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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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Goncharov A, Gorocs Z, Pradhan R, Ko B, Ajmal A, Rodriguez A, Baum D, Veszpremi M, Yang X, Pindrys M, Zheng T, Wang O, Ramella-Roman JC, McShane MJ, Ozcan A. Insertable Glucose Sensor Using a Compact and Cost-Effective Phosphorescence Lifetime Imager and Machine Learning. ACS NANO 2024; 18:23365-23379. [PMID: 39137319 PMCID: PMC11363142 DOI: 10.1021/acsnano.4c06527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
Optical continuous glucose monitoring (CGM) systems are emerging for personalized glucose management owing to their lower cost and prolonged durability compared to conventional electrochemical CGMs. Here, we report a computational CGM system, which integrates a biocompatible phosphorescence-based insertable biosensor and a custom-designed phosphorescence lifetime imager (PLI). This compact and cost-effective PLI is designed to capture phosphorescence lifetime images of an insertable sensor through the skin, where the lifetime of the emitted phosphorescence signal is modulated by the local concentration of glucose. Because this phosphorescence signal has a very long lifetime compared to tissue autofluorescence or excitation leakage processes, it completely bypasses these noise sources by measuring the sensor emission over several tens of microseconds after the excitation light is turned off. The lifetime images acquired through the skin are processed by neural network-based models for misalignment-tolerant inference of glucose levels, accurately revealing normal, low (hypoglycemia) and high (hyperglycemia) concentration ranges. Using a 1 mm thick skin phantom mimicking the optical properties of human skin, we performed in vitro testing of the PLI using glucose-spiked samples, yielding 88.8% inference accuracy, also showing resilience to random and unknown misalignments within a lateral distance of ∼4.7 mm with respect to the position of the insertable sensor underneath the skin phantom. Furthermore, the PLI accurately identified larger lateral misalignments beyond 5 mm, prompting user intervention for realignment. The misalignment-resilient glucose concentration inference capability of this compact and cost-effective PLI makes it an appealing wearable diagnostics tool for real-time tracking of glucose and other biomarkers.
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Affiliation(s)
- Artem Goncharov
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
- Bioengineering
Department, University of California, Los Angeles, California 90095, United States
- California
NanoSystems Institute (CNSI), University
of California, Los Angeles, California 90095, United States
| | - Zoltan Gorocs
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
- Bioengineering
Department, University of California, Los Angeles, California 90095, United States
- California
NanoSystems Institute (CNSI), University
of California, Los Angeles, California 90095, United States
| | - Ridhi Pradhan
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Brian Ko
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Ajmal Ajmal
- Department
of Biomedical Engineering, Florida International
University, Miami, Florida 33199, United States
| | - Andres Rodriguez
- Department
of Biomedical Engineering, Florida International
University, Miami, Florida 33199, United States
| | - David Baum
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
| | - Marcell Veszpremi
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
| | - Xilin Yang
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
- Bioengineering
Department, University of California, Los Angeles, California 90095, United States
- California
NanoSystems Institute (CNSI), University
of California, Los Angeles, California 90095, United States
| | - Maxime Pindrys
- Department
of Physics, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Tianle Zheng
- Department
of Computer Science, University of California, Los Angeles, California 90095, United States
| | - Oliver Wang
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
| | - Jessica C. Ramella-Roman
- Department
of Biomedical Engineering, Florida International
University, Miami, Florida 33199, United States
| | - Michael J. McShane
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
- Department
of Materials Science and Engineering, Texas
A&M University, College Station, Texas 77843, United States
| | - Aydogan Ozcan
- Electrical
& Computer Engineering Department, University
of California, Los Angeles, California 90095, United States
- Bioengineering
Department, University of California, Los Angeles, California 90095, United States
- California
NanoSystems Institute (CNSI), University
of California, Los Angeles, California 90095, United States
- Department
of Surgery, University of California, Los Angeles, California 90095, United States
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3
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Pleus S, Eichenlaub M, Waldenmaier D, Freckmann G. A Critical Discussion of Alert Evaluations in the Context of Continuous Glucose Monitoring System Performance. J Diabetes Sci Technol 2024; 18:847-856. [PMID: 38477308 PMCID: PMC11307228 DOI: 10.1177/19322968241236504] [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] [Indexed: 03/14/2024]
Abstract
Many continuous glucose monitoring (CGM) systems provide functionality which alerts users of potentially unwanted glycemic conditions. These alerts can include glucose threshold alerts to call the user's attention to hypoglycemia or hyperglycemia, predictive alerts warning about impeding hypoglycemia or hyperglycemia, and rate-of-change alerts. A recent review identified 129 articles about CGM performance studies, of which approximately 25% contained alert evaluations. In some studies, real alerts were assessed; however, most of these studies retrospectively determined the timing of CGM alerts because not all CGM systems record alerts which necessitates manual documentation. In contrast to assessment of real alerts, retrospective determination allows assessment of a variety of alert settings for all three types of glycemic condition alerts. Based on the literature and the Clinical and Laboratory Standards Institute's POCT05 guideline, two common approaches to threshold alert evaluation were identified, one value-based and one episode-based approach. In this review, a critical discussion of the two approaches, including a post hoc analysis of clinical study data, indicates that the episode-based approach should be preferred over the value-based approach. For predictive alerts, fewer results were found in the literature, and retrospective determination of CGM alert timing is complicated by the prediction algorithms being proprietary information. Rate-of-change alert evaluations were not reported in the identified literature, and POCT05 does not contain recommendations for assessment. A possible approach is discussed including post hoc analysis of clinical study data. To conclude, CGM systems should record alerts, and the episode-based approach to alert evaluation should be preferred.
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Affiliation(s)
- Stefan Pleus
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm,
Germany
| | - Manuel Eichenlaub
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm,
Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm,
Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm,
Germany
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4
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Fuchs S, Caserto JS, Liu Q, Wang K, Shariati K, Hartquist CM, Zhao X, Ma M. A Glucose-Responsive Cannula for Automated and Electronics-Free Insulin Delivery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2403594. [PMID: 38639424 PMCID: PMC11223976 DOI: 10.1002/adma.202403594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Indexed: 04/20/2024]
Abstract
Automated delivery of insulin based on continuous glucose monitoring is revolutionizing the way insulin-dependent diabetes is treated. However, challenges remain for the widespread adoption of these systems, including the requirement of a separate glucose sensor, sophisticated electronics and algorithms, and the need for significant user input to operate these costly therapies. Herein, a user-centric glucose-responsive cannula is reported for electronics-free insulin delivery. The cannula-made from a tough, elastomer-hydrogel hybrid membrane formed through a one-pot solvent exchange method-changes permeability to release insulin rapidly upon physiologically relevant varying glucose levels, providing simple and automated insulin delivery with no additional hardware or software. Two prototypes of the cannula are evaluated in insulin-deficient diabetic mice. The first cannula-an ends-sealed, subcutaneously inserted prototype-normalizes blood glucose levels for 3 d and controls postprandial glucose levels. The second, more translational version-a cannula with the distal end sealed and the proximal end connected to a transcutaneous injection port-likewise demonstrates tight, 3-d regulation of blood glucose levels when refilled twice daily. This proof-of-concept study may aid in the development of "smart" cannulas and next-generation insulin therapies at a reduced burden-of-care toll and cost to end-users.
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Affiliation(s)
- Stephanie Fuchs
- Biological and Environmental Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Julia S. Caserto
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca NY, 14853, USA
| | - Qingsheng Liu
- Biological and Environmental Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Kecheng Wang
- Biological and Environmental Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Kaavian Shariati
- Biological and Environmental Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Chase M. Hartquist
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Minglin Ma
- Biological and Environmental Engineering, Cornell University, Ithaca, NY, 14853, USA
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5
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Rohner DG, Burget L, Henzen C, Fischli S. Impact on diabetes control and patient-reported outcomes of a newer implantable continuous glucose monitoring system (Eversense® CGM System): a single-centre retro- and prospective observational study. Swiss Med Wkly 2024; 154:3366. [PMID: 38579290 DOI: 10.57187/s.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY The Eversense® CGM System is the first and only continuous glucose monitoring system (CGMS) that uses a fully subcutaneous implanted sensor. This study aimed to evaluate effectiveness, safety and patient-reported outcomes in patients using the Eversense® CGM System in a realistic clinical setting, assessed at a single Swiss diabetes centre (Luzerner Kantonsspital) with prolonged follow-up. METHODS This was a prospective and retrospective observational study that included patients with type 1 diabetes mellitus in whom at least one Eversense® glucose sensor was implanted between 2017 and 2022. The primary endpoint was the change in HbA1c levels from the baseline (before implantation of the sensor) to 6 ± 2 and 12 ± 2 months and the last follow-up (newest available value) after implantation. The secondary outcome measures were the number of premature sensor breakdowns, adverse events related to the implantation procedure (infection, bleeding, difficulties with implantation or explantation) and patient-related outcomes (assessed with a questionnaire). RESULTS A total of 33 patients participated in this study. The median follow-up time was 50 (IQR 22.3-58.5) months. In total, 178 sensor implantations were performed. Valid HbA1c results were available for 26 participants. Compared to the baseline values, HbA1c levels at 6 and 12 months and the last follow-up changed by -0.25%, -0.45 and -0.2 (p = 0.278, 0.308 and 0.296, respectively). We recorded 16 (9%) premature sensor breakdowns, all occurring between 2019 and 2020. Apart from one late-onset infection and four complicated sensor removals, no major complications were assessed. The results of the questionnaire showed a subjective improvement in hypoglycaemia rates, a better perception of hypoglycaemia and the impression of better diabetes management. Common issues with the device reported by the patients were technical errors (connection problems) and problems with the removal procedure. CONCLUSIONS The use of the Eversense® CGM System resulted in changes in HbA1c of between -0.2% and -0.45%. The rate of premature sensor breakdown was low. Major complications following sensor implantation or removal were absent, apart from one case of infection and four cases of complicated removal. Patient-reported outcomes with the Eversense® CGM System showed a subjective positive impact on hypoglycaemia rates, greater confidence in managing hypoglycaemia and diabetes in general, and easy handling of the transmitter and mobile app. Technical issues must be considered but are nowadays, with the use of the newest sensor generation, very rare.
