Non-invasive polarimetric measurement of glucose concentration in the anterior chamber of the eye

Non-contact monitoring of glucose concentration and pH by integration of wearable and implantable hydrogel sensors with optical coherence tomography

Optical coherence tomography (OCT) is a noninvasive imaging technique with large penetration depth into the tissue, but limited chemical specificity. By incorporating functional co-monomers, hydrogels can be designed to respond to specific molecules and undergo reversible volume changes. In this study, we present implantable and wearable biocompatible hydrogel sensors combined with OCT to monitor their thickness change as a tool for continuous and real-time monitoring of glucose concentration and pH. The results demonstrate the potential of combining hydrogel biosensors with OCT for non-contact continuous in-vivo monitoring of physiological parameters.

Experimental and probabilistic model validation of ultrasonic MEMS transceiver for blood glucose sensing

In contrast to traditional laboratory glucose monitoring, recent developments have focused on blood glucose self-monitoring and providing patients with a self-monitoring device. This paper proposes a system based on ultrasound principles for quantifying glucose levels in blood by conducting an in-vitro experiment with goat blood before human blood. The ultrasonic transceiver is powered by a frequency generator that operates at 40 kHz and 1.6 V, and variations in glucose level affect the ultrasonic transceiver readings. The RVM probabilistic model is used to determine the variation in glucose levels in a blood sample. Blood glucose levels are measured simultaneously using a commercial glucose metre for confirmation. The experimental data values proposed are highly correlated with commercial glucose metre readings. The proposed ultrasonic MEMS-based blood glucometer measures a glucose level of [Formula: see text] mg/dl. In the near future, the miniature version of the experimental model may be useful to human society.

Noninvasive Blood Glucose Monitoring Systems Using Near-Infrared Technology—A Review

The past few decades have seen ongoing development of continuous glucose monitoring (CGM) systems that are noninvasive and accurately measure blood glucose levels. The conventional finger-prick method, though accurate, is not feasible for use multiple times a day, as it is painful and test strips are expensive. Although minimally invasive and noninvasive CGM systems have been introduced into the market, they are expensive and require finger-prick calibrations. As the diabetes trend is high in low- and middle-income countries, a cost-effective and easy-to-use noninvasive glucose monitoring device is the need of the hour. This review paper briefly discusses the noninvasive glucose measuring technologies and their related research work. The technologies discussed are optical, transdermal, and enzymatic. The paper focuses on Near Infrared (NIR) technology and NIR Photoplethysmography (PPG) for blood glucose prediction. Feature extraction from PPG signals and glucose prediction with machine learning methods are discussed. The review concludes with key points and insights for future development of PPG NIR-based blood glucose monitoring systems.

Optical phantoms for biomedical polarimetry: a review

Calibration, quantification, and standardization of the polarimetric instrumentation, as well as interpretation and understanding of the obtained data, require the development and use of well-calibrated phantoms and standards. We reviewed the status of tissue phantoms for a variety of applications in polarimetry; more than 500 papers are considered. We divided the phantoms into five groups according to their origin (biological/nonbiological) and fundamental polarimetric properties of retardation, depolarization, and diattenuation. We found that, while biological media are generally depolarizing, retarding, and diattenuating, only one of all the phantoms reviewed incorporated all these properties, and few considered at least combined retardation and depolarization. Samples derived from biological tissue, such as tendon and muscle, remain extremely popular to quickly ascertain a polarimetric system, but do not provide quantifiable results aside from relative direction of their principal optical axis. Microspheres suspensions are the most utilized phantoms for depolarization, and combined with theoretical models can offer true quantification of depolarization or degree of polarization. There is a real paucity of birefringent phantoms despite the retardance being one of the most interesting parameters measurable with polarization techniques. Therefore, future work should be directed at generating truly reliable and repeatable phantoms for this metric determination. Diattenuating phantoms are rare and application-specific. Given that diattenuation is considered to be low in most biological tissues, the lack of such phantoms is seen as less problematic. The heterogeneity of the phantoms reviewed points to a critical need for standardization in this field. Ultimately, all research groups involved in polarimetric studies and instruments development would benefit from sharing a limited set of standardized polarimetric phantoms, as is done earlier in the round robin investigations in ellipsometry.

The Progress of Glucose Monitoring-A Review of Invasive to Minimally and Non-Invasive Techniques, Devices and Sensors

Current glucose monitoring methods for the ever-increasing number of diabetic people around the world are invasive, painful, time-consuming, and a constant burden for the household budget. The non-invasive glucose monitoring technology overcomes these limitations, for which this topic is significantly being researched and represents an exciting and highly sought after market for many companies. This review aims to offer an up-to-date report on the leading technologies for non-invasive (NI) and minimally-invasive (MI) glucose monitoring sensors, devices currently available in the market, regulatory framework for accuracy assessment, new approaches currently under study by representative groups and developers, and algorithm types for signal enhancement and value prediction. The review also discusses the future trend of glucose detection by analyzing the usage of the different bands in the electromagnetic spectrum. The review concludes that the adoption and use of new technologies for glucose detection is unavoidable and closer to become a reality.

