Kinetics of glucose delivery to subcutaneous tissue in rats measured with 0.3-mm amperometric microsensors

In Vivo Monitoring of Glucose Using Ultrasound-Induced Resonance in Implantable Smart Hydrogel Microstructures

A novel glucose sensor is presented using smart hydrogels as biocompatible implantable sensing elements, which eliminates the need for implanted electronics and uses an external medical-grade ultrasound transducer for readout. The readout mechanism uses resonance absorption of ultrasound waves in glucose-sensitive hydrogels. In vivo glucose concentration changes in the interstitial fluid lead to swelling or deswelling of the gels, which changes the resonance behavior. The hydrogels are designed and shaped such as to exhibit specific mechanical resonance frequencies while remaining sonolucent to other frequencies. Thus, they allow conventional and continued ultrasound imaging, while yielding a sensing signal at specific frequencies that correlate with glucose concentration. The resonance frequencies can be tuned by changing the shape and mechanical properties of the gel structures, such as to allow for multiple, colocated implanted hydrogels with different sensing characteristics or targets to be employed and read out, without interference using the same ultrasound transducer, by simply toggling frequencies. The fact that there is no need for any implantable electronics, also opens up the path toward future use of biodegradable hydrogels, thus creating a platform that allows injection of sensors that do not need to be retrieved when they reach the end of their useful lifespan.

Electrochemical sensor array for glucose monitoring fabricated by rapid immobilization of active glucose oxidase within photochemically polymerized hydrogels

BACKGROUND

Currently, monitoring blood glucose levels for diabetic patients is invasive and painful, involving pricking the finger to obtain a blood sample three to four times daily. The need for frequent tests and pain involved with testing leads to poor compliance. In order to raise compliance, we propose to create an implantable electrochemical sensor array that would monitor glucose levels continuously.

METHODS

Glucose sensor arrays were fabricated on gold electrodes on flexible polyimide sheets by photopolymerization of the biocompatible polymer poly(ethylene glycol) diacrylate (PEG-DA) to develop hydrogels and encapsulate the sensing elements. Using conventional silicon fabrication methods, arrays of five gold microdisk electrodes were fabricated using lift-off photolithography and sputtering techniques. A redox polymer was then attached electrostatically to the electrode, and glucose oxidase was entrapped inside the hydrogel on the array of electrodes by ultraviolet-initiated photopolymerization of PEG-DA.

RESULTS

When the array of fabricated sensors was sampled together the elements behaved like one large electrode with peak current equivalent to the sum of individual array elements. The enzyme, glucose oxidase, catalyzed the oxidation of glucose and then exchanged electrons with the redox polymer in the hydrogel. The entrapped glucose oxidase was found to respond linearly to increasing glucose concentrations (0-360 mg/dl), as determined using cyclic voltammetry.

CONCLUSION

The fabricated microarray sensors were individually addressable and showed no cross talk between adjacent array elements as assessed using cyclic voltammetry. We have fabricated an array of glucose sensors on flexible polyimide sheets that exhibits the desired linear response in the biological range.

Development of a highly responsive needle-type glucose sensor using polyimide for a wearable artificial endocrine pancreas

To produce a long-life, stable, miniature glucose sensor for a wearable artificial endocrine pancreas (WAEP), we developed a novel microneedle-type glucose sensor using polyimide, designated the PI sensor (outer diameter, 0.3 mm; length, 16 mm), and investigated its characteristics in vitro and in vivo. In the in vitro study, we tested the sensor in 0.9% NaCl solution with varying glucose concentrations and observed an excellent linear relationship between the sensor output and glucose concentration (range: 0-500 mg/100 ml). In in vivo experiments, the PI sensor was inserted into the abdominal subcutaneous tissue of beagle dogs (n = 5), and interstitial fluid glucose concentrations were monitored after sensor calibration. Simultaneously, blood glucose concentrations were also monitored continuously with another PI sensor placed intravenously. The correlation and time delay between subcutaneous tissue glucose (Y) and blood glucose concentrations (X: 30-350 mg/100 ml) were Y = 1.03X + 7.98 (r = 0.969) and 6.6 +/- 1.2 min, respectively. We applied the new WAEP system/PI sensor and an intravenous insulin infusion algorithm developed previously for glycemic control in diabetic dogs. The use of the WAEP system resulted in excellent glycemic control after an oral glucose challenge of 1.5 g/kg (post-challenge blood glucose levels: 176 +/- 18 mg/100 ml at 65 min and 93 +/- 23 mg/100 ml at 240 min), without any hypoglycemia. Thus, we confirmed that our new PI sensor has excellent sensor characteristics in vitro and in vivo. The new WAEP using this sensor is potentially suitable for clinical application.

Experimental and theoretical aspects of glucose measurement using a microcantilever modified by enzyme-containing polyacrylamide

We report a glucose oxidase-containing polyacrylamide hydrogel-coated microcantilever sensor for the measurement of glucose. This enzymatic reaction of glucose results in swelling of the hydrogel due to formation of charged ions (gluconate molecules and protons). The microcantilever undergoes reversible and reproducible bending deflection upon exposure to solutions containing various glucose concentrations due to swelling or shrinking of the hydrogels. The microcantilever deflections increase when the glucose concentrations increase. A theoretical model has been built to correlate volume changes of the gel with microcantilever bending. The calculated data matched with the experimental results very well. Such hydrogel-coated microcantilevers could potentially be used to prepare microcantilever-based chemical and biological sensors when other enzymes are immobilized in the hydrogel.