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Affiliation(s)
- Dimitri Guy Rohner
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lukas Burget
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
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6
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Mittal R, Koutras N, Maya J, Lemos JRN, Hirani K. Blood glucose monitoring devices for type 1 diabetes: a journey from the food and drug administration approval to market availability. Front Endocrinol (Lausanne) 2024; 15:1352302. [PMID: 38559693 PMCID: PMC10978642 DOI: 10.3389/fendo.2024.1352302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Blood glucose monitoring constitutes a pivotal element in the clinical management of Type 1 diabetes (T1D), a globally escalating metabolic disorder. Continuous glucose monitoring (CGM) devices have demonstrated efficacy in optimizing glycemic control, mitigating adverse health outcomes, and augmenting the overall quality of life for individuals afflicted with T1D. Recent progress in the field encompasses the refinement of electrochemical sensors, which enhances the effectiveness of blood glucose monitoring. This progress empowers patients to assume greater control over their health, alleviating the burdens associated with their condition, and contributing to the overall alleviation of the healthcare system. The introduction of novel medical devices, whether derived from existing prototypes or originating as innovative creations, necessitates adherence to a rigorous approval process regulated by the Food and Drug Administration (FDA). Diverse device classifications, stratified by their associated risks, dictate distinct approval pathways, each characterized by varying timelines. This review underscores recent advancements in blood glucose monitoring devices primarily based on electrochemical sensors and elucidates their regulatory journey towards FDA approval. The advent of innovative, non-invasive blood glucose monitoring devices holds promise for maintaining stringent glycemic control, thereby preventing T1D-associated comorbidities, and extending the life expectancy of affected individuals.
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Affiliation(s)
- Rahul Mittal
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicole Koutras
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Jonathan Maya
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Joana R. N. Lemos
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Khemraj Hirani
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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7
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Piet A, Jablonski L, Daniel Onwuchekwa JI, Unkel S, Weber C, Grzegorzek M, Ehlers JP, Gaus O, Neumann T. Non-Invasive Wearable Devices for Monitoring Vital Signs in Patients with Type 2 Diabetes Mellitus: A Systematic Review. Bioengineering (Basel) 2023; 10:1321. [PMID: 38002444 PMCID: PMC10669651 DOI: 10.3390/bioengineering10111321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Type 2 diabetes mellitus (T2D) poses a significant global health challenge and demands effective self-management strategies, including continuous blood glucose monitoring (CGM) and lifestyle adaptations. While CGM offers real-time glucose level assessment, the quest for minimizing trauma and enhancing convenience has spurred the need to explore non-invasive alternatives for monitoring vital signs in patients with T2D. Objective: This systematic review is the first that explores the current literature and critically evaluates the use and reporting of non-invasive wearable devices for monitoring vital signs in patients with T2D. Methods: Employing the PRISMA and PICOS guidelines, we conducted a comprehensive search to incorporate evidence from relevant studies, focusing on randomized controlled trials (RCTs), systematic reviews, and meta-analyses published since 2017. Of the 437 publications identified, seven were selected based on predetermined criteria. Results: The seven studies included in this review used various sensing technologies, such as heart rate monitors, accelerometers, and other wearable devices. Primary health outcomes included blood pressure measurements, heart rate, body fat percentage, and cardiorespiratory endurance. Non-invasive wearable devices demonstrated potential for aiding T2D management, albeit with variations in efficacy across studies. Conclusions: Based on the low number of studies with higher evidence levels (i.e., RCTs) that we were able to find and the significant differences in design between these studies, we conclude that further evidence is required to validate the application, efficacy, and real-world impact of these wearable devices. Emphasizing transparency in bias reporting and conducting in-depth research is crucial for fully understanding the implications and benefits of wearable devices in T2D management.
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Affiliation(s)
- Artur Piet
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
| | - Lennart Jablonski
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
| | | | - Steffen Unkel
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Christian Weber
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
- Department of Knowledge Engineering, University of Economics in Katowice, 40-287 Katowice, Poland
| | - Jan P. Ehlers
- Department of Didactics and Educational Research in Health Science, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Gaus
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
| | - Thomas Neumann
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
- Faculty of Economics and Management, Otto von Guericke University Magdeburg, 39106 Magdeburg, Germany
- University Department of Neurology, Otto von Guericke University Magdeburg, 39106 Magdeburg, Germany
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8
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Freckmann G, Eichenlaub M, Waldenmaier D, Pleus S, Wehrstedt S, Haug C, Witthauer L, Jendle J, Hinzmann R, Thomas A, Eriksson Boija E, Makris K, Diem P, Tran N, Klonoff DC, Nichols JH, Slingerland RJ. Clinical Performance Evaluation of Continuous Glucose Monitoring Systems: A Scoping Review and Recommendations for Reporting. J Diabetes Sci Technol 2023; 17:1506-1526. [PMID: 37599389 PMCID: PMC10658695 DOI: 10.1177/19322968231190941] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The use of different approaches for design and results presentation of studies for the clinical performance evaluation of continuous glucose monitoring (CGM) systems has long been recognized as a major challenge in comparing their results. However, a comprehensive characterization of the variability in study designs is currently unavailable. This article presents a scoping review of clinical CGM performance evaluations published between 2002 and 2022. Specifically, this review quantifies the prevalence of numerous options associated with various aspects of study design, including subject population, comparator (reference) method selection, testing procedures, and statistical accuracy evaluation. We found that there is a large variability in nearly all of those aspects and, in particular, in the characteristics of the comparator measurements. Furthermore, these characteristics as well as other crucial aspects of study design are often not reported in sufficient detail to allow an informed interpretation of study results. We therefore provide recommendations for reporting the general study design, CGM system use, comparator measurement approach, testing procedures, and data analysis/statistical performance evaluation. Additionally, this review aims to serve as a foundation for the development of a standardized CGM performance evaluation procedure, thereby supporting the goals and objectives of the Working Group on CGM established by the Scientific Division of the International Federation of Clinical Chemistry and Laboratory Medicine.
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Affiliation(s)
- Guido Freckmann
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Manuel Eichenlaub
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stephanie Wehrstedt
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Lilian Witthauer
- Diabetes Center Berne, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Johan Jendle
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rolf Hinzmann
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Roche Diabetes Care GmbH, Mannheim, Germany
| | - Andreas Thomas
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Pirna, Germany
| | - Elisabet Eriksson Boija
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Equalis AB, Uppsala, Sweden
| | - Konstantinos Makris
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Clinical Biochemistry Department, KAT General Hospital, Athens, Greece
| | - Peter Diem
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Endokrinologie Diabetologie Bern, Bern, Switzerland
| | - Nam Tran
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - David C. Klonoff
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - James H. Nichols
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robbert J. Slingerland
- IFCC Scientific Division - Working Group on Continuous Glucose Monitoring
- Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands
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9
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Yogev D, Goldberg T, Arami A, Tejman-Yarden S, Winkler TE, Maoz BM. Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges. APL Bioeng 2023; 7:031506. [PMID: 37781727 PMCID: PMC10539032 DOI: 10.1063/5.0152290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.
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Affiliation(s)
| | | | | | | | | | - Ben M. Maoz
- Authors to whom correspondence should be addressed: and
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10
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Nan K, Jiang YN, Li M, Wang B. Recent Progress in Diboronic-Acid-Based Glucose Sensors. BIOSENSORS 2023; 13:618. [PMID: 37366983 DOI: 10.3390/bios13060618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Non-enzymatic sensors with the capability of long-term stability and low cost are promising in glucose monitoring applications. Boronic acid (BA) derivatives offer a reversible and covalent binding mechanism for glucose recognition, which enables continuous glucose monitoring and responsive insulin release. To improve selectivity to glucose, a diboronic acid (DBA) structure design has been explored and has become a hot research topic for real-time glucose sensing in recent decades. This paper reviews the glucose recognition mechanism of boronic acids and discusses different glucose sensing strategies based on DBA-derivatives-based sensors reported in the past 10 years. The tunable pKa, electron-withdrawing properties, and modifiable group of phenylboronic acids were explored to develop various sensing strategies, including optical, electrochemical, and other methods. However, compared to the numerous monoboronic acid molecules and methods developed for glucose monitoring, the diversity of DBA molecules and applied sensing strategies remains limited. The challenges and opportunities are also highlighted for the future of glucose sensing strategies, which need to consider practicability, advanced medical equipment fitment, patient compliance, as well as better selectivity and tolerance to interferences.
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Affiliation(s)
- Ke Nan
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
- School of Pharmaceutical Sciences, Cixi Biomedical Research Institute, Wenzhou Medical University, Wenzhou 325035, China
| | - Yu-Na Jiang
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
- School of Pharmaceutical Sciences, Cixi Biomedical Research Institute, Wenzhou Medical University, Wenzhou 325035, China
| | - Meng Li
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
- International Cooperation Base of Biomedical Materials Technology and Application, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
| | - Bing Wang
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
- School of Pharmaceutical Sciences, Cixi Biomedical Research Institute, Wenzhou Medical University, Wenzhou 325035, China
- International Cooperation Base of Biomedical Materials Technology and Application, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
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11
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Pfützner A, Tencer B, Stamm B, Mehta M, Sharma P, Gilyazev R, Jensch H, Thomé N, Huth M. Miniaturization of an Osmotic Pressure-Based Glucose Sensor for Continuous Intraperitoneal and Subcutaneous Glucose Monitoring by Means of Nanotechnology. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094541. [PMID: 37177745 PMCID: PMC10181718 DOI: 10.3390/s23094541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
The Sencell sensor uses glucose-induced changes in an osmotic pressure chamber for continuous glucose measurement. A final device shall have the size of a grain of rice. The size limiting factor is the piezo-resistive pressure transducers inside the core sensor technology (resulting chamber volume: 70 µL. To achieve the necessary miniaturization, these pressure transducers were replaced by small (4000 × 400 × 150 nm³) nano-granular tunneling resistive (NTR) pressure sensors (chamber volume: 750 nL). For benchmark testing, we filled the miniaturized chamber with bovine serum albumin (BSA, 1 mM) and exposed it repeatedly to distilled water followed by 1 mM BSA solution. Thereafter, we manufactured sensors with glucose testing chemistry (ConcanavalinA/dextran) and investigated sensor performance with dynamic glucose changes between 0 and 300 mg/dL. Evaluation of the miniaturized sensors resulted in reliable pressure changes, both in the BSA benchmark experiment (30-35 mBar) and in the dynamic in vitro continuous glucose test (40-50 mBar). These pressure results were comparable to similar experiments with the previous larger in vitro sensors (30-50 mBar). In conclusion, the NTR pressure sensor technology was successfully employed to reduce the size of the core osmotic pressure chamber by more than 95% without loss in the osmotic pressure signal.
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Affiliation(s)
- Andreas Pfützner
- Lifecare AS, 5058 Bergen, Norway
- Lifecare Nanobiosensors GmbH, 55128 Mainz, Germany
- Lifecare Laboratories GmbH, 55128 Mainz, Germany
- Pfützner Science & Health Institute, 55128 Mainz, Germany
- Institute for Internal Medicine and Laboratory Medicine, University for Digital Technologies in Medicine & Dentistry, 9516 Wiltz, Luxembourg
| | | | - Boris Stamm
- Lifecare Nanobiosensors GmbH, 55128 Mainz, Germany
| | - Mandar Mehta
- Lifecare Nanobiosensors GmbH, 55128 Mainz, Germany
| | | | | | | | - Nicole Thomé
- Lifecare Laboratories GmbH, 55128 Mainz, Germany
| | - Michael Huth
- Institute of Physics, Goethe-Universität, 60323 Frankfurt am Main, Germany
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12
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Chmayssem A, Nadolska M, Tubbs E, Sadowska K, Vadgma P, Shitanda I, Tsujimura S, Lattach Y, Peacock M, Tingry S, Marinesco S, Mailley P, Lablanche S, Benhamou PY, Zebda A. Insight into continuous glucose monitoring: from medical basics to commercialized devices. Mikrochim Acta 2023; 190:177. [PMID: 37022500 DOI: 10.1007/s00604-023-05743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.