A polysulfobetaine hydrogel for immobilization of a glucose-binding protein

A hydrogel based on sulfobetaine methacrylate monomer and crosslinker was investigated as a potential material for fluorescent glucose biosensor applications.

Detection and Monitoring of Microparticles Under Skin by Optical Coherence Tomography as an Approach to Continuous Glucose Sensing Using Implanted Retroreflectors

We demonstrate the feasibility of using optical coherence tomography (OCT) to image and detect 2.8 μm diameter microparticles (stationary and moving) on a highly-reflective gold surface both in clear media and under skin in vitro. The OCT intensity signal can clearly report the microparticle count, and the OCT response to the number of microparticles shows a good linearity. The detect ability of the intensity change (2.9% ± 0.5%) caused by an individual microparticle shows the high sensitivity of monitoring multiple particles using OCT. An optical sensing method based on this feasibility study is described for continuously measuring blood sugar levels in the subcutaneous tissue, and a molecular recognition unit is designed using competitive binding to modulate the number of bound microparticles as a function of glucose concentration. With further development, an ultra-small, implantable sensor might provide high specificity and sensitivity for long-term continuous monitoring of blood glucose concentration.

Dual-wavelength polarimetric glucose sensing in the presence of birefringence and motion artifact using anterior chamber of the eye phantoms

Noninvasive glucose monitoring is being investigated as a tool for effectively managing diabetes mellitus. Optical polarimetry has emerged as one such method, which can potentially be used to ascertain blood glucose levels by measuring the aqueous humor glucose levels in the anterior chamber of the eye. The key limitation for realizing this technique is the presence of sample noise due to corneal birefringence, which in the presence of motion artifact can confound the glucose signature in the aqueous humor of the eye. We present the development and characterization of a real-time, closed-loop, dual-wavelength polarimetric system for glucose monitoring using both a custom-built plastic eye phantom (in vitro) and isolated rabbit corneas (ex vivo) mounted in an artificial anterior chamber. The results show that the system can account for these noise sources and can monitor physiologic glucose levels accurately for a limited range of motion-induced birefringence. Using the dual-wavelength system in vitro and ex vivo, standard errors were 14.5 mg/dL and 22.4 mg/dL, respectively, in the presence of birefringence with motion. The results indicate that although dual-wavelength polarimetry has a limited range of compensation for motion-induced birefringence, when aligned correctly, it can minimize the effect of time-varying corneal birefringence for a range of motion larger than what has been reported in vivo.

Safety and accuracy of a new long-term subconjunctival glucose sensor

BACKGROUND

A new biosensor has been developed by EyeSense (Großostheim, Germany) that is placed into the conjunctiva of one eye to measure the glucose concentration of the surrounding tissue in a non-invasive manner. In the present study we investigated the correlation between glucose concentrations measured by the EyeSense implant and those determined by finger prick testing, as well as the tolerability and safety of the implant over a 16-week period.

METHODS

The study was performed in 28 diabetic patients. The biosensor was inserted under local anesthesia and sterile conditions. Correlations between capillary glucose measured by laboratory methods and interstitial glucose determined by the biosensor were investigated by inducing increases and decreases in glucose values between 60 and 300 mg/dL.

RESULTS

Most patients experienced a mild subconjunctival hemorrhage postoperatively. Except for the minor sensation of the presence of foreign body, the implants were well tolerated. Three patients lost the ocular mini insert spontaneously, whereas there was a function failure of the insert in four patients. Error grid analysis showed that the percentage of data pairs in the acceptable ranges (zone A and B) was very high (>96%). However, there was a shift from zone A to zone B during observation. This was due primarily to an increase in the lag time between capillary and interstitial measured glucose.

CONCLUSION

he present study demonstrates good tolerability and measurement performance of the biosensor. The reasons for an increase in the lag time are still unknown; local reactions may be involved.

First clinical evaluation of a new long-term subconjunctival glucose sensor

BACKGROUND

To evaluate the feasibility of an implantable subconjunctival glucose monitoring system (SGMS) for glucose monitoring in humans, we investigated the in vivo performance of the sensor in a clinical trial with five patients.

METHODS

The new SGMS consists of an implantable ocular mini implant (OMI) and a hand-held fluorescence photometer. The implantable subconjunctival glucose sensor is composed of a fluorescence resonance energy transfer system based on Concanavalin A chemistry, embedded in a nelfilcon polymer hydrogel disk. Blood glucose changes in humans were induced by oral glucose intake and insulin injections.

RESULTS

The in vivo response of the new SGMS was tested in a first human clinical study with five diabetes patients. The OMI was well tolerated in the eyes of the patients. The SGMS exhibited high correlation coefficients (>0.88) with blood glucose changes and a good stability of the sensor response to glucose for the study period of 2 weeks. Lag times were in the range of 5-10 min. A total of 98% of all data pairs was in the clinical acceptable ranges A and B of the consensus error grid.

CONCLUSIONS

For the first time, the possibility to measure glucose in vivo in the subconjunctival interstitial fluid for a period of 2 weeks was demonstrated in a human clinical trial.

