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Liu Y, Zhang J, Chun X, Gao Y, Yao R, Liang Y, Zhu L, He Y, Huang W. Performance of Continuous Glucose Monitoring in Patients With Acute Respiratory Failure: A Prospective, Single-Center Observational Study. Endocr Pract 2024; 30:795-801. [PMID: 38876178 DOI: 10.1016/j.eprac.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/23/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) may have benefits in achieving glycemic control in critically ill patients. The aim of this study was to assess the accuracy of the Freestyle Libre H (professional version similar to the Libre Pro) in patients with acute respiratory failure (ARF) in the intensive care unit (ICU). METHODS Fifty-two adult patients with ARF were selected. The performance of CGM was evaluated using the arterial blood glucose (aBG) and point-of-care (POC) glucose levels as the reference values. Numerical accuracy was evaluated by the mean absolute relative difference, Bland-Altman analysis, %15/15 (the percentage of CGM values within 15 mg/dL or 15% of reference values <100 or >100 mg/dL, respectively), %20/20, and %30/30. Clinical accuracy was assessed using the Clarke error grid analysis. RESULTS A total of 519 and 1504 pairs of aBG/CGM and POC/CGM glucose values were analyzed. The mean absolute relative difference values were 13.8% and 14.7%, respectively. The mean deviations of the Bland-Altman analysis were 0.82 mmol/L and 0.81 mmol/L. The proportions of CGM values within %15/15, %20/20, and %30/30 of the aBG values were 62.6%, 75.5%, and 92.4%, respectively; those within %15/15, %20/20, and %30/30 of the POC values were 57.1%, 72.9%, and 88.7%, respectively. The Clarke error grid analysis showed that 97.8% and 99.3% of the values were located in zone A + B. Additionally, the accuracy of CGM was not affected by general patient factors. CONCLUSION This study demonstrated that the accuracy of CGM in patients with ARF is lower than that in most outpatients and it is not affected by general patient factors. Whether CGM is beneficial to glucose management in the intensive care unit needs further evaluation.
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Affiliation(s)
- Yanhua Liu
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Jianna Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Xueli Chun
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Rong Yao
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Yin Liang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Ling Zhu
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Ying He
- Anesthesia & Operation Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenxia Huang
- General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
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2
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Bao Z, Lu S, Zhang D, Wang G, Cui X, Liu G. Wearable Microneedle Patch for Colorimetric Detection of Multiple Signature Biomarkers in vivo Toward Diabetic Diagnosis. Adv Healthc Mater 2024; 13:e2303511. [PMID: 38353398 DOI: 10.1002/adhm.202303511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/05/2024] [Indexed: 02/19/2024]
Abstract
Type 2 diabetes is rapidly emerging as a global public health problem. While blood glucose monitoring has been the primary method of managing diabetes for decades, the increasing global prevalence of the disease suggests that there might be a need to identify additional biomarkers for a more precise early diagnosis. Herein, a microneedle patch based wearable sensor is developed for the purpose of diabetic diagnosis. Utilizing methacrylic acid modified gelatin and polyvinyl alcohol in the fabrication of microneedles has improved their mechanical properties for skin penetration and increased swelling capacity for interstitial fluid extraction, thanks to the double crosslinking mechanism. The fabricated microneedles are further integrated with test paper functionalized with enzyme and dye molecules to detect multiple signature biomarkers of diabetes in vivo through a colorimetric reaction. Such a wearable microneedle patch holds significant promise for the real-time monitoring of various biomarkers related to chronic diseases and aging.