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Affiliation(s)
- Ayman Chmayssem
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France
| | - Małgorzata Nadolska
- Institute of Nanotechnology and Materials Engineering, Faculty of Applied Physics and Mathematics, Gdansk University of Technology, 80-233, Gdansk, Poland
| | - Emily Tubbs
- Univ. Grenoble Alpes, CEA, INSERM, IRIG, 38000, Grenoble, Biomics, France
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
| | - Kamila Sadowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland
| | - Pankaj Vadgma
- School of Engineering and Materials Science, Queen Mary University of London, Mile End, London, E1 4NS, UK
| | - Isao Shitanda
- Department of Pure and Applied Chemistry, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
- Research Institute for Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
| | - Seiya Tsujimura
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan
- Division of Material Science, Faculty of Pure and Applied Science, University of Tsukuba, 1-1-1, Tennodai, Ibaraki, Tsukuba, 305-5358, Japan
| | | | - Martin Peacock
- Zimmer and Peacock, Nedre Vei 8, Bldg 24, 3187, Horten, Norway
| | - Sophie Tingry
- Institut Européen Des Membranes, UMR 5635, IEM, Université Montpellier, ENSCM, CNRS, Montpellier, France
| | - Stéphane Marinesco
- Plate-Forme Technologique BELIV, Lyon Neuroscience Research Center, UMR5292, Inserm U1028, CNRS, Univ. Claude-Bernard-Lyon I, 69675, Lyon 08, France
| | - Pascal Mailley
- Univ. Grenoble Alpes, CEA, LETI, 38000, Grenoble, DTBS, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Pierre Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Abdelkader Zebda
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France.
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan.
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13
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Kim ER, Joe C, Mitchell RJ, Gu MB. Biosensors for healthcare: current and future perspectives. Trends Biotechnol 2023; 41:374-395. [PMID: 36567185 DOI: 10.1016/j.tibtech.2022.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Biosensors are utilized in several different fields, including medicine, food, and the environment; in this review, we examine recent developments in biosensors for healthcare. These involve three distinct types of biosensor: biosensors for in vitro diagnosis with blood, saliva, or urine samples; continuous monitoring biosensors (CMBs); and wearable biosensors. Biosensors for in vitro diagnosis have seen a significant expansion recently, with newly reported clustered regularly interspaced short palindromic repeats (CRISPR)/Cas methodologies and improvements to many established integrated biosensor devices, including lateral flow assays (LFAs) and microfluidic/electrochemical paper-based analytical devices (μPADs/ePADs). We conclude with a discussion of two novel groups of biosensors that have drawn great attention recently, continuous monitoring and wearable biosensors, as well as with perspectives on the commercialization and future of biosensors.
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Affiliation(s)
- Eun Ryung Kim
- Department of Biotechnology, Korea University, Anam-dong, Sungbuk-Gu, Seoul 02841, Republic of Korea
| | - Cheulmin Joe
- Department of Biotechnology, Korea University, Anam-dong, Sungbuk-Gu, Seoul 02841, Republic of Korea
| | - Robert J Mitchell
- Department of Biological Sciences, UNIST, Ulsan 44919, Republic of Korea
| | - Man Bock Gu
- Department of Biotechnology, Korea University, Anam-dong, Sungbuk-Gu, Seoul 02841, Republic of Korea.
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14
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Del Baldo F, Fracassi F. Continuous Glucose Monitoring in Dogs and Cats: Application of New Technology to an Old Problem. Vet Clin North Am Small Anim Pract 2023; 53:591-613. [PMID: 36854635 DOI: 10.1016/j.cvsm.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
In recent years, glucose monitoring has been revolutionized by the development of continuous glucose monitoring systems (CGMS), which are wearable non/minimally invasive devices that measure glucose concentration almost continuously for several consecutive d/wk. The Abbott FreeStyle Libre is the CGMS used most commonly. It has adequate clinical accuracy both in dogs and cats, even though the accuracy is lower in the hypoglycemic range. It allows an accurate identification of glycemic excursions occurring throughout the day as well as of glucose variations during consecutive days, enabling the clinician to make a more informed decision about the insulin dose and frequency of administration.
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Affiliation(s)
- Francesca Del Baldo
- Department of Veterinary Medical Science, University of Bologna, via Tolara di Sopra, 40066, Ozzano dell'Emilia, Bologna, Italy.
| | - Federico Fracassi
- Department of Veterinary Medical Science, University of Bologna, via Tolara di Sopra, 40066, Ozzano dell'Emilia, Bologna, Italy
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15
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Dovc K, Bode BW, Battelino T. Continuous and Intermittent Glucose Monitoring in 2022. Diabetes Technol Ther 2023; 25:S15-S29. [PMID: 36802188 DOI: 10.1089/dia.2023.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Klemen Dovc
- University Medical Center University Children's Hospital Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bruce W Bode
- Atlanta Diabetes Associates and Emory University School of Medicine, Atlanta, GA, USA
| | - Tadej Battelino
- University Medical Center University Children's Hospital Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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16
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Battelino T, Alexander CM, Amiel SA, Arreaza-Rubin G, Beck RW, Bergenstal RM, Buckingham BA, Carroll J, Ceriello A, Chow E, Choudhary P, Close K, Danne T, Dutta S, Gabbay R, Garg S, Heverly J, Hirsch IB, Kader T, Kenney J, Kovatchev B, Laffel L, Maahs D, Mathieu C, Mauricio D, Nimri R, Nishimura R, Scharf M, Del Prato S, Renard E, Rosenstock J, Saboo B, Ueki K, Umpierrez GE, Weinzimer SA, Phillip M. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 2023; 11:42-57. [PMID: 36493795 DOI: 10.1016/s2213-8587(22)00319-9] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
Randomised controlled trials and other prospective clinical studies for novel medical interventions in people with diabetes have traditionally reported HbA1c as the measure of average blood glucose levels for the 3 months preceding the HbA1c test date. The use of this measure highlights the long-established correlation between HbA1c and relative risk of diabetes complications; the change in the measure, before and after the therapeutic intervention, is used by regulators for the approval of medications for diabetes. However, with the increasing use of continuous glucose monitoring (CGM) in clinical practice, prospective clinical studies are also increasingly using CGM devices to collect data and evaluate glucose profiles among study participants, complementing HbA1c findings, and further assess the effects of therapeutic interventions on HbA1c. Data is collected by CGM devices at 1-5 min intervals, which obtains data on glycaemic excursions and periods of asymptomatic hypoglycaemia or hyperglycaemia (ie, details of glycaemic control that are not provided by HbA1c concentrations alone that are measured continuously and can be analysed in daily, weekly, or monthly timeframes). These CGM-derived metrics are the subject of standardised, internationally agreed reporting formats and should, therefore, be considered for use in all clinical studies in diabetes. The purpose of this consensus statement is to recommend the ways CGM data might be used in prospective clinical studies, either as a specified study endpoint or as supportive complementary glucose metrics, to provide clinical information that can be considered by investigators, regulators, companies, clinicians, and individuals with diabetes who are stakeholders in trial outcomes. In this consensus statement, we provide recommendations on how to optimise CGM-derived glucose data collection in clinical studies, including the specific glucose metrics and specific glucose metrics that should be evaluated. These recommendations have been endorsed by the American Association of Clinical Endocrinologists, the American Diabetes Association, the Association of Diabetes Care and Education Specialists, DiabetesIndia, the European Association for the Study of Diabetes, the International Society for Pediatric and Adolescent Diabetes, the Japanese Diabetes Society, and the Juvenile Diabetes Research Foundation. A standardised approach to CGM data collection and reporting in clinical trials will encourage the use of these metrics and enhance the interpretability of CGM data, which could provide useful information other than HbA1c for informing therapeutic and treatment decisions, particularly related to hypoglycaemia, postprandial hyperglycaemia, and glucose variability.
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Affiliation(s)
- Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | | | | | - Guillermo Arreaza-Rubin
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA, USA
| | | | | | - Elaine Chow
- Phase 1 Clinical Trial Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pratik Choudhary
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly Close
- diaTribe Foundation, San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Auf der Bult, Hanover, Germany
| | | | - Robert Gabbay
- American Diabetes Association, Arlington, VA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Satish Garg
- Barbara Davis Centre for Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Tina Kader
- Jewish General Hospital, Montreal, QC, Canada
| | | | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Lori Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - David Maahs
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, CA, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBERDEM (Instituto de Salud Carlos III), Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Revital Nimri
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rimei Nishimura
- The Jikei University School of Medicine, Jikei University, Tokyo, Japan
| | - Mauro Scharf
- Centro de Diabetes Curitiba and Division of Pediatric Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, Montpellier, France; INSERM Clinical Investigation Centre, Montpellier, France
| | - Julio Rosenstock
- Velocity Clinical Research, Medical City, Dallas, TX; University of Texas Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Kohjiro Ueki
- Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Moshe Phillip
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Muhs A, Bobrowski T, Lielpētere A, Schuhmann W. Catalytic Biosensors Operating under Quasi-Equilibrium Conditions for Mitigating the Changes in Substrate Diffusion. Angew Chem Int Ed Engl 2022; 61:e202211559. [PMID: 36253337 PMCID: PMC10099152 DOI: 10.1002/anie.202211559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 11/07/2022]
Abstract
Despite the success of continuous glucose measuring systems operating through the skin for about 14 days, long-term implantable biosensors are facing challenges caused by the foreign-body reaction. We present a conceptually new strategy using catalytic enzyme-based biosensors based on a measuring sequence leading to minimum disturbance of the substrate equilibrium concentration by controlling the sensor between "on" and "off" state combined with short potentiometric data acquisition. It is required that the enzyme activity can be completely switched off and no parasitic side reactions allow substrate turnover. This is achieved by using an O2 -independent FAD-dependent glucose dehydrogenase embedded within a crosslinked redox polymer. A short measuring interval allows the glucose concentration equilibrium to be restored quickly which enables the biosensor to operate under quasi-equilibrium conditions.
