Detection of sympathoadrenal discharge by parameterisation of skin conductance and ECG measurement

A multiparameter model for non-invasive detection of hypoglycemia

OBJECTIVE

Severe hypoglycemia is the most serious acute complication for people with type 1 diabetes (T1D). Approximately 25% of people with T1D have impaired ability to recognize impending hypoglycemia, and nocturnal episodes are feared.

APPROACH

We have investigated the use of non-invasive sensors for detection of hypoglycemia based on a mathematical model which combines several sensor measurements to identify physiological responses to hypoglycemia. Data from randomized single-blinded euglycemic and hypoglycemic glucose clamps in 20 participants with T1D and impaired awareness of hypoglycemia was used in the analyses.

MAIN RESULTS

Using a sensor combination of sudomotor activity at three skin sites, ECG-derived heart rate and heart rate corrected QT interval, near-infrared and bioimpedance spectroscopy; physiological responses associated with hypoglycemia could be identified with an F1 score accuracy up to 88%.

SIGNIFICANCE

We present a novel model for identification of non-invasively measurable physiological responses related to hypoglycemia, showing potential for detection of moderate hypoglycemia using a wearable sensor system.

Integrated In-Ear Device for Auditory Health Assessment

Clinical assessment of the human auditory system is an integral part of evaluating the health of a patient's cognitive processes. Conventional tests performed by audiologists include the Auditory Steady State Response (ASSR) and the Auditory Brainstem Response (ABR), both of which present an audio stimulus to the patient in order to elicit a change in brain state measurable by electroencephalography (EEG) techniques. Spatial monitoring of the electrophysiological activity in the auditory cortex, temporal cortex, and brain stem during auditory stimulus evaluation can be used to pinpoint to location of auditory dysfunction along the auditory pathway. However, given the obtrusive nature of conventional auditory evaluation techniques and the lack of information about sound transduction and cochlear dynamics usually irrecoverable by EEG, a better approach is needed to improve its clinical utility. Here, we present an in-ear device for auditory health assessment that integrates a sound engine for stimulation and high-density dry-electrode EEG for real-time simultaneous recording of brain activity. This system provides ease-of-use and patient comfort. We also investigate the auditory transfer function of the hearing system as an intricate convolution of the tympanic membrane, middle ear bones, and the cochlear subsystems.

Evaluation of Hypoglycaemia with Non-Invasive Sensors in People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia

People with type 1 diabetes and impaired awareness of hypoglycaemia (IAH) are prone to severe hypoglycaemia. Previous attempts to develop non-invasive hypoglycaemia alarm systems have shown promising results, but it is not known if such alarms can detect severe hypoglycaemia in people with IAH. We aimed to explore whether a combination of non-invasive sensors could reliably evaluate hypoglycaemia (plasma glucose (PG) minimum 2.5 mmol/L) in people with IAH. Twenty participants with type 1 diabetes and IAH underwent randomly ordered, single blinded hyperinsulinemic euglycaemic and hyperinsulinemic hypoglycaemic clamps. Sweating, skin temperature, ECG, counterregulatory hormones and symptoms of hypoglycaemia were assessed. Overall, we were not able to detect clamp-induced hypoglycaemia with sufficient sensitivity and specificity for further clinical use. As a post-hoc analysis, we stratified participants according to their ability to identify hypoglycaemic symptoms during hypoglycaemic clamps. Five out of 20 participants could identify such symptoms. These participants had a significantly higher adrenaline response to hypoglycaemia (p < 0.001) and were reliably identified by sensors. Based on our observations, a non-invasive alarm system based on measurement of sweating responses and ECG changes during hypoglycaemia might provide an alert at a plasma glucose concentration around 2.5 mmol/L if an adequate sympatho-adrenal reaction is elicited.