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Affiliation(s)
- Ziting Bao
- CUHK(SZ)-Boyalife Joint Laboratory for Regenerative Medicine Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Sheng Lu
- CUHK(SZ)-Boyalife Joint Laboratory for Regenerative Medicine Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Duo Zhang
- CUHK(SZ)-Boyalife Joint Laboratory for Regenerative Medicine Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Guanyu Wang
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Xiaolin Cui
- CUHK(SZ)-Boyalife Joint Laboratory for Regenerative Medicine Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Guozhen Liu
- CUHK(SZ)-Boyalife Joint Laboratory for Regenerative Medicine Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen, 518172, China
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Abstract
For diabetics, taking regular blood glucose measurements is crucial. However, traditional blood glucose monitoring methods are invasive and unfriendly to diabetics. Recent studies have proposed a biofluid-based glucose sensing technique that creatively combines wearable devices with noninvasive glucose monitoring technology to enhance diabetes management. This is a revolutionary advance in the diagnosis and management of diabetes, reflects the thoughtful modernization of medicine, and promotes the development of digital medicine. This paper reviews the research progress of noninvasive continuous blood glucose monitoring (CGM), with a focus on the biological liquids that replace blood in monitoring systems, the technical principles of continuous noninvasive glucose detection, and the output and calibration of sensor signals. In addition, the existing limits of noninvasive CGM systems and prospects for the future are discussed. This work serves as a resource for further promoting the development of noninvasive CGM systems.
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Affiliation(s)
- Yilin Li
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, 100069, PR China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, PR China
| | - Yueyue Chen
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, 100069, PR China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, PR China
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4
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Kalogeropoulou MS, Iglesias-Platas I, Beardsall K. Should continuous glucose monitoring be used to manage neonates at risk of hypoglycaemia? Front Pediatr 2023; 11:1115228. [PMID: 37025284 PMCID: PMC10070986 DOI: 10.3389/fped.2023.1115228] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
The National Institute for Clinical Excellence (NICE) now recommends that continuous glucose monitoring (CGM) be offered to adults and children with diabetes who are at risk from hypoglycaemia. Hypoglycaemia is common in the neonatal period, and is a preventable cause of poor neurodevelopmental outcome, but is CGM helpful in the management of neonates at risk of hypoglycaemia? Neonatal studies have shown that CGM can detect clinically silent hypoglycaemia, which has been associated with reduced executive and visual function in early childhood. Intervention trials have further shown CGM can support the targeting of glucose levels in high-risk extremely preterm neonates. In spite of significant advances in technology, including smaller sensors, better accuracy and factory calibration, further progress and adoption into clinical practice has been limited as current devices are not designed nor have regulatory approval for the specific needs of the newborn. The use of CGM has the potential to support clinical management, and prevention of hypoglycaemia but must be set within its current limitations. The data CGM provides however also provides an important opportunity to improve our understanding of potential risks of hypoglycaemia and the impact of clinical interventions to prevent it.
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Affiliation(s)
| | - Isabel Iglesias-Platas
- Department of Paediatrics, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Kathryn Beardsall
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Correspondence: Kathryn Beardsall
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5
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Rigon FA, Ronsoni MF, Vianna AGD, de Lucca Schiavon L, Hohl A, van de Sande-Lee S. Flash glucose monitoring system in special situations. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:883-894. [PMID: 35657123 PMCID: PMC10118756 DOI: 10.20945/2359-3997000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.