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Affiliation(s)
- Anna Muhs
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Tim Bobrowski
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Anna Lielpētere
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
| | - Wolfgang Schuhmann
- Analytical Chemistry-Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Universitätsstrasse 150, 44780, Bochum, Germany
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18
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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19
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Xiong M, Neeley AB. Adverse cutaneous reaction to the Eversense E3 continuous glucose monitor in a platinum-allergic patient. Contact Dermatitis 2022; 87:535-536. [PMID: 35971793 DOI: 10.1111/cod.14200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Michelle Xiong
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, United States.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Anne B Neeley
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, United States
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20
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Lin L, Liu K, Feng H, Li J, Chen H, Zhang T, Xue B, Si J. Glucose trajectory prediction by deep learning for personal home care of type 2 diabetes mellitus: modelling and applying. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:10096-10107. [PMID: 36031985 DOI: 10.3934/mbe.2022472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Glucose management for people with type 2 diabetes mellitus is essential but challenging due to the multi-factored and chronic disease nature of diabetes. To control glucose levels in a safe range and lessen abnormal glucose variability efficiently and economically, an intelligent prediction of glucose is demanding. A glucose trajectory prediction system based on subcutaneous interstitial continuous glucose monitoring data and deep learning models for ensuing glucose trajectory was constructed, followed by the application of personalised prediction models on one participant with type 2 diabetes in a community. The predictive accuracy was then assessed by RMSE (root mean square error) using blood glucose data. Changes in glycaemic parameters of the participant before and after model intervention were also compared to examine the efficacy of this intelligence-aided health care. Individual Recurrent Neural Network model was developed on glucose data, with an average daily RMSE of 1.59 mmol/L in the application segment. In terms of the glucose variation, the mean glucose decreased by 0.66 mmol/L, and HBGI dropped from 12.99 × 102 to 9.17 × 102. However, the participant also had increased stress, especially in eating and social support. Our research presented a personalised care system for people with diabetes based on deep learning. The intelligence-aided health management system is promising to enhance the outcome of diabetic patients, but further research is also necessary to decrease stress in the intelligence-aided health management and investigate the stress impacts on diabetic patients.
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Affiliation(s)
- Lingmin Lin
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
- School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
| | - Kailai Liu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Huan Feng
- School of Medical Humanities, Tianjin Medical University, Tianjin, China
| | - Jing Li
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Hengle Chen
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Tao Zhang
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Boyun Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Jiarui Si
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
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21
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Ji SH, Dong C, Chen R, Shen CC, Xiao J, Gu YJ, Gao JL. Effects of Variability in Glycemic Indices on Longevity in Chinese Centenarians. Front Nutr 2022; 9:955101. [PMID: 35879983 PMCID: PMC9307500 DOI: 10.3389/fnut.2022.955101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Large fluctuations in blood glucose levels greatly impact the health and life span of elderly individuals. This study describes the characteristics of variability in glycemic indices in centenarians with the aim of emphasizing the importance of glycemic variability in elderly people. Methods We recruited individuals from Rugao City, Jiangsu Province, China from April 2020 to May 2021. The study cohort included 60 centenarians and 60 first-generation offspring, as well as 20 randomly selected non-cohabitant control individuals aged 60–80 years. A FreeStyle Libre H (hospital version) continuous glucose monitoring (CGM) device (Abbott Ireland UK) was used to measure glycemic variability. The indices measured included the time in target glucose range (TIR), time below target glucose range (TBR), time above target glucose range (TAR), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), coefficient of variation (CV), standard deviation of blood glucose (SDBG), continuous overlapping net glycemic action (CONGA), glucose management indicator (GMI) and estimated glycated hemoglobin (eHbA1c). Logistic regression was used to analyze the association between glycemic variability and longevity. Results Mean blood glucose (MBG), eHbA1c, GMI, mean fasting plasma glucose (M-FPG) and CONGA were lower in the centenarian group (p all < 0.05). PPGE-2 was higher in the control group than that measured in the centenarian and first-generation offspring groups (p < 0.05). There were no differences between the groups in MAGE, MODD, MAG, or TIR (p > 0.05). The risk of not achieving longevity increased with each one unit increase in MBG by 126% [2.26 (1.05–4.91)], eHbA1c by 67% [1.67 (1.03–2.72)], GMI by 568% [6.68 (1.11–40.30)], M-FPG by 365% [4.65 (1.57–13.75)], M-PPG1h by 98% [1.98 (1.18–3.31)], CONGA1 by 102% [2.02 (1.01–4.06)], Li by 200% [3.00 (1.04–8.61)], and PPGE-2 by 150% [2.50 (1.39–4.50)]. However, the risk of achieving longevity decreased with each unit increase of LBGI by 53% [0.47 (0.28–0.80)], ADRR by 60% [0.40 (0.18–0.86)], and TBR by 11% [0.89 (0.80–0.98)]. Conclusion Fluctuation in blood glucose levels in centenarians is relatively small. Maintaining an average blood glucose level and keeping blood glucose fluctuations in the normal range is conducive to longevity.
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Affiliation(s)
- Sheng-han Ji
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Medical School of Nantong University, Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Rou Chen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Medical School of Nantong University, Nantong University, Nantong, China
| | - Chen-chen Shen
- Department of Cardiology, Rugao Bo'ai Branch of Nantong University Affiliated Hospital, Nantong, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Yun-juan Gu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Department of Health Medicine, Affiliated Hospital of Nantong University, Nantong, China
- *Correspondence: Yun-juan Gu
| | - Jian-lin Gao
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
- Jian-lin Gao
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22
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Domingo-Lopez DA, Lattanzi G, H. J. Schreiber L, Wallace EJ, Wylie R, O'Sullivan J, Dolan EB, Duffy GP. Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus. Adv Drug Deliv Rev 2022; 185:114280. [PMID: 35405298 DOI: 10.1016/j.addr.2022.114280] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/21/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus refers to a group of metabolic disorders which affect how the body uses glucose impacting approximately 9% of the population worldwide. This review covers the most recent technological advances envisioned to control and/or reverse Type 1 diabetes mellitus (T1DM), many of which will also prove effective in treating the other forms of diabetes mellitus. Current standard therapy for T1DM involves multiple daily glucose measurements and insulin injections. Advances in glucose monitors, hormone delivery systems, and control algorithms generate more autonomous and personalised treatments through hybrid and fully automated closed-loop systems, which significantly reduce hypo- and hyperglycaemic episodes and their subsequent complications. Bi-hormonal systems that co-deliver glucagon or amylin with insulin aim to reduce hypoglycaemic events or increase time spent in target glycaemic range, respectively. Stimuli responsive materials for the controlled delivery of insulin or glucagon are a promising alternative to glucose monitors and insulin pumps. By their self-regulated mechanism, these "smart" drugs modulate their potency, pharmacokinetics and dosing depending on patients' glucose levels. Islet transplantation is a potential cure for T1DM as it restores endogenous insulin and glucagon production, but its use is not yet widespread due to limited islet sources and risks of chronic immunosuppression. New encapsulation strategies that promote angiogenesis and oxygen delivery while protecting islets from recipients' immune response may overcome current limiting factors.
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23
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Lundquist J, Horstmann B, Pestov D, Ozgur U, Avrutin V, Topsakal E. Energy-Efficient, On-Demand Activation of Biosensor Arrays for Long-Term Continuous Health Monitoring. BIOSENSORS 2022; 12:bios12050358. [PMID: 35624659 PMCID: PMC9138492 DOI: 10.3390/bios12050358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
Wearable biosensors for continuous health monitoring, particularly those used for glucose detection, have a limited operational lifetime due to biodegradation and fouling. As a result, patients must change sensors frequently, increasing cost and patient discomfort. Arrays of multiple sensors, where the individual devices can be activated on demand, increase overall operational longevity, thereby reducing cost and improving patient outcomes. This work demonstrates the feasibility of this approach via decomposition of combustible nitrocellulose membranes that protect the individual sensors from exposure to bioanalytes using a current pulse. Metal contacts, connected by graphene-loaded PEDOT:PSS polymer on the surface of the membrane, deliver the required energy to decompose the membrane. Nitrocellulose membranes with a thickness of less than 1 µm consistently transfer on to polydimethylsiloxane (PDMS) wells. An electrical energy as low as 68 mJ has been shown to suffice for membrane decomposition.
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Affiliation(s)
- Jonathan Lundquist
- Department of Electrical and Computer Engineering, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA; (J.L.); (B.H.); (U.O.); (E.T.)
| | - Benjamin Horstmann
- Department of Electrical and Computer Engineering, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA; (J.L.); (B.H.); (U.O.); (E.T.)
| | - Dmitry Pestov
- Nanomaterials Core Characterization Facility, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA;
| | - Umit Ozgur
- Department of Electrical and Computer Engineering, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA; (J.L.); (B.H.); (U.O.); (E.T.)
| | - Vitaliy Avrutin
- Department of Electrical and Computer Engineering, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA; (J.L.); (B.H.); (U.O.); (E.T.)
- Correspondence: ; Tel.: +1-804-828-0181
| | - Erdem Topsakal
- Department of Electrical and Computer Engineering, College of Engineering, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, USA; (J.L.); (B.H.); (U.O.); (E.T.)