Non-invasive glucose monitoring technology in diabetes management: a review

The frequent monitoring of glucose is an essential part of diabetes management. Despite the fact that almost all the commercially successful blood glucose monitoring devices are invasive, there is an immense need to develop non-invasive glucose monitoring (NGM) devices that will alleviate the pain and suffering of diabetics associated with the frequent pricking of skin for taking the blood sample for glucose testing. There have been numerous developments in the field of NGM during the last decade, which stress the need for a critical review. This manuscript aims to review the various NGM techniques and devices. The challenges and future trends in NGM are also discussed.

Noninvasive polarimetric-based glucose monitoring: an in vivo study

BACKGROUND

Since 1990, there has been significant research devoted toward development of a noninvasive physiological glucose sensor. In this article, we report on the use of optical polarimetry for the noninvasive measurement of physiological glucose concentration in the anterior chamber of the eye of New Zealand white (NZW) rabbits.

METHOD

Measurements were acquired using a custom-designed laser-based optical polarimetry system in a total of seven NZW rabbits anesthetized using an isoflurane-only anesthesia protocol. Aqueous humor-based polarimetric measurements were obtained by coupling light through the anterior chamber of the eye. Blood glucose levels were first stabilized and then altered with intravenous dextrose and insulin administration and measured every 3-5 min with a standard glucometer and intermittently with a YSI 2300 glucose analyzer. Acquired polarimetric glucose signals are calibrated to measured blood glucose concentration.

RESULTS

Based on a total of 41 data points, Clarke error grid analysis indicated 93% in zone A, 7% in zone B, and 0% in zones C and D, with reference concentrations between 93 and 521 mg/dl. Errors in prediction are shown to be related to gross movement of the rabbit during the procedures, incurring time-varying corneal birefringence effects that directly affect the measured polarimetric signal. These effects can be compensated for with appropriate design modifications.

CONCLUSIONS

An optical polarimetry technique was used for in vivo physiological glucose monitoring. The technique demonstrated provides a basis for the development of a noninvasive polarimetric glucose monitor for home, personal, or hospital use.

Characterizing dual wavelength polarimetry through the eye for monitoring glucose

Diabetes is an insidious disease that afflicts millions of people worldwide and typically requires the person with the disease to monitor their blood sugar level via finger or forearm sticks multiple times daily. Therefore, the ability to noninvasively measure glucose would be a significant advancement for the diabetic community. The use of optically polarized light passed through the anterior chamber of the eye is one proposed noninvasive approach for glucose monitoring. However, the birefringence of the cornea and the difficulty in coupling the light across the eye have been major drawbacks toward realizing this approach. A dual wavelength optical polarimetric approach has been proposed as a means to potentially overcome the birefringence noise but has never been fully characterized. Therefore, in this paper an optical model has been developed along with experiments performed on New Zealand White rabbit eyes for characterizing the light path and corneal birefringence at two different wavelengths as they are passed through the anterior chamber of the eye. The results show that, without index matching, it is possible to couple the light in and out of the eye but only across a very limited range otherwise the light does not come back out of the eye. It was also shown that there is potential to use a dual wavelength approach to accommodate the birefringence noise of the cornea in the presence of eye motion. These results will be used to help guide the final design of the polarimetric system for use in noninvasive monitoring of glucose in vivo.

Real-time, closed-loop dual-wavelength optical polarimetry for glucose monitoring

The development of a real-time, dual-wavelength optical polarimetric system to ultimately probe the aqueous humor glucose concentrations as a means of noninvasive diabetic glucose monitoring is the long-term goal of this research. The key impact of the work is the development of an approach for the reduction of the time-variant corneal birefringence due to motion artifact, which is still a limiting factor preventing the realization of such a device. Our dual-wavelength approach utilizes real-time, closed-loop feedback that employs a classical three-term feedback controller and efficiently reduces the effect of motion artifact that appears as a common noise source for both wavelengths. In vitro results are shown for the open-loop system, and although the dual-wavelength system helps to reduce the noise, it is shown that closed-loop control is necessary to bring the noise down to a sufficient level for physiological monitoring. Specifically, in vitro measurement results with the closed-loop dual-wavelength approach demonstrate a sensitivity of 12.8 mg/dl across the physiologic glucose range in the presence of time-variant test cell birefringence. Overall, it is shown that this polarimetric system has the potential to be used as a noninvasive measure of glucose for diabetes.

Current development in non-invasive glucose monitoring

Painless control of blood glycemic levels could improve life quality of diabetes patients, enabling a better regulation of hyper- and hypoglycaemia episodes and thereby avoiding physiological complications. Although research groups have been trying for decades to separate non-invasive glucose information from interference compounds, none of the available commercial devices offers enough precision to replace lancet approaches. Many reviews have already been published on this topic, but the great amount of information available and the fast development of technologies require a continuous update in the research status. Besides the description of current in-vivo methods and the analysis of devices available commercially, one also explains treatment algorithms useful for multivariate analysis.