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Affiliation(s)
- Fernanda Augustini Rigon
- Programa de Pós-graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil,
| | - Marcelo Fernando Ronsoni
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - André Gustavo Daher Vianna
- Centro de Diabetes de Curitiba, Departamento de Doenças Endócrinas, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil
| | | | - Alexandre Hohl
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Simone van de Sande-Lee
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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6
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Jones JC, Bodenstine TM. Connexins and Glucose Metabolism in Cancer. Int J Mol Sci 2022; 23:ijms231710172. [PMID: 36077565 PMCID: PMC9455984 DOI: 10.3390/ijms231710172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Connexins are a family of transmembrane proteins that regulate diverse cellular functions. Originally characterized for their ability to mediate direct intercellular communication through the formation of highly regulated membrane channels, their functions have been extended to the exchange of molecules with the extracellular environment, and the ability to modulate numerous channel-independent effects on processes such as motility and survival. Notably, connexins have been implicated in cancer biology for their context-dependent roles that can both promote or suppress cancer cell function. Moreover, connexins are able to mediate many aspects of cellular metabolism including the intercellular coupling of nutrients and signaling molecules. During cancer progression, changes to substrate utilization occur to support energy production and biomass accumulation. This results in metabolic plasticity that promotes cell survival and proliferation, and can impact therapeutic resistance. Significant progress has been made in our understanding of connexin and cancer biology, however, delineating the roles these multi-faceted proteins play in metabolic adaptation of cancer cells is just beginning. Glucose represents a major carbon substrate for energy production, nucleotide synthesis, carbohydrate modifications and generation of biosynthetic intermediates. While cancer cells often exhibit a dependence on glycolytic metabolism for survival, cellular reprogramming of metabolic pathways is common when blood perfusion is limited in growing tumors. These metabolic changes drive aggressive phenotypes through the acquisition of functional traits. Connections between glucose metabolism and connexin function in cancer cells and the surrounding stroma are now apparent, however much remains to be discovered regarding these relationships. This review discusses the existing evidence in this area and highlights directions for continued investigation.
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7
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Ju J, Li L, Regmi S, Zhang X, Tang S. Microneedle-Based Glucose Sensor Platform: From Vitro to Wearable Point-of-Care Testing Systems. BIOSENSORS 2022; 12:bios12080606. [PMID: 36005002 PMCID: PMC9405967 DOI: 10.3390/bios12080606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022]
Abstract
Significant advanced have recently been made in exploiting microneedle-based (MN-based) diabetes devices for minimally invasive wearable biosensors and for continuous glucose monitoring. Within this emerging class of skin-worn MN-based sensors, the ISF can be utilized as a rich biomarker source to diagnose diabetes. While initial work of MN devices focused on ISF extraction, the recent research trend has been oriented toward developing in vivo glucose sensors coupled with optical or electrochemical (EC) instrumentation. This outlook highlights the essential characteristics of the sensing mechanisms, rational design, sensing properties, and applications. Finally, we describe the opinions about the challenge and prospects of optical and EC MN-based device platforms for the fabrication of wearable biosensors and their application potential in the future.
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Affiliation(s)
- Jian Ju
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
- Oujiang Lab, Wenzhou 325001, China
- Correspondence: (J.J.); (S.T.)
| | - Lin Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
- School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325035, China
| | - Sagar Regmi
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Xinyu Zhang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
| | - Shixing Tang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
- Correspondence: (J.J.); (S.T.)
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8
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Martinez F, Rodriguez E, Vernon-Carter E, Alvarez-Ramirez J. A simple two-compartment model for analysis of feedback control of glucose regulation. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Pazos MD, Hu Y, Elani Y, Browning KL, Jiang N, Yetisen AK. Tattoo Inks for Optical Biosensing in Interstitial Fluid. Adv Healthc Mater 2021; 10:e2101238. [PMID: 34510804 DOI: 10.1002/adhm.202101238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The persistence of traditional tattoo inks presents an advantage for continuous and long-term health monitoring in point of care devices. The replacement of tattoo pigments with optical biosensors aims a promising alternative for monitoring blood biomarkers. Tattoo inks functionalization enables the control of interstitial biomarkers with correlated concentrations in plasma, to diagnose diseases, evaluate progression, and prevent complications associated with physio pathological disorders or medication mismatches. The specific biomarkers in interstitial fluid provide a new source of information, especially for skin diseases. The study of tattoo inks displays insufficient regulation in their composition, a lack of reports of the related complications, and a need for further studies on their degradation kinetics. This review focuses on tattoo optical biosensors for monitoring dermal interstitial biomarkers and discusses the clinical advantages and main challenges for in vivo implantation. Tattoo functionalization provides a minimally invasive, reversible, biocompatible, real-time sensing with long-term permanence and multiplexing capabilities for the control, diagnosis, and prevention of illness; it enables self-controlling management by the patient, but also the possibility of sending the records to the doctor.
