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Yuan CY, Halim B, Kong YW, Lu J, Dutt-Ballerstadt R, Eckenberg P, Hillen K, Koski A, Milenkowic V, Netzer E, Obeyesekere V, Reid S, Sims C, Vogrin S, Wu HP, Seidl T, O'Neal DN. Combining an Electrochemical Continuous Glucose Sensor With an Insulin Delivery Cannula: A Feasibility Study. J Diabetes Sci Technol 2024:19322968241236771. [PMID: 38491800 DOI: 10.1177/19322968241236771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Combining a continuous glucose monitor with an insulin delivery cannula (CGM-IS) could benefit clinical outcomes. We evaluated the feasibility of a single-needle insertion electrochemical investigational CGM-IS (Pacific Diabetes Technologies, Portland, Oregon) in type 1 diabetes adults. METHODS Following 48 hours run-in using a Medtronic 780G in manual mode with a commercial insulin set, 12 participants commenced insulin delivery using the CGM-IS. A standardized test meal was eaten on the mornings of days 1 and 4. Venous samples were collected every 10 minutes one hour prior to and 15 minutes post-meal for four hours. CGM-IS glucose measurements were post-processed with a single capillary blood calibration during warm-up and benchmarked against YSI. A Dexcom G6 sensor was worn post-consent to study end. RESULTS Mean absolute relative difference (MARD) for the CGM-IS glucose measurements was 9.2% (484 paired data points). Consensus error grid revealed 88.6% within zone A and 100% in A + B. Mean (SD) % bias was -3.5 (11.7) %. There were 35 paired YSI readings <100 mg/dL cutoff and 449 ≥100 mg/dL with 81.4% within ±15 mg/dL or ±15%, and 89.9% within ±20 mg/dL or ±20%. Two cannula occlusions required discontinuation of insulin delivery: one at 70 hours post insertion and another during the day 4 meal test. Mean (SD) Dexcom glucose measurements during run-in and between meal tests was respectively 161.3 ± 27.3 mg/dL versus 158.0 ± 25.6 mg/dL; P = .39 and corresponding mean total daily insulin delivered by the pump was 58.0 ± 25.4 Units versus 57.1 ± 28.8 Units; P = .47. CONCLUSIONS Insulin delivery and glucose sensing with the investigational CGM-IS was feasible. Longer duration studies are needed.
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Affiliation(s)
- Cheng Yi Yuan
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Bella Halim
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Yee W Kong
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Jean Lu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | | | - Ken Hillen
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Anh Koski
- Pacific Diabetes Technologies, Portland, OR, USA
| | | | - Emma Netzer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Varuni Obeyesekere
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Solomon Reid
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Catriona Sims
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Huan-Ping Wu
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Thomas Seidl
- Pacific Diabetes Technologies, Portland, OR, USA
| | - David N O'Neal
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
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2
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Schoemaker M, Martensson A, Mader JK, Nørgaard K, Freckmann G, Benhamou PY, Diem P, Heinemann L. Combining Glucose Monitoring and Insulin Infusion in an Integrated Device: A Narrative Review of Challenges and Proposed Solutions. J Diabetes Sci Technol 2023:19322968231203237. [PMID: 37798963 DOI: 10.1177/19322968231203237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The introduction of automated insulin delivery (AID) systems has enabled increasing numbers of individuals with type 1 diabetes (T1D) to improve their glycemic control largely. However, use of AID systems is limited due to their complexity and costs associated. The user must wear both a continuously monitoring glucose system and an insulin infusion pump. The glucose sensor and the insulin catheter must be inserted at two different body sites using different insertion devices. In addition, the user must pair and manage the different systems. These communicate with the AID software implemented on the pump or on a third device such as a dedicated display device or smart phone application. These components might be developed and commercialized by different manufacturers, which in turn can cause difficulties for patients seeking technical support. A possible solution to these challenges would be to integrate the glucose sensor and insulin catheter into a single device. This would allow the glucose sensor and insulin catheter to be inserted simultaneously, eliminating the need for pairing, and simplifying system management. In recent years, different technologies have been developed and evaluated in clinical investigations that combine the glucose sensor and the insulin catheter in one platform. The consistent finding of all these studies is that integration has no adverse effect on insulin infusion and glucose measurements provided that certain conditions are met. In this review, we discuss the perceived challenges of such an approach and discuss possible solutions that have been proposed.
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Affiliation(s)
| | | | | | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Peter Diem
- Artificial Intelligence in Health and Nutrition, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Lutz Heinemann
- Science-Consulting in Diabetes GmbH, Düsseldorf, Germany
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3
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Tuning Pore Structure and Specific Surface Area of Graphene Frameworks via One-Step Fast Pyrolysis Strategy: Impact on Electrochemical Sensing Behavior of Catechol. Microchem J 2023. [DOI: 10.1016/j.microc.2023.108441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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4
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Sachdeva P, M AR, Shukla R, Sahani A. A review on artificial pancreas and regenerative medicine used in the management of Type 1 diabetes mellitus. J Med Eng Technol 2022; 46:693-702. [PMID: 35801984 DOI: 10.1080/03091902.2022.2095049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetes mellitus is one of the fastest-growing lifestyle disorders in the world. While numerous regimes have been developed to manage diabetes, there continue to be high numbers of diabetes-related deaths worldwide. The review gives a brief introduction to the pathology and aetiology of the disorder, different solutions developed over time with their advantages and disadvantages, and highlights the technological components and challenges of the latest technologies: artificial pancreas and regenerative medicine. The study is restricted to a set of high-quality publications from the last decade.