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Renard E, Riveline JP, Hanaire H, Guerci B. Reduction of clinically important low glucose excursions with a long-term implantable continuous glucose monitoring system in adults with type 1 diabetes prone to hypoglycaemia: the France Adoption Randomized Clinical Trial. Diabetes Obes Metab 2022; 24:859-867. [PMID: 34984786 DOI: 10.1111/dom.14644] [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: 09/05/2021] [Revised: 12/07/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the glucose control outcomes of the implantable Eversense real-time continuous glucose monitoring (CGM) system compared to self-monitoring of blood glucose or intermittently scanned CGM in patients with type 1 (T1D) or type 2 diabetes (T2D). PATIENTS AND METHODS This was a randomized (2:1), prospective, national, multicentre study. All participants, aged >18 years and on multiple daily insulin injections or insulin pump treatment, had a sensor inserted, which was activated only in the "enabled" group. Included patients had T1D or T2D with a glycated haemoglobin (HbA1c) level > 8% (64 mmol/mol) (Cohort 1) or T1D with a time spent with glucose values below 70 mg/dL (3.8 mmol/l) (TBR<70 ) for >1.5 h/d during the previous 28 days (Cohort 2). The primary outcomes were HbA1c change at D180 (Cohort 1) or change in time spent with glucose values below 54 mg/dL (TBR<54 ) during the period of Day (D)90 to D120 (Cohort 2). A covariance model (analyses of covariance) was used for endpoint analyses. RESULTS Overall, 149 patients were included in Cohort 1 and 90 in Cohort 2. In Cohort 1, the adjusted mean difference (enabled - control) in HbA1c at D180 was -0.1% (95% confidence interval [CI] -0.4; 0.1; P = 0.341). No significant difference in time with values in the range 70 to 180 mg/dL or time with values above range (>180 mg/dL) was observed. In Cohort 2, the mean adjusted difference in TBR<54 was -1.6% (95% CI -3.1; -0.1; P = 0.039) during D90 to D120 and remained at -2.6% (95% CI -4.5; -0.6; P = 0.011) during D150 to D180 (prespecified secondary outcome). The CGM system was found to be safe. CONCLUSION This study shows that the Eversense CGM system can significantly decrease TBR<54 in patients with T1D prone to hypoglycaemia.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, INSERM Clinical Investigation Centre 1411, Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Lariboisiere University Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, INSERM UMRS-1138, Paris, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Bruno Guerci
- Department of Endocrinology, Diabetology and Nutrition, Brabois Hospital and University of Lorraine, Vandoeuvre Lès Nancy, France
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25
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Clinical Use of a 180-Day Implantable Glucose Monitoring System in Dogs with Diabetes Mellitus: A Case Series. Animals (Basel) 2022; 12:ani12070860. [PMID: 35405848 PMCID: PMC8996934 DOI: 10.3390/ani12070860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary A novel continuous glucose monitoring system (CGMS) equipped with a long-term sensor has recently been developed for humans with diabetes mellitus. The sensor is inserted under the skin and continuously measures the glucose in the interstitial fluid over a period of up to 180 days. The aim of this study was to describe, for the first time, the clinical use of this novel CGMS in three diabetic dogs (DD). The insertion and use of the device were straightforward and well tolerated by the dogs. Some device-related issues, such as sensor dislocation and trouble with daily calibrations, were reported. A good correlation between the glucose values measured by this CGMS and those obtained with a flash glucose monitoring system and a portable-blood glucose meter, previously validated for use in DD, was found (rs = 0.85 and rs = 0.81, respectively). The functional life of the sensor was 180 days in two of the three dogs, and the use of the device provided high satisfaction to the owners. This innovative device might be considered a future alternative for continuous glucose monitoring in dogs with diabetes mellitus. Abstract The novel Eversense XL continuous glucose monitoring system (Senseonics, Inc., Germantown, Maryland) has recently been developed for monitoring diabetes in humans. The sensor is fully implanted and has a functional life of up to 180 days. The present study describes the use of Eversense XL in three diabetic dogs (DD) with good glycemic control managed by motivated owners. The insertion and use of the device were straightforward and well tolerated by the dogs. During the wearing period, some device-related drawbacks, such as sensor dislocation and daily calibrations, were reported. A good correlation between the glucose values measured by the Eversense XL and those obtained with two commercially available devices, previously validated for use in DD, was found (rs = 0.85 and rs = 0.81, respectively). The life of the sensor was 180 days in two of the DD and provided high satisfaction. This innovative device might be considered a future alternative for home glucose monitoring in DD.
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26
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Moser O, Sternad C, Eckstein ML, Szadkowska A, Michalak A, Mader JK, Ziko H, Elsayed H, Aberer F, Sola-Gazagnes A, Larger E, Fadini GP, Bonora BM, Bruttomesso D, Boscari F, Freckmann G, Pleus S, Christiansen SC, Sourij H. Performance of intermittently scanned continuous glucose monitoring systems in people with type 1 diabetes: A pooled analysis. Diabetes Obes Metab 2022; 24:522-529. [PMID: 34866293 DOI: 10.1111/dom.14609] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022]
Abstract
AIMS To conduct a pooled analysis to assess the performance of intermittently scanned continuous glucose monitoring (isCGM) in association with the rate of change in sensor glucose in a cohort of children, adolescents, and adults with type 1 diabetes. MATERIAL AND METHODS In this pooled analysis, isCGM system accuracy was assessed depending on the rate of change in sensor glucose. Clinical studies that have been investigating isCGM accuracy against blood glucose, accompanied with collection time points were included in this analysis. isCGM performance was assessed by means of median absolute relative difference (MedARD), Parkes error grid (PEG) and Bland-Altman plot analyses. RESULTS Twelve studies comprising 311 participants were included, with a total of 15 837 paired measurements. The overall MedARD (interquartile range) was 12.7% (5.9-23.5) and MedARD differed significantly based on the rate of change in glucose (P < 0.001). An absolute difference of -22 mg/dL (-1.2 mmol/L) (95% limits of agreement [LoA] 60 mg/dL (3.3 mmol/L), -103 mg/dL (-5.7 mmol/L)) was found when glucose was rapidly increasing (isCGM glucose minus reference blood glucose), while a -32 mg/dL (1.8 mmol/L) (95% LoA 116 mg/dL (6.4 mmol/L), -51 mg/dL (-2.8 mmol/L)) absolute difference was observed in periods of rapidly decreasing glucose. CONCLUSIONS The performance of isCGM was good when compared to reference blood glucose measurements. The rate of change in glucose for both increasing and decreasing glucose levels diminished isCGM performance, showing lower accuracy during high rates of glucose change.
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Affiliation(s)
- Othmar Moser
- Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz
| | - Max L Eckstein
- Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Łódź, Poland
| | - Arkadiusz Michalak
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Łódź, Poland
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Hesham Elsayed
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz
| | - Agnes Sola-Gazagnes
- Department of Diabetology, Cochin Hospital, APHP Centre-Université de Paris, Paris, France
| | - Etienne Larger
- Department of Diabetology, Cochin Hospital, APHP Centre-Université de Paris, Paris, France
- Université de Paris, Paris, France
| | | | | | | | | | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sverre C Christiansen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olav's University Hospital, Trondheim, Norway
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz
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27
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Weitgasser R, Ocenasek H, Fallwickl S. Race Across America: First Athlete With Type 1 Diabetes to Finish Solo With Diabetes Technology Support. Diabetes Spectr 2022; 35:227-231. [PMID: 35668881 PMCID: PMC9160562 DOI: 10.2337/ds21-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Raimund Weitgasser
- Department of Internal Medicine/Diabetology and Metabolism, Wehrle-Diakonissen Hospital, Salzburg, Austria
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Helmuth Ocenasek
- Institute for Sport and Health Medicine, Linz, Austria
- CARDIOMED Centre for Outpatient Cardiac Rehabilitation, Linz, Austria
| | - Susanne Fallwickl
- Cardio-Pulmonary Rehabilitation, Rehabilitation Center Hochegg, Grimmenstein, Austria
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28
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Garg SK, Liljenquist D, Bode B, Christiansen MP, Bailey TS, Brazg RL, Denham DS, Chang AR, Akturk HK, Dehennis A, Tweden KS, Kaufman FR. Evaluation of Accuracy and Safety of the Next-Generation Up to 180-Day Long-Term Implantable Eversense Continuous Glucose Monitoring System: The PROMISE Study. Diabetes Technol Ther 2022; 24:84-92. [PMID: 34515521 PMCID: PMC8817689 DOI: 10.1089/dia.2021.0182] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Use of continuous glucose monitoring (CGM) systems is being rapidly adopted as standard of care for insulin-requiring patients with diabetes. The PROMISE study (NCT03808376) evaluated the accuracy and safety of the next-generation implantable Eversense CGM system for up to 180 days. Methods: This was a prospective multicenter study involving 181 subjects with diabetes at 8 USA sites. All subjects were inserted with a primary sensor. Ninety-six subjects had a second sensor, either an identical sensor or a modified sensor (sacrificial boronic acid [SBA]), inserted in their other arm (53 and 43 subjects, respectively). Accuracy was evaluated by comparing CGM to YSI 2300 glucose analyzer (Yellow Springs Instrument [YSI]) values during 10 clinic visits (day 1-180). Confirmed event detection rates, calibration stability, sensor survival, and serious adverse events (SAEs) were evaluated. Results: For primary sensors, the percent CGM readings within 20%/20% of YSI values was 92.9%; overall mean absolute relative difference (MARD) was 9.1%. The confirmed alert detection rate at 70 mg/dL was 93% and at 180 mg/dL was 99%. The median percentage of time for one calibration per day was 56%. Sixty-five percent of the primary sensors survived to 180 days. For the SBA sensors, the percent CGM readings within 20%/20% of YSI values was 93.9%; overall MARD was 8.5%. The confirmed alert detection rate at 70 mg/dL was 94% and at 180 mg/dL was 99%. The median percentage of time for one calibration per day was 63%. Ninety percent of the SBA sensors survived to 180 days. No device- or insertion/removal procedure-related SAEs were reported. Conclusion: These data show the next-generation Eversense CGM system had sustained accuracy and safety up to 180 days, with an improved calibration scheme and survival, using the primary or SBA sensors.
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Affiliation(s)
- Satish K. Garg
- University of Colorado, Aurora, Colorado, USA
- Address correspondence to: Satish K. Garg, MD, Editor-in-Chief, Diabetes Tech. & Therap., Professor of Medicine and Pediatrics, Garg Endowed Chairs & Director Adult Program, Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Court, Room M20-1323 Aurora, CO 80045, USA
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | - Katherine S. Tweden
- Senseonics, Inc., Germantown, Maryland, USA
- Address correspondence to: Katherine S. Tweden, PhD, Senseonics, Inc., 20451 Seneca Meadows Pkwy, Germantown, MD 20876, USA
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Recent Advances in Wearable Optical Sensor Automation Powered by Battery versus Skin-like Battery-Free Devices for Personal Healthcare-A Review. NANOMATERIALS 2022; 12:nano12030334. [PMID: 35159679 PMCID: PMC8838083 DOI: 10.3390/nano12030334] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/11/2022]
Abstract
Currently, old-style personal Medicare techniques rely mostly on traditional methods, such as cumbersome tools and complicated processes, which can be time consuming and inconvenient in some circumstances. Furthermore, such old methods need the use of heavy equipment, blood draws, and traditional bench-top testing procedures. Invasive ways of acquiring test samples can potentially cause patient discomfort and anguish. Wearable sensors, on the other hand, may be attached to numerous body areas to capture diverse biochemical and physiological characteristics as a developing analytical tool. Physical, chemical, and biological data transferred via the skin are used to monitor health in various circumstances. Wearable sensors can assess the aberrant conditions of the physical or chemical components of the human body in real time, exposing the body state in time, thanks to unintrusive sampling and high accuracy. Most commercially available wearable gadgets are mechanically hard components attached to bands and worn on the wrist, with form factors ultimately constrained by the size and weight of the batteries required for the power supply. Basic physiological signals comprise a lot of health-related data. The estimation of critical physiological characteristics, such as pulse inconstancy or variability using photoplethysmography (PPG) and oxygen saturation in arterial blood using pulse oximetry, is possible by utilizing an analysis of the pulsatile component of the bloodstream. Wearable gadgets with “skin-like” qualities are a new type of automation that is only starting to make its way out of research labs and into pre-commercial prototypes. Flexible skin-like sensing devices have accomplished several functionalities previously inaccessible for typical sensing devices due to their deformability, lightness, portability, and flexibility. In this paper, we studied the recent advancement in battery-powered wearable sensors established on optical phenomena and skin-like battery-free sensors, which brings a breakthrough in wearable sensing automation.
