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Psotta C, Cirovic S, Gudmundsson P, Falk M, Mandal T, Reichhart T, Leech D, Ludwig R, Kittel R, Schuhmann W, Shleev S. Continuous ex vivo glucose sensing in human physiological fluids using an enzymatic sensor in a vein replica. Bioelectrochemistry 2023; 152:108441. [PMID: 37087795 DOI: 10.1016/j.bioelechem.2023.108441] [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: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
Managing blood glucose can affect important clinical outcomes during the intraoperative phase of surgery. However, currently available instruments for glucose monitoring during surgery are few and not optimized for the specific application. Here we report an attempt to exploit an enzymatic sensor in a vein replica that could continuously monitor glucose level in an authentic human bloodstream. First, detailed investigations of the superficial venous systems of volunteers were carried out using ocular and palpating examinations, as well as advanced ultrasound measurements. Second, a tubular glucose-sensitive biosensor mimicking a venous system was designed and tested. Almost ideal linear dependence of current output on glucose concentration in phosphate buffer saline was obtained in the range 2.2-22.0 mM, whereas the dependence in human plasma was less linear. Finally, the developed biosensor was investigated in whole blood under homeostatic conditions. A specific correlation was found between the current output and glucose concentration at the initial stage of the biodevice operation. However, with time, blood coagulation during measurements negatively affected the performance of the biodevice. When the experimental results were remodeled to predict the response without the influence of blood coagulation, the sensor output closely followed the blood glucose level.
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Affiliation(s)
- Carolin Psotta
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden; Aptusens AB, 293 94 Kyrkhult, Sweden
| | - Stefan Cirovic
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden
| | - Petri Gudmundsson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden
| | - Magnus Falk
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden
| | - Tanushree Mandal
- School of Chemistry & Ryan Institute, University of Galway, University Road, Galway, Ireland
| | - Thomas Reichhart
- Department of Food Science and Technology, BOKU - University of Natural Resources and Life Sciences, 1190 Vienna, Austria; DirectSens Biosensors GmbH, 3400 Klosterneuburg, Austria
| | - Dónal Leech
- School of Chemistry & Ryan Institute, University of Galway, University Road, Galway, Ireland
| | - Roland Ludwig
- Department of Food Science and Technology, BOKU - University of Natural Resources and Life Sciences, 1190 Vienna, Austria; DirectSens Biosensors GmbH, 3400 Klosterneuburg, Austria
| | - Roman Kittel
- Department of Food Science and Technology, BOKU - University of Natural Resources and Life Sciences, 1190 Vienna, Austria
| | - Wolfgang Schuhmann
- Analytical Chemistry - Center for Electrochemical Sciences, Faculty of Chemistry and Biochemistry, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Sergey Shleev
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden; Aptusens AB, 293 94 Kyrkhult, Sweden.
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Carlsson CJ, Nørgaard