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Vargas E, Nandhakumar P, Ding S, Saha T, Wang J. Insulin detection in diabetes mellitus: challenges and new prospects. Nat Rev Endocrinol 2023:10.1038/s41574-023-00842-3. [PMID: 37217746 DOI: 10.1038/s41574-023-00842-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Tremendous progress has been made towards achieving tight glycaemic control in individuals with diabetes mellitus through the use of frequent or continuous glucose measurements. However, in patients who require insulin, accurate dosing must consider multiple factors that affect insulin sensitivity and modulate insulin bolus needs. Accordingly, an urgent need exists for frequent and real-time insulin measurements to closely track the dynamic blood concentration of insulin during insulin therapy and guide optimal insulin dosing. Nevertheless, traditional centralized insulin testing cannot offer timely measurements, which are essential to achieving this goal. This Perspective discusses the advances and challenges in moving insulin assays from traditional laboratory-based assays to frequent and continuous measurements in decentralized (point-of-care and home) settings. Technologies that hold promise for insulin testing using disposable test strips, mobile systems and wearable real-time insulin-sensing devices are discussed. We also consider future prospects for continuous insulin monitoring and for fully integrated multisensor-guided closed-loop artificial pancreas systems.
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Affiliation(s)
- Eva Vargas
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ponnusamy Nandhakumar
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Shichao Ding
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Tamoghna Saha
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
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Vargas E, Aiello EM, Ben Hassine A, Ruiz-Valdepeñas Montiel V, Pinsker JE, Church MM, Laffel LM, Doyle FJ, Patti ME, Dassau E, Wang J. Concept of the "Universal Slope": Toward Substantially Shorter Decentralized Insulin Immunoassays. Anal Chem 2022; 94:9217-9225. [PMID: 35715001 DOI: 10.1021/acs.analchem.2c02178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Decentralized sensing of analytes in remote locations is today a reality. However, the number of measurable analytes remains limited, mainly due to the requirement for time-consuming successive standard additions calibration used to address matrix effects and resulting in greatly delayed results, along with more complex and costly operation. This is particularly challenging in commonly used immunoassays of key biomarkers that typically require from 60 to 90 min for quantitation based on two standard additions, hence hindering their implementation for rapid and routine diagnostic applications, such as decentralized point-of-care (POC) insulin testing. In this work we have developed and demonstrated the theoretical framework for establishing a universal slope for direct calibration-free POC insulin immunoassays in serum samples using an electrochemical biosensor (developed originally for extended calibration by standard additions). The universal slope is presented as an averaged slope constant, relying on 68 standard additions-based insulin determinations in human sera. This new quantitative analysis approach offers reliable sample measurement without successive standard additions, leading to a dramatically simplified and faster assay (30 min vs 90 min when using 2 standard additions) and greatly reduced costs, without compromising the analytical performance while significantly reducing the analyses costs. The substantial improvements associated with the new universal slope concept have been demonstrated successfully for calibration-free measurements of serum insulin in 30 samples from individuals with type 1 diabetes using meticulous statistical analysis, supporting the prospects of applying this immunoassay protocol to routine decentralized POC insulin testing.
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Affiliation(s)
- Eva Vargas
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | - Eleonora M Aiello
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Amira Ben Hassine
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | | | - Jordan E Pinsker
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Mary-Elizabeth Patti
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
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