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Affiliation(s)
- Martalu D Pazos
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
- Leo Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, Copenhagen University, Copenhagen, 2100, Denmark
| | - Yubing Hu
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
| | - Yuval Elani
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
| | - Kathryn L Browning
- Leo Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, Copenhagen University, Copenhagen, 2100, Denmark
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
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10
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Liu Y, Yu Q, Luo X, Yang L, Cui Y. Continuous monitoring of diabetes with an integrated microneedle biosensing device through 3D printing. MICROSYSTEMS & NANOENGINEERING 2021; 7:75. [PMID: 34631143 PMCID: PMC8481261 DOI: 10.1038/s41378-021-00302-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 05/14/2023]
Abstract
Diabetes is a prevalent chronic metabolic disease with multiple clinical manifestations and complications, and it is among the leading causes of death. Painless and continuous monitoring of interstitial glucose is highly desirable for diabetes management. Here we unprecedentedly show continuous monitoring of diabetes with an integrated microneedle biosensing device. The device was manufactured with a 3D printing process, a microfabrication process, an electroplating process, and an enzyme immobilization step. The device was inserted into the dermis layer of mouse skin and showed accurate sensing performance for monitoring subcutaneous glucose levels in normal or diabetic mice. The detection results were highly correlated with those obtained from a commercial blood glucose meter. We anticipate that the study could open exciting avenues for monitoring and managing diabetes, alongside fundamental studies of subcutaneous electronic devices.
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Affiliation(s)
- Yiqun Liu
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
| | - Qi Yu
- Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, 100034 Beijing, P. R. China
| | - Xiaojin Luo
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
| | - Li Yang
- Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, 100034 Beijing, P. R. China
| | - Yue Cui
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
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11
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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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12
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Pfützner A, Demircik F, Pfützner J, Kessler K, Strobl S, Spatz J, Pfützner AH, Lier A. System Accuracy Assessment of a Combined Invasive and Noninvasive Glucometer. J Diabetes Sci Technol 2020; 14:575-581. [PMID: 31640424 PMCID: PMC7576942 DOI: 10.1177/1932296819883306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The pain associated with pricking the fingertip for blood glucose self-testing is considered to be a major burden in diabetes treatment. This study was performed to evaluate the system accuracy of the invasive TensorTip Combo Glucometer (CoG) device component in accordance with ISO15197:2015 requirements and to explore the accuracy of the noninvasive tissue glucose prediction component. METHODS One hundred samples were obtained from people with type 1 and type 2 diabetes and healthy volunteers (43 females, 57 males; age: 53 ± 16 years), with glucose distribution as requested by the ISO standard. Three strip lots were tested twice by healthcare professionals in comparison to YSI 2300 Stat Plus reference method followed by a noninvasive tissue glucose reading (NI-CoG). Mean Absolute (Relative) Difference (MARD) was calculated and a consensus error grid (CEG) analysis was performed. RESULTS The ISO system accuracy criteria were met with the invasive strip technology by 586/600 of the data points (97.1%) and for each strip lot separately. All invasive results (100%) were within CEG-zone A and total MARD was calculated to be 7.1%. With the noninvasive reading, 99% of raw data points were in A + B (91.1% and 7.8%), and the total MARD was calculated to be 18.1%. DISCUSSION The invasive component of the CoG device was shown to be in full compliance with the current ISO15197 criteria. Good results were also obtained with the NI-CoG tissue glucose prediction. This noninvasive technology would potentially be suitable for frequent pain-free glucose monitoring in many people with diabetes.