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Affiliation(s)
- Pallavi Sachdeva
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | - Ashrit R M
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | - Rahul Shukla
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | - Ashish Sahani
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
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5
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Shang T, Zhang JY, Thomas A, Arnold MA, Vetter BN, Heinemann L, Klonoff DC. Products for Monitoring Glucose Levels in the Human Body With Noninvasive Optical, Noninvasive Fluid Sampling, or Minimally Invasive Technologies. J Diabetes Sci Technol 2022; 16:168-214. [PMID: 34120487 PMCID: PMC8721558 DOI: 10.1177/19322968211007212] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Conventional home blood glucose measurements require a sample of blood that is obtained by puncturing the skin at the fingertip. To avoid the pain associated with this procedure, there is high demand for medical products that allow glucose monitoring without blood sampling. In this review article, all such products are presented. METHODS In order to identify such products, four different sources were used: (1) PubMed, (2) Google Patents, (3) Diabetes Technology Meeting Startup Showcase participants, and (4) experts in the field of glucose monitoring. The information obtained were filtered by using two inclusion criteria: (1) regulatory clearance, and/or (2) significant coverage in Google News starting in the year 2016, unless the article indicated that the product had been discontinued. The identified bloodless monitoring products were classified into three categories: (1) noninvasive optical, (2) noninvasive fluid sampling, and (3) minimally invasive devices. RESULTS In total, 28 noninvasive optical, 6 noninvasive fluid sampling, and 31 minimally invasive glucose monitoring products were identified. Subsequently, these products were characterized according to their regulatory, technological, and consumer features. Products with regulatory clearance are described in greater detail according to their advantages and disadvantages, and with design images. CONCLUSIONS Based on favorable technological features, consumer features, and other advantages, several bloodless products are commercially available and promise to enhance diabetes management. Paths for future products are discussed with an emphasis on understanding existing barriers related to both technical and non-technical issues.
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Affiliation(s)
- Trisha Shang
- Diabetes Technology Society, Burlingame, California, USA
| | | | - Andreas Thomas
- AGDT (Working group of Diabetes Technology), Germany, Ulm, Germany
| | - Mark A. Arnold
- University of Iowa, Department of Chemistry, Iowa City, Iowa, USA
| | | | | | - David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, California, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, California 94401, USA.
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6
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Heifler O, Borberg E, Harpak N, Zverzhinetsky M, Krivitsky V, Gabriel I, Fourman V, Sherman D, Patolsky F. Clinic-on-a-Needle Array toward Future Minimally Invasive Wearable Artificial Pancreas Applications. ACS NANO 2021; 15:12019-12033. [PMID: 34157222 PMCID: PMC8397432 DOI: 10.1021/acsnano.1c03310] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 05/28/2023]
Abstract
In order to reduce medical facility overload due to the rise of the elderly population, modern lifestyle diseases, or pandemics, the medical industry is currently developing point-of-care and home medical device systems. Diabetes is an incurable and lifetime disease, accountable for a significant mortality and socio-economic public health burden. Thus, tight glucose control in diabetic patients, which can prevent the onset of its late complications, is of enormous importance. Despite recent advances, the current best achievable management of glucose control is still inadequate, due to several key limitations in the system components, mainly related to the reliability of sensing components, both temporally and chemically, and the integration of sensing and delivery components in a single wearable platform, which is yet to be achieved. Thus, advanced closed-loop artificial pancreas systems able to modulate insulin delivery according to the measured sensor glucose levels, independently of patient supervision, represent a key requirement of development efforts. Here, we demonstrate a minimally invasive, transdermal, multiplex, and versatile continuous metabolites monitoring system in the subcutaneous interstitial fluid space based on a chemically modified SiNW-FET nanosensor array on microneedle elements. Using this technology, ISF-borne metabolites require no extraction and are measured directly and continuously by the nanosensors. Due to their chemical sensing mechanism, the nanosensor response is only influenced by the specific metabolite of interest, and no response is observed in the presence of potential exogenous and endogenous interferents known to seriously affect the response of current electrochemical glucose detection approaches. The 2D architecture of this platform, using a single SOI substrate as a top-down multipurpose material, resulted in a standard fabricated chip with 3D functionality. After proving the ability of the system to act as a selective multimetabolites sensor, we have implemented our platform to reach our main goal for in vivo continuous glucose monitoring of healthy human subjects. Furthermore, minor adjustments to the fabrication technique allow the on-chip integration of microinjection needle elements, which can ideally be used as a drug delivery system. Preliminary experiments on a mice animal model successfully demonstrated the single-chip capability to both monitor glucose levels as well as deliver insulin. By that, we hope to provide in the future a cost-effective and reliable wearable personalized clinical tool for patients and a strong tool for research, which will be able to perform direct monitoring of clinical biomarkers in the ISF as well as synchronized transdermal drug delivery by this single-chip multifunctional platform.
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Affiliation(s)
- Omri Heifler
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ella Borberg
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nimrod Harpak
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Marina Zverzhinetsky
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Vadim Krivitsky
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Itay Gabriel
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Victor Fourman
- School
of Mechanical Engineering, the Iby and Aladar Fleischman Faculty of
Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dov Sherman
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- School
of Mechanical Engineering, the Iby and Aladar Fleischman Faculty of
Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Fernando Patolsky
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
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