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30
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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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Boscari F, Vettoretti M, Cavallin F, Amato AML, Uliana A, Vallone V, Avogaro A, Facchinetti A, Bruttomesso D. Implantable and transcutaneous continuous glucose monitoring system: a randomized cross over trial comparing accuracy, efficacy and acceptance. J Endocrinol Invest 2022; 45:115-124. [PMID: 34196924 PMCID: PMC8246426 DOI: 10.1007/s40618-021-01624-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/22/2021] [Indexed: 01/23/2023]
Abstract
AIM To compare accuracy, efficacy and acceptance of implantable and transcutaneous continuous glucose monitoring (CGM) systems. METHODS In a randomized crossover trial we compared 12 weeks with Eversense implantable sensor (EVS) and 12 weeks with Dexcom G5 transcutaneous sensor (DG5) in terms of accuracy, evaluated as Mean Absolute Relative Difference (MARD) vs capillary glucose (SMBG), time of CGM use, adverse events, efficacy (as HbA1c, time in range, time above and below range) and psychological outcomes evaluated with Diabetes Treatment Satisfaction Questionnaire (DTSQ), Glucose Monitoring Satisfaction Survey (GMSS), Hypoglycemia Fear Survey (HFS2), Diabetes Distress Scale (DDS). RESULTS 16 subjects (13 males, 48.8 ± 10.1 years, HbA1c 55.8 ± 7.9 mmol/mol, mean ± SD) completed the study. DG5 was used more than EVS [percentage of use 95.7 ± 3.6% vs 93.5 ± 4.3% (p = 0.02)]. MARD was better with EVS (12.2 ± 11.5% vs. 13.1 ± 14.7%, p< 0.001). No differences were found in HbA1c. While using EVS time spent in range increased and time spent in hyperglycemia decreased, but these data were not confirmed by analysis of retrofitted data based on SMBG values. EVS reduced perceived distress, without significant changes in other psychological outcomes. CONCLUSIONS CGM features may affect glycemic control and device acceptance.
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Affiliation(s)
- F Boscari
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - M Vettoretti
- Department of Information Engineering (DEI), University of Padova, Padova, Italy
| | - F Cavallin
- Independent Statistician, Solagna, Italy
| | - A M L Amato
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - A Uliana
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - V Vallone
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - A Facchinetti
- Department of Information Engineering (DEI), University of Padova, Padova, Italy
| | - D Bruttomesso
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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32
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Farhoudi N, Laurentius LB, Magda JJ, Reiche CF, Solzbacher F. In Vivo Monitoring of Glucose Using Ultrasound-Induced Resonance in Implantable Smart Hydrogel Microstructures. ACS Sens 2021; 6:3587-3595. [PMID: 34543020 DOI: 10.1021/acssensors.1c00844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Navid Farhoudi
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Lars B. Laurentius
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Jules J. Magda
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Christopher F. Reiche
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84112, United States
| | - Florian Solzbacher
- Departments of Electrical and Computer Engineering, Materials Science & Engineering, and Biomedical Engineering, University of Utah, Salt Lake City, Utah 84112, United States
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Irace C, Cutruzzolà A, Tweden K, Kaufman FR. Device profile of the eversense continuous glucose monitoring system for glycemic control in type-1 diabetes: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:909-914. [PMID: 34528851 DOI: 10.1080/17434440.2021.1982380] [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: 10/20/2022]
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) systems offer real-time data to facilitate diabetes management. The novel Eversense CGM has been approved in Europe and the US. The unique characteristics are the fully implantable sensor and the sensor life up to 180 days. AREAS COVERED This expert review describes the results of clinical trials, and the accuracy and safety of the Eversense system. The overall MARD ranges from 8.5% to 9.4%, the 20/20% agreement rate ranges from 84% to 94%, and the percent of values in zones A and B on the Clarke Error Grid is 99.2%. No device-related serious adverse events have been described during pivotal trial studies. The most frequently reported device- or procedure-related adverse events are sensor adhesive patch location site irritation (0.66%), inability to remove the sensor upon first attempt (0.76%), and location site infection (0.96%). Mean A1c reduction is about 0.4% from pivotal trials and real-world studies. EXPERT OPINION The Eversense system is novel and differentiated from transcutaneous CGM systems. The long life, the removable transmitter, and the on-body vibration alerts offer opportunities to properly manage diabetes with both MDI and insulin pump therapy.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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Zhang Y, Sun J, Liu L, Qiao H. A review of biosensor technology and algorithms for glucose monitoring. J Diabetes Complications 2021; 35:107929. [PMID: 33902999 DOI: 10.1016/j.jdiacomp.2021.107929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus (DM) has become a serious illness in the whole world. Until now, there is no effective cure for patients with DM. It is well known that the glucose level is one key factor to determine the progress of DM. It is also an important reference to carry out the accurate and timely treatment for patients with DM. In this article, the related biosensors technology that can be utilized to identify and predict glucose level are reviewed in detail, including the algorithms that can help to achieve numerical value of glucose level. Firstly, the biosensor technology based on the physiological fluids are illustrated, including blood, sweat, interstitial fluid, ocular fluid, and other available fluids. Secondly, the algorithms for achieving numerical value of glucose level are investigated, including the physiological model-based method and the machine learning-based method. Finally, the future development trend and challenges of glucose level monitoring are given and the conclusions are drawn.
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Affiliation(s)
- Yaguang Zhang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Jingxue Sun
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Liansheng Liu
- School of Electronics and Information Engineering, Harbin Institute of Technology, Harbin 150080, China
| | - Hong Qiao
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China.
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35
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Daly A, Hovorka R. Technology in the management of type 2 diabetes: Present status and future prospects. Diabetes Obes Metab 2021; 23:1722-1732. [PMID: 33950566 PMCID: PMC7611289 DOI: 10.1111/dom.14418] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
The growing incidence of type 2 diabetes (T2D) is a significant health concern, representing 90% of diabetes cases worldwide. As the disease progresses, resultant insulin deficiency and hyperglycaemia necessitates insulin therapy in many cases. It has been recognized that a significant number of people who have a clinical requirement for insulin therapy, as well as their healthcare professionals, are reluctant to intensify treatment with insulin due to fear of hypoglycaemia, poor understanding of treatment regimens or lack of engagement, and are therefore at higher risk of developing complications from poor glycaemic control. Over the past decade, the rise of diabetes technologies, including dosing advisors, continuous glucose monitoring systems, insulin pumps and automated insulin delivery systems, has led to great improvements in the therapies available, particularly to those requiring insulin. Although the focus has largely been on delivering these therapies to the type 1 diabetes population, it is becoming increasingly recognized that people with T2D face similar challenges to achieve recommended glycaemic standards and also have the potential to benefit from these advances. In this review, we discuss diabetes technologies that are currently available for people with T2D and the evidence supporting their use, as well as future prospects. We conclude that there is a clinical need to extend the use of these technologies to the T2D population to curb the consequences of suboptimal disease management in this group.
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Affiliation(s)
- Aideen Daly
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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36
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Brinkmann BH, Karoly PJ, Nurse ES, Dumanis SB, Nasseri M, Viana PF, Schulze-Bonhage A, Freestone DR, Worrell G, Richardson MP, Cook MJ. Seizure Diaries and Forecasting With Wearables: Epilepsy Monitoring Outside the Clinic. Front Neurol 2021; 12:690404. [PMID: 34326807 PMCID: PMC8315760 DOI: 10.3389/fneur.2021.690404] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
It is a major challenge in clinical epilepsy to diagnose and treat a disease characterized by infrequent seizures based on patient or caregiver reports and limited duration clinical testing. The poor reliability of self-reported seizure diaries for many people with epilepsy is well-established, but these records remain necessary in clinical care and therapeutic studies. A number of wearable devices have emerged, which may be capable of detecting seizures, recording seizure data, and alerting caregivers. Developments in non-invasive wearable sensors to measure accelerometry, photoplethysmography (PPG), electrodermal activity (EDA), electromyography (EMG), and other signals outside of the traditional clinical environment may be able to identify seizure-related changes. Non-invasive scalp electroencephalography (EEG) and minimally invasive subscalp EEG may allow direct measurement of seizure activity. However, significant network and computational infrastructure is needed for continuous, secure transmission of data. The large volume of data acquired by these devices necessitates computer-assisted review and detection to reduce the burden on human reviewers. Furthermore, user acceptability of such devices must be a paramount consideration to ensure adherence with long-term device use. Such devices can identify tonic–clonic seizures, but identification of other seizure semiologies with non-EEG wearables is an ongoing challenge. Identification of electrographic seizures with subscalp EEG systems has recently been demonstrated over long (>6 month) durations, and this shows promise for accurate, objective seizure records. While the ability to detect and forecast seizures from ambulatory intracranial EEG is established, invasive devices may not be acceptable for many individuals with epilepsy. Recent studies show promising results for probabilistic forecasts of seizure risk from long-term wearable devices and electronic diaries of self-reported seizures. There may also be predictive value in individuals' symptoms, mood, and cognitive performance. However, seizure forecasting requires perpetual use of a device for monitoring, increasing the importance of the system's acceptability to users. Furthermore, long-term studies with concurrent EEG confirmation are lacking currently. This review describes the current evidence and challenges in the use of minimally and non-invasive devices for long-term epilepsy monitoring, the essential components in remote monitoring systems, and explores the feasibility to detect and forecast impending seizures via long-term use of these systems.
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Affiliation(s)
| | - Philippa J Karoly
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Ewan S Nurse
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia.,Seer Medical, Melbourne, VIC, Australia
| | | | - Mona Nasseri
- Department of Neurology, Mayo Foundation, Rochester, MN, United States.,School of Engineering, University of North Florida, Jacksonville, FL, United States
| | - Pedro F Viana
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Greg Worrell
- Department of Neurology, Mayo Foundation, Rochester, MN, United States
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mark J Cook
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
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Xu L, Zhang X, Wang Z, Haidry AA, Yao Z, Haque E, Wang Y, Li G, Daeneke T, McConville CF, Kalantar-Zadeh K, Zavabeti A. Low dimensional materials for glucose sensing. NANOSCALE 2021; 13:11017-11040. [PMID: 34152349 DOI: 10.1039/d1nr02529e] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Biosensors are essential components for effective healthcare management. Since biological processes occur on molecular scales, nanomaterials and nanosensors intrinsically provide the most appropriate landscapes for developing biosensors. Low-dimensional materials have the advantage of offering high surface areas, increased reactivity and unique physicochemical properties for efficient and selective biosensing. So far, nanomaterials and nanodevices have offered significant prospects for glucose sensing. Targeted glucose biosensing using such low-dimensional materials enables much more effective monitoring of blood glucose levels, thus providing significantly better predictive diabetes diagnostics and management. In this review, recent advances in using low dimensional materials for sensing glucose are summarized. Sensing fundamentals are discussed, as well as invasive, minimally-invasive and non-invasive sensing methods. The effects of morphological characteristics and size-dependent properties of low dimensional materials are explored for glucose sensing, and the key performance parameters such as selectivity, stability and sensitivity are also discussed. Finally, the challenges and future opportunities that low dimensional materials can offer for glucose sensing are outlined.
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Affiliation(s)
- Linling Xu
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211100, China
| | - Xianfei Zhang
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211100, China
| | - Zhe Wang
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211100, China
| | - Azhar Ali Haidry
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211100, China
| | - Zhengjun Yao
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211100, China
| | - Enamul Haque
- School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
| | - Yichao Wang
- Institute for Frontier Materials, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia
| | - Gang Li
- Department of Chemical Engineering, The University of Melbourne, Parkville, VIC, 3010 Australia.
| | - Torben Daeneke
- School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
| | - Chris F McConville
- Institute for Frontier Materials, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia
| | - Kourosh Kalantar-Zadeh
- School of Chemical Engineering, University of New South Wales (UNSW), Kensington, NSW 2052, Australia.
| | - Ali Zavabeti
- Department of Chemical Engineering, The University of Melbourne, Parkville, VIC, 3010 Australia.
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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Abstract
Technology has revolutionised our society. From the creation of the internet to smartphones and applications (apps), technology has changed how we communicate with each other, undertake regular tasks in our lives and access information at our fingertips. Technology has also transformed how we deliver healthcare with electronic patient records, more sensitive imaging modalities and newer treatments that are less invasive yet more cost-effective. The management of diabetes mellitus is an area that has kept pace with this revolution. With the emergence of a range of widely used technological options that can improve quality of life and metabolic outcomes, general physicians need to be aware of their application in diabetes, as well as how to manage acute diabetes presentations in people using these devices. This article aims to improve the knowledge that general physicians may have with diabetes technologies and guide them on the acute management in people using these technologies.
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Affiliation(s)
| | - Sufyan Hussain
- St Thomas' Hospital, London, UK and King's College London, London, UK
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40
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Welles TS, Ahn J. Investigation of the effects of electrochemical reactions on complex metal tribocorrosion within the human body. Heliyon 2021; 7:e07023. [PMID: 34041392 PMCID: PMC8144002 DOI: 10.1016/j.heliyon.2021.e07023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/13/2020] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
Although total hip arthroplasty (THA) is considered to be the most successful orthopedic operation in restoring mobility and relieving pain, common Metal-on-Metal (MoM) implants developed in the past decade suffer from severe inflammatory reactions of the surrounding tissue caused by the premature corrosion and degradation of the implant. A substantial amount of research has been dedicated to the investigation of mechanically driven fretting and crevice corrosion as the primary mechanism of implant failure. However, the exact mechanism by which hip implant breakdown occurs remains unknown, as current in vitro fretting and crevice corrosion studies have failed to completely replicate the corrosion characteristics of recovered implants. Here, we show that minor electric potential oscillations on a model hip implant replicate the corrosion of failed implants without the introduction of mechanical wear. We found in a controlled lab setting that small electrical oscillations, of similar frequency and magnitude as those resulting from ambient electromagnetic waves interacting with the metal of the implant, can force electrochemical reactions within a simulated synovial fluid environment that have not been previously predicted. In lab testing we have shown the replication of titanium, phosphorous, and oxygen deposition onto the surface of ASTM astm:F75 CoCrMo metal alloy test specimens, matching the chemical composition of previously retrieved wear particles from failed patient prosthetics. Our results demonstrate that the electrical activity and ensuing electrochemical activity excites two corrosion failure modes: direct dissolution of the medically implantable alloy, leaching metal ions into the body, and surface deposition growth, forming the precursor of secondary wear particles. We anticipate our findings to be the foundation for the future development and testing of electrochemically resistant implantable material.
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Affiliation(s)
- Thomas S. Welles
- Department of Mechanical and Aerospace Engineering, Syracuse University, Syracuse, NY 13244-1240, USA
| | - Jeongmin Ahn
- Department of Mechanical and Aerospace Engineering, Syracuse University, Syracuse, NY 13244-1240, USA
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Stuart T, Cai L, Burton A, Gutruf P. Wireless and battery-free platforms for collection of biosignals. Biosens Bioelectron 2021; 178:113007. [PMID: 33556807 PMCID: PMC8112193 DOI: 10.1016/j.bios.2021.113007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
Recent progress in biosensors have quantitively expanded current capabilities in exploratory research tools, diagnostics and therapeutics. This rapid pace in sensor development has been accentuated by vast improvements in data analysis methods in the form of machine learning and artificial intelligence that, together, promise fantastic opportunities in chronic sensing of biosignals to enable preventative screening, automated diagnosis, and tools for personalized treatment strategies. At the same time, the importance of widely accessible personal monitoring has become evident by recent events such as the COVID-19 pandemic. Progress in fully integrated and chronic sensing solutions is therefore increasingly important. Chronic operation, however, is not truly possible with tethered approaches or bulky, battery-powered systems that require frequent user interaction. A solution for this integration challenge is offered by wireless and battery-free platforms that enable continuous collection of biosignals. This review summarizes current approaches to realize such device architectures and discusses their building blocks. Specifically, power supplies, wireless communication methods and compatible sensing modalities in the context of most prevalent implementations in target organ systems. Additionally, we highlight examples of current embodiments that quantitively expand sensing capabilities because of their use of wireless and battery-free architectures.
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Affiliation(s)
- Tucker Stuart
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Le Cai
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Alex Burton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Philipp Gutruf
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA; Department of Electrical Engineering, University of Arizona, Tucson, AZ, 85721, USA; Bio5 Institute, University of Arizona, Tucson, AZ, 85721, USA; Neuroscience GIDP, University of Arizona, Tucson, AZ, 85721, USA.
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Eberle C, Stichling S, Löhnert M. Diabetology 4.0: Scoping Review of Novel Insights and Possibilities Offered by Digitalization. J Med Internet Res 2021; 23:e23475. [PMID: 33759789 PMCID: PMC8074865 DOI: 10.2196/23475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background The increasing prevalence of diabetes mellitus and associated morbidity worldwide justifies the need to create new approaches and strategies for diabetes therapy. Therefore, the ongoing digitalization offers novel opportunities in this field. Objective The aim of this study is to provide an updated overview of available technologies, possibilities, and novel insights into diabetes therapy 4.0. Methods A scoping review was carried out, and a literature search was performed using electronic databases (MEDLINE [PubMed], Cochrane Library, Embase, CINAHL, and Web of Science). The results were categorized according to the type of technology presented. Results Different types of technology (eg, glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mobile health apps, telemedicine, and electronic medical records) may help to improve diabetes treatment. These improvements primarily affect glycemic control. However, they may also help in increasing the autonomy and quality of life of people who are diagnosed with diabetes mellitus. Conclusions Diabetes technologies have developed rapidly over the last few years and offer novel insights into diabetes therapy and a chance to improve and individualize diabetes treatment. Challenges that need to be addressed in the following years relate to data security, interoperability, and the development of standards.
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Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Maxine Löhnert
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
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Yang C, Huang X, Li X, Yang C, Zhang T, Wu Q, liu D, Lin H, Chen W, Hu N, Xie X. Wearable and Implantable Intraocular Pressure Biosensors: Recent Progress and Future Prospects. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002971. [PMID: 33747725 PMCID: PMC7967055 DOI: 10.1002/advs.202002971] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Indexed: 05/09/2023]
Abstract
Biosensors worn on or implanted in eyes have been garnering substantial attention since being proven to be an effective means to acquire critical biomarkers for monitoring the states of ophthalmic disease, diabetes. Among these disorders, glaucoma, the second leading cause of blindness globally, usually results in irreversible blindness. Continuous intraocular pressure (IOP) monitoring is considered as an effective measure, which provides a comprehensive view of IOP changes that is beyond reach for the "snapshots" measurements by clinical tonometry. However, to satisfy the applications in ophthalmology, the development of IOP sensors are required to be prepared with biocompatible, miniature, transparent, wireless and battery-free features, which are still challenging with many current fabrication processes. In this work, the recent advances in this field are reviewed by categorizing these devices into wearable and implantable IOP sensors. The materials and structures exploited for engineering these IOP devices are presented. Additionally, their working principle, performance, and the potential risk that materials and device architectures may pose to ocular tissue are discussed. This review should be valuable for preferable structure design, device fabrication, performance optimization, and reducing potential risk of these devices. It is significant for the development of future practical IOP sensors.
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Affiliation(s)
- Cheng Yang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xiangling Li
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- School of Biomedical EngineeringSun Yat‐Sen UniversityGuangzhou510006China
| | - Chengduan Yang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Tao Zhang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- School of Biomedical EngineeringSun Yat‐Sen UniversityGuangzhou510006China
| | - Qianni Wu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Dong liu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Haotian Lin
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Weirong Chen
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Ning Hu
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
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Boscari F, Vettoretti M, Amato AML, Vallone V, Uliana A, Iori E, Avogaro A, Facchinetti A, Bruttomesso D. Comparing the accuracy of transcutaneous sensor and 90-day implantable glucose sensor. Nutr Metab Cardiovasc Dis 2021; 31:650-657. [PMID: 33594987 DOI: 10.1016/j.numecd.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/07/2020] [Accepted: 09/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Continuous glucose monitoring improves glycemic control in diabetes. This study compared the accuracy of the Dexcom G5 Mobile (Dexcom, San Diego, CA) transcutaneous sensor (DG5) and the first version of Eversense (Senseonics,Inc., Germantown, MD) implantable sensor (EVS). METHODS AND RESULTS Subjects with type 1 diabetes (T1D) and using EVS wore simultaneously DG5 for seven days. At day 3, patients were admitted to a clinical research center (CRC) to receive breakfast with delayed and increased insulin bolus to induce glucose excursions. At CRC, venous glucose was monitored every 15 min (or 5 min during hypoglycemia) for 6 h by YSI 2300 STAT PLUS™ glucose and lactate analyzer. At home patients were requested to perform 4 fingerstick glucose measurements per day. Eleven patients (9 males, age 47.4 ± 11.3 years, M±SD) were enrolled. During home-stay the median [25th-75th percentile] absolute relative difference (ARD) over all CGM-fingerstick matched-pairs was 11.64% [5.38-20.65]% for the DG5 and 10.75% [5.15-19.74]% for the EVS (p-value = 0.58). At CRC, considering all the CGM-YSI matched-pairs, the DG5 showed overall smaller median ARD than EVS, 7.91% [4.14-14.30]% vs 11.4% [5.04-18.54]% (p-value<0.001). Considering accuracy during blood glucose swings, DG5 performed better than EVS when glucose rate-of-change was -0.5 to -1.5 mg/dL/min, with median ARD of 7.34% [3.71-12.76]% vs 13.59% [4.53-20.78]% (p-value<0.001), and for rate-of-change < -1.5 mg/dl/min, with median ARD of 5.23% [2.09-15.29]% vs 12.73% [4.14-20.82]% (p-value = 0.02). CONCLUSIONS DG5 was more accurate than EVS at CRC, especially when glucose decreased. No differences were found at home.
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Affiliation(s)
- Federico Boscari
- University of Padova, Department of Medicine (DIMED), Padova, Italy
| | - Martina Vettoretti
- University of Padova, Department of Information Engineering (DEI), Padova, Italy
| | | | - Valeria Vallone
- University of Padova, Department of Medicine (DIMED), Padova, Italy
| | - Ambra Uliana
- University of Padova, Department of Medicine (DIMED), Padova, Italy
| | - Elisabetta Iori
- University of Padova, Department of Medicine (DIMED), Padova, Italy
| | - Angelo Avogaro
- University of Padova, Department of Medicine (DIMED), Padova, Italy
| | - Andrea Facchinetti
- University of Padova, Department of Information Engineering (DEI), Padova, Italy
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Strollo F, Furia A, Verde P, Bellia A, Grussu M, Mambro A, Petrelli MD, Gentile S. Technological innovation of Continuous Glucose Monitoring (CGM) as a tool for commercial aviation pilots with insulin-treated diabetes and stakeholders/regulators: A new chance to improve the directives? Diabetes Res Clin Pract 2021; 172:108638. [PMID: 33358969 DOI: 10.1016/j.diabres.2020.108638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
Civil aviation pilots who develop insulin-treated diabetes and want to renew a Commercial Pilot License (CPL) represent a medical, social and regulatory problem. This depends on justified concerns about hypoglycemia, the most threatening event for people who carry out jobs requiring a high level of concentration and reliability. This negatively affects social and working aspects of pilots' lives, who have a high profile and a high-cost professional qualification. It could be possible now to revise this attitude thanks to the availability of Continuous Glucose Monitoring (CGM) devices. CGM clearly showed to prevent hypoglycemic events in insulin-treated diabetic patients by allowing strict monitoring and trend prediction of glucose levels. By systematizing available data on such devices and present regulations in CPL issuance worldwide, our review can be used as handy tool for a fruitful discussion among the scientific community, national and international civil aviation regulators, stakeholders and pilots, aimed at evaluating the evidence-based opportunity to revise CPL issuance criteria for insulin-treated diabetic pilots. For the above-mentioned reasons, there are, among the regulatory administrations of Civil Aviation around the globe, several different approaches and limitations set for the subjects with insulin-treated diabetes who want to obtain, or renew, a CPL.
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Affiliation(s)
- F Strollo
- AMD (Associazione Medici Diabetologi), ESAM (European Society of Aerospace Medicine) and IRCCS San Raffaele Pisana, Rome, Italy.
| | - A Furia
- ENAC (Italian National Civil Aviation Authority), Aeromedical Section, Rome, Italy
| | - P Verde
- AIMAS (Italian Association of AeroSpace Medicine) and IAF (Italian Air Force), Experimental Flight Center, Aerospace Medicine Department, Pratica di Mare, Rome, Italy
| | - A Bellia
- SID (Società Italiana di Diabetologia), Department of Systems Medicine, Rome University, "Tor Vergata", Italy
| | - M Grussu
- ANIAD (Italian National Association of Athletes with Diabetes), Oristano, Italy
| | - A Mambro
- AIMAS (Italian Association of AeroSpace Medicine), Anesthesiology and Resuscitation Unit, Alesini CTO Hospital, Rome, Italy
| | - M D Petrelli
- SID (Società Italiana di Diabetologia), Clinic of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - S Gentile
- Associazione Medici Diabetologi), Campania University "Luigi Vanvitelli", Naples, Italy, and Nefrocenter Research & Nyx Start-UP, Naples, Italy
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Dovc K, Battelino T. Time in range centered diabetes care. Clin Pediatr Endocrinol 2021; 30:1-10. [PMID: 33446946 PMCID: PMC7783127 DOI: 10.1297/cpe.30.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Optimal glycemic control remains challenging and elusive for many people with diabetes. With the comprehensive clinical evidence on safety and efficiency in large populations, and with broader reimbursement, the adoption of continuous glucose monitoring (CGM) is rapidly increasing. Standardized visual reporting and interpretation of CGM data and clear and understandable clinical targets will help professionals and individuals with diabetes use diabetes technology more efficiently, and finally improve long-term outcomes with less everyday disease burden. For the majority of people with type 1 or type 2 diabetes, time in range (between 70 and 180 mg/dL, or 3.9 and 10 mmol/L) target of more than 70% is recommended, with each incremental increase of 5% towards this target being clinically meaningful. At the same time, the goal is to minimize glycemic excursions: a recommended target for a time below range (< 70 mg/dL or < 3.9 mmol/L) is less than 4%, and time above range (> 180 mg/dL or 10 mmol/L) less than 25%, with less stringent goals for older individuals or those at increased risk. These targets should be individualized: the personal use of CGM with the standardized data presentation provides all necessary means to accurately tailor diabetes management to the needs of each individual with diabetes.
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Affiliation(s)
- Klemen Dovc
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Cowart K. A Review of the First Long-term Implantable Continuous Glucose Monitoring System Available in the United States. J Diabetes Sci Technol 2021; 15:160-166. [PMID: 31833388 PMCID: PMC7782996 DOI: 10.1177/1932296819890865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although real-time continuous glucose monitoring (rtCGM) has been shown to improve glycemic control in patients with type 1 diabetes mellitus and type 2 diabetes mellitus treated with insulin, rates of adoption have been low. A novel approach, with the use of a long-term implantable continuous glucose monitoring (LTI CGM) has the potential to overcome barriers to rtCGM. The purpose of this review is to provide a background on the first LTI CGM technology to be approved, along with a review of contraindications, interference, safety, accuracy, and efficacy. Considerations for patient selection are discussed based on the available evidence. METHODS PubMed, EMBASE, and Cochrane Library were searched for keywords and subject headings to identify studies assessing LTI CGM. RESULTS Seven studies were identified which assessed LTI CGM. Mean absolute relative difference is similar to available CGM devices. Rates of adverse events were low. Change in hemoglobin A1c with LTI CGM may be comparable to rtCGM. CONCLUSIONS Based on the available evidence, LTI CGM appears to be safe and accurate. Additional clinical trial investigation is warranted to evaluate the glycemic efficacy of LTI CGM.
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Affiliation(s)
- Kevin Cowart
- Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Kevin Cowart, PharmD, MPH, BCACP, CDE, Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd. MDC 30, Tampa, FL 33612, USA.
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Joseph JI. Review of the Long-Term Implantable Senseonics Continuous Glucose Monitoring System and Other Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2021; 15:167-173. [PMID: 32345047 PMCID: PMC7783000 DOI: 10.1177/1932296820911919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The article published by Kevin Cowart in this issue of the Journal of Diabetes Science and Technology (JDST) is a detailed overview of the clinical trial data and analysis used to demonstrate the safety and effectiveness of the Eversense continuous glucose monitoring (CGM) System for regulatory approval and clinical acceptance. The article describes the published study results for safety, accuracy, reliability, ease of insertion/removal, adverse events, and ease of diabetes patient-use for controlling their glucose levels short and long term. The author nicely compares Eversense CGM System safety and performance with the short-term subcutaneous tissue CGM systems being commercialized by Dexcom, Medtronic Diabetes, and Abbott Diabetes. This comparison may help the clinician define which type of patient with diabetes might benefit the most from the long-term implantable CGM system. The majority of studied patients describe a positive experience managing their diabetes with the Eversense CGM System and request implantation of a new sensor 90 or 180 days later.
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Affiliation(s)
- Jeffrey I. Joseph
- Jeffrey I. Joseph, DO, Department of Anesthesiology, Sidney Kimmel Medical College, Jefferson Artificial Pancreas Center, Thomas Jefferson University, 1020 Locust Street, JAH # 565, Philadelphia, PA 19072, USA.
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Functional nanostructured metal oxides and its hybrid electrodes – Recent advancements in electrochemical biosensing applications. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105522] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fokkert M, van Dijk PR, Edens MA, Díez Hernández A, Slingerland R, Gans R, Delgado Álvarez E, Bilo H. Performance of the Eversense versus the Free Style Libre Flash glucose monitor during exercise and normal daily activities in subjects with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:8/1/e001193. [PMID: 32784247 PMCID: PMC7418676 DOI: 10.1136/bmjdrc-2020-001193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Accurate blood glucose measurements are important in persons with diabetes during normal daily activities (NDA), even more so during exercise. We aimed to investigate the performance of fluorescence sensor-based and glucose oxidase-based interstitial glucose measurement during (intensive) exercise and NDA. RESEARCH DESIGN AND METHODS Prospective, observational study in 23 persons with type 1 diabetes when mountain biking for 6 days, followed by 6 days of NDA. Readings of the Eversense (fluorescence-based continuous glucose monitoring (CGM); subcutaneously implanted) and of the Free Style Libre (FSL; glucose oxidase-based flash glucose monitoring (FGM); transcutaneously placed) were compared with capillary glucose levels (Free Style Libre Precision NeoPro strip (FSLCstrip)). RESULTS Mean average differences (MAD) and mean average relative differences (MARD) were significantly different when comparing exercise with NDA (reference FSLCstrip); Eversense MAD 25±19 vs 17±6 mg/dL (p<0.001); MARD 17±6 vs 13%±6% (p<0.01) and FSL MAD 32±17 vs 18±8 mg/dL (p<0.01); MARD 20±7 vs 12%±5% (p<0.001).When analyzing the data according to the Integrated Continuous Glucose Monitoring Approvals (class II-510(K) guidelines), the overall performance of interstitial glucose readings within 20% of the FSLCstrip during exercise compared with NDA was 69% vs 81% for the Eversense and 59% vs 83% for the FSL, respectively. Within 15% of the FSLCstrip was 59% vs 70% for the Eversense and 46% vs 71% for the FSL. CONCLUSIONS During exercise, both fluorescence and glucose oxidase-based interstitial glucose measurements (using Eversense and FSL sensors) were less accurate compared with measurements during NDA. Even when acknowledging the beneficial effects of CGM or FGM, users should be aware of the risk of diminished accuracy of interstitial glucose readings during (intensive) exercise.
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Affiliation(s)
- Marion Fokkert
- Department of Clinical Chemistry, Isala, Zwolle, NA, The Netherlands
| | - Peter R van Dijk
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Diabetes Research Center, Isala, Zwolle, NA, The Netherlands
| | - Mireille A Edens
- Department Innovation and Science, Isala, Zwolle, NA, The Netherlands
| | | | | | - Rijk Gans
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elías Delgado Álvarez
- Sección de Diabetes, Universidad de Oviedo, Oviedo, Asturias, Spain
- Sección de Diabetes, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Henk Bilo
- Diabetes Research Center, Isala, Zwolle, NA, The Netherlands
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