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Affiliation(s)
- Andreas Pfützner
- Pfützner Science & Health Institute, Mainz, Germany
- Sciema UG, Mainz, Germany
- Technical University, Department of Life Sciences, Bingen, Germany
- University for Digital Technologies in Medicine and Dentistry, Wiltz, Luxembourg
| | - Filiz Demircik
- Pfützner Science & Health Institute, Mainz, Germany
- Sciema UG, Mainz, Germany
| | - Johannes Pfützner
- Pfützner Science & Health Institute, Mainz, Germany
- Technical University, Department of Life Sciences, Bingen, Germany
| | - Kim Kessler
- Technical University, Department of Life Sciences, Bingen, Germany
| | | | - Jan Spatz
- Pfützner Science & Health Institute, Mainz, Germany
- Sciema UG, Mainz, Germany
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Shokrekhodaei M, Quinones S. Review of Non-invasive Glucose Sensing Techniques: Optical, Electrical and Breath Acetone. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1251. [PMID: 32106464 PMCID: PMC7085605 DOI: 10.3390/s20051251] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
Annual deaths in the U.S. attributed to diabetes are expected to increase from 280,210 in 2015 to 385,840 in 2030. The increase in the number of people affected by diabetes has made it one of the major public health challenges around the world. Better management of diabetes has the potential to decrease yearly medical costs and deaths associated with the disease. Non-invasive methods are in high demand to take the place of the traditional finger prick method as they can facilitate continuous glucose monitoring. Research groups have been trying for decades to develop functional commercial non-invasive glucose measurement devices. The challenges associated with non-invasive glucose monitoring are the many factors that contribute to inaccurate readings. We identify and address the experimental and physiological challenges and provide recommendations to pave the way for a systematic pathway to a solution. We have reviewed and categorized non-invasive glucose measurement methods based on: (1) the intrinsic properties of glucose, (2) blood/tissue properties and (3) breath acetone analysis. This approach highlights potential critical commonalities among the challenges that act as barriers to future progress. The focus here is on the pertinent physiological aspects, remaining challenges, recent advancements and the sensors that have reached acceptable clinical accuracy.
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Affiliation(s)
- Maryamsadat Shokrekhodaei
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Stella Quinones
- Department of Metallurgical, Materials and Biomedical Engineering, The University of Texas at El Paso, El Paso, TX 79968, USA;
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Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2020; 29:1317-1326. [PMID: 30737761 DOI: 10.1007/s11695-018-03684-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few investigations have been conducted that compared blood glucose in patients with diabetes mellitus (DM2) and morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG) or gastric bypass (LRYGB). We aimed to compare the effects of these procedures using continuous glucose monitoring (CGM). METHODS We prospectively studied patients that had qualified for LSG or LRYGB. The inclusion criteria were DM2 of ≤ 5 years, for which patients were taking oral anti-diabetic drugs, or no glucose metabolism disorder; and morbid obesity. CGM was performed between admission and the 10th postoperative day. RESULTS We studied 16 patients with DM2 and 16 without. Eighteen patients underwent LSG and 14 underwent LRYGB. The median hemoglobin A1c was 5.5% (5.4-5.9%) in DM2 patients, which did not differ from control (p = 0.460). Preoperative mean daily glucose concentration was similar between DM2 and control patients (p = 0.622). For patients with DM2, LRYGB was associated with more frequent low glucose status, and these episodes lasted longer than in DM2 patients that underwent LSG (p = 0.035 and 0.049, respectively). DM2 patients that underwent LRYGB demonstrated lower glucose concentrations from third postoperative day than those that underwent LSG. Patients without DM2 did not demonstrate differences in daily mean glucose concentrations, or in incidence nor duration of hypoglycemia throughout the observation period. CONCLUSION A significantly larger reduction in interstitial glucose concentration is present from third day in patients with DM2 who undergo LRYGB vs. LSG, accompanied by a lower incidence and shorter duration of low glucose episodes.