Implanted electrochemical glucose sensors for the management of diabetes

By maintaining a near normal (70-120 mg/dL) glucose concentration, diabetic patients can drastically reduce the likelihood of the occurrence of diabetes complications. In the near future, subcutaneously implanted electrochemical glucose sensors will be available to provide frequent or continuous information on which timely treatment decisions, such as insulin injection or glucose source intake, can be based, as well as timely alarm signals. The currently engineered devices are of three types: (a) innocuous microsensors, with actively mass-transporting areas < 10(-3) cm2, replaced twice a week by the patient; (b) self-contained, surgeon-implanted, transmitter-containing packages of > 1 cm2 area, operating for > 100 days; and (c) devices transporting subcutaneous fluid to an external sensor, based on implanted microfiltration or microdialysis fibers or on iontophoretic transport of the subcutaneous fluid through the skin.

Interstitial glucose concentration and glycemia: implications for continuous subcutaneous glucose monitoring

The changes in plasma glucose concentration and in interstitial glucose concentration, determined with a miniaturized subcutaneous glucose sensor, were investigated in anesthetized nondiabetic rats. Interstitial glucose was estimated through two different calibration procedures. First, after a glucose load, the magnitude of the increase in interstitial glucose, estimated through a one-point calibration procedure, was 70% of that in plasma glucose. We propose that this is due to the effect of endogenous insulin on peripheral glucose uptake. Second, during the spontaneous secondary decrease in plasma glucose after the glucose load, interstitial glucose decreased faster than plasma glucose, which may also be due to the effect of insulin on peripheral glucose uptake. Third, during insulin-induced hypoglycemia, the decrease in interstitial glucose was less marked than that of plasma glucose, suggesting that hypoglycemia suppressed transfer of glucose into the interstitial tissue; subsequently, interstitial glucose remained lower than plasma glucose during its return to basal value, suggesting that the stimulatory effect of insulin on peripheral glucose uptake was protracted. If these observations obtained in rats are relevant to human physiology, such discrepancies between plasma and interstitial glucose concentration may have major implications for the use of a subcutaneous glucose sensor in continuous blood glucose monitoring in diabetic patients.

Continuous amperometric monitoring of glucose in a brittle diabetic chimpanzee with a miniature subcutaneous electrode

The performance of an amperometric biosensor, consisting of a subcutaneously implanted miniature (0.29 mm diameter, 5 x 10(-4) cm2 mass transporting area), 90 s 10-90% rise/decay time glucose electrode, and an on-the-skin electrocardiogram Ag/AgCl electrode was tested in an unconstrained, naturally diabetic, brittle, type I, insulin-dependent chimpanzee. The chimpanzee was trained to wear on her wrist a small electronic package and to present her heel for capillary blood samples. In five sets of measurements, averaging 5 h each, 82 capillary blood samples were assayed, their concentrations ranging from 35 to 400 mg/dl. The current readings were translated to blood glucose concentration by assaying, at t = 1 h, one blood sample for each implanted sensor. The rms error in the correlation between the sensor-measured glucose concentration and that in capillary blood was 17.2%, 4.9% above the intrinsic 12.3% rms error of the Accu-Chek II reference, through which the illness of the chimpanzee was routinely managed. Linear regression analysis of the data points taken at t>1 h yielded the relationship (Accu-Chek) = 0. 98 x (implanted sensor) + 4.2 mg/dl, r2 = 0.94. The capillary blood and the subcutaneous glucose concentrations were statistically indistinguishable when the rate of change was less than 1 mg/(dl. min). However, when the rate of decline exceeded 1.8 mg/(dl.min) after insulin injection, the subcutaneous glucose concentration was transiently higher.

Measurement and modeling of the transient difference between blood and subcutaneous glucose concentrations in the rat after injection of insulin

The kinetics of the fall in subcutaneous fluid glucose concentration in anesthetized rats (n = 7) after intravenous injection of insulin (0.5 units/kg) was studied by using 5 x 10(-4) cm2 active area, <150-sec 10-90% response time, amperometric glucose sensors. The onset of the decline in the subcutaneous glucose concentration was delayed and statistically different (P < 0.001) from that in blood (8.9 +/- 2.1 min vs. 3.3 +/- 0.5 min). Similarly, the rate of drop in glucose concentration between 6 and 20 min after the insulin injection was different for subcutaneous tissue (3.9 +/- 1.3 mg.dl-1. min-1) and blood (6.8 +/- 2.0 mg.dl-1.min-1) (P = 0.003). The hypoglycemic nadir in subcutaneous fluid occurred 24.5 +/- 6.8 min after that in the blood (P < 0.001). A "forward" mass-transfer model, predicting the subcutaneous glucose concentration from the blood glucose concentrations and an "inverse" model, predicting the blood glucose concentration from the subcutaneous glucose concentration were derived. By using an algorithm based on the latter, the average discrepancy between the measured blood glucose concentration and that estimated from the subcutaneous measurement through the entire 4-hr experiment was reduced from 22.9% to 11.1% (P = 0.025). The maximum discrepancy during the 40-min period after the injection of insulin was reduced from 84.1% to 29.3% (P = 0.006).