glucose sensing upon interferences by other species that ligand to boronic acids, such as lactate and human serum albumin. We examined the stability of our sensors over a period of weeks at room temperature and demonstrated that we could further stabilize our sensing materials by reversibly dehydrating them for storage.

The chemistry of commercial continuous glucose monitors

The analytical methodologies of the continuous glucose monitors (CGMs) commercialized to date are described. The devices include two noninvasive products: the GlucoWatch (Cygnus, Redwood City, CA) G2 Biographer uses iontophoresis to obtain a sample and electrochemistry for glucose detection, and PENDRA (Pendragon Medical Ltd., Zurich, Switzerland) utilizes impedance spectroscopy. Three minimally invasive systems employ subcutaneous amperometric sensors-Guardian REAL-Time (Medtronic MiniMed, Sylmar, CA), DexCom STS-7 (DexCom, San Diego, CA), and FreeStyle Navigator (Abbott Diabetes Care, Alameda, CA). The GlucoDay (A. Menarini I.F.R. S.r.l., Florence, Italy) collects a sample with a minimally invasive microdialysis fiber and measures the glucose electrochemically.

Glucose concentration monitoring using a small Fabry-Perot etalon

Accurate measurements of aqueous glucose concentrations have been made in a double-chamber Fabry-Perot etalon that can be miniaturized for subcutaneous implantation to determine the concentration of glucose in interstitial fluid. In general, optical approaches to glucose detection measure light intensity, which in tissue varies due to inherent scattering and absorption. In our measurements, we compare the spectral positions of transmission maximums in two adjunct sections of an etalon in order to determine the refractive index difference between these sections and therefore we can tolerate large changes in intensity. With this approach, we were able to determine aqueous glucose concentrations between 0 mg/dl and 700 mg/dl within the precision of our reference measurement (+/-2.5 mg/dl or 2% of the measurement value). The use of reference cavities eliminates interference due to temperature variations, and we show the temperature independence over a temperature range of 32 degrees C to 42 degrees C. Furthermore, external filters eliminate interference from large molecule contaminants.

TheClinical Research Tool: a high-performance microdialysis-based system for reliably measuring interstitial fluid glucose concentration

BACKGROUND

A novel microdialysis-based continuous glucose monitoring system, the so-called Clinical Research Tool (CRT), is presented. The CRT was designed exclusively for investigational use to offer high analytical accuracy and reliability. The CRT was built to avoid signal artifacts due to catheter clogging, flow obstruction by air bubbles, and flow variation caused by inconstant pumping. For differentiation between physiological events and system artifacts, the sensor current, counter electrode and polarization voltage, battery voltage, sensor temperature, and flow rate are recorded at a rate of 1 Hz.

METHOD

In vitro characterization with buffered glucose solutions (c(glucose) = 0 - 26 x 10(-3) mol liter(-1)) over 120 h yielded a mean absolute relative error (MARE) of 2.9 +/- 0.9% and a recorded mean flow rate of 330 +/- 48 nl/min with periodic flow rate variation amounting to 24 +/- 7%. The first 120 h in vivo testing was conducted with five type 1 diabetes subjects wearing two systems each. A mean flow rate of 350 +/- 59 nl/min and a periodic variation of 22 +/- 6% were recorded.

RESULTS

Utilizing 3 blood glucose measurements per day and a physical lag time of 1980 s, retrospective calibration of the 10 in vivo experiments yielded a MARE value of 12.4 +/- 5.7. Clarke error grid analysis resulted in 81.0%, 16.6%, 0.8%, 1.6%, and 0% in regions A, B, C, D, and E, respectively.

CONCLUSION

The CRT demonstrates exceptional reliability of system operation and very good measurement performance. The ability to differentiate between artifacts and physiological effects suggests the use of the CRT as a reference tool in clinical investigations.

Clinical evaluation of bionime rightest GM310 biosensors with a simplified electrode fabrication for alternative-site blood glucose tests

BACKGROUND

Most processes for fabricating biosensors applied to screen-printed carbon electrodes (SPCEs) are complex. This study presents a novel one-step process for manufacturing electrodes for injection-molding biosensors.

METHODS

During the sensor-fabrication process, barrel-plated gold electrodes were inserted into an injection-molded base. The electrode directly touched the electrical contact of a meter. We analyzed technical measurements for this biosensor, including tests of the measurement range, within-run imprecision, and between-meter imprecision. In clinical trials, experienced technicians tested 3 alternative sites (fingertip, palm, and arm). The results were simultaneously compared with plasma values obtained with the hexokinase method on the Olympus AU640 instrument. Analytical results were evaluated according to International Standards Organization 15197 (ISO 15197:2003) criteria and by Clarke error grid analysis (EGA), and CVs were calculated to evaluate within-run imprecision.

RESULTS

The glucose measurement range was 0.6- 33.3 mmol/L (y = 0.96x + 0.07 mmol/L; r(2) = 0.9977). The CVs in the within-run imprecision test were 1.7%-3.5%, and the overall CV was 2.1%, indicating good reproducibility of results. The Student t-tests of mean values from 5 meters revealed statistically insignificant differences (P > 0.05). In clinical trials, the agreement of the Rightest GM310 meter results with those of a laboratory method complied with ISO 15197:2003 criteria. In the EGA, 100% of the values were within the acceptable zones (A + B), and the proportion of values within zone A exceeded 95%.

CONCLUSIONS

The Bionime Rightest GM310 meter applied a simplified process for biosensor fabrication and displayed acceptable performance for monitoring glucose concentrations at alternative test sites.

Electrochemical Sensors for Clinic Analysis

Demanded by modern medical diagnosis, advances in microfabrication technology have led to the development of fast, sensitive and selective electrochemical sensors for clinic analysis. This review addresses the principles behind electrochemical sensor design and fabrication, and introduces recent progress in the application of electrochemical sensors to analysis of clinical chemicals such as blood gases, electrolytes, metabolites, DNA and antibodies, including basic and applied research. Miniaturized commercial electrochemical biosensors will form the basis of inexpensive and easy to use devices for acquiring chemical information to bring sophisticated analytical capabilities to the non-specialist and general public alike in the future.