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Karunathilaka SR, Arnold MA, Small GW. Nocturnal Hypoglycemic Alarm Based on Near-Infrared Spectroscopy: In Vivo Studies with a Rat Animal Model. Anal Chem 2019; 91:1855-1862. [PMID: 30605302 DOI: 10.1021/acs.analchem.8b03437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A noninvasive method for detecting episodes of nocturnal hypoglycemia is demonstrated with in vivo measurements made with a rat animal model. Employing spectra collected from the near-infrared combination region of 4000-5000 cm-1, piecewise linear discriminant analysis (PLDA) is used to classify spectra into alarm and nonalarm data classes on the basis of whether or not they correspond to glucose concentrations below a user-defined hypoglycemic threshold. A reference spectrum and corresponding glucose concentration are acquired at the start of the monitoring period, and spectra are then collected continuously and converted to absorbance units relative to the initial reference spectrum. The resulting differential spectra correspond to differential glucose concentrations that reflect the differences in concentration between each spectrum and the reference. Given an alarm threshold (e.g., 3.0 mM), a database of calibration differential spectra can be partitioned into two groups containing spectra above and below the threshold. A classification model is then computed with PLDA. The resulting model can be applied to the differential spectra collected during the monitoring period in order to identify spectra whose corresponding glucose concentrations lie in the hypoglycemic range. In this work, the alarm algorithm was tested in two single-day studies performed with anesthetized rats. Glucose concentrations spanned the range of 1.6 to 13.5 mM (29 to 244 mg/dL). For both rats, the alarm algorithm performed well. On average, 87.5% of alarm events were correctly detected, and the occurrence of false alarms was 7.2%. False alarms were restricted to times when the glucose concentrations were very close to the alarm threshold rather than at random times, thus demonstrating the potential of the approach for practical use.
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Affiliation(s)
- Sanjeewa R Karunathilaka
- Department of Chemistry & Optical Science and Technology Center , University of Iowa , Iowa City , Iowa 52242 , United States
| | - Mark A Arnold
- Department of Chemistry & Optical Science and Technology Center , University of Iowa , Iowa City , Iowa 52242 , United States
| | - Gary W Small
- Department of Chemistry & Optical Science and Technology Center , University of Iowa , Iowa City , Iowa 52242 , United States
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Li W, Sun C, Yu S, Pu Z, Zhang P, Xu K, Song Z, Li D. Flattened fiber-optic ATR sensor enhanced by silver nanoparticles for glucose measurement. Biomed Microdevices 2018; 20:104. [DOI: 10.1007/s10544-018-0346-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shi T, Zhang Y, Lu L. Effect of physiological parameters on glucose microcirculation compartmental model in glucose monitoring. BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2017.1413595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ting Shi
- Faculty of Information Technology, Beijing University of Technology, Beijing, PR China
- Department of Medicine, University of California School of Medicine, Torrance, CA, USA
| | - Yiming Zhang
- Faculty of Information Technology, Beijing University of Technology, Beijing, PR China
| | - Luo Lu
- Department of Medicine, University of California School of Medicine, Torrance, CA, USA
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Shi T, Li D, Li G, Zhang Y, Xu K, Lu L. Corrigendum to "Modeling and Measurement of Correlation between Blood and Interstitial Glucose Changes". J Diabetes Res 2017; 2017:3164027. [PMID: 28913362 PMCID: PMC5585541 DOI: 10.1155/2017/3164027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 12/02/2022] Open
Abstract
[This corrects the article DOI: 10.1155/2016/4596316.].
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Affiliation(s)
- Ting Shi
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China
- College of Electronic Information and Control Engineering, Beijing University of Technology, Beijing 100124, China
- Department of Medicine, Division of Molecular Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Dachao Li
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China
| | - Guoqing Li
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China
| | - Yiming Zhang
- College of Electronic Information and Control Engineering, Beijing University of Technology, Beijing 100124, China
| | - Kexin Xu
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China
| | - Luo Lu
- Department of Medicine, Division of Molecular Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- *Luo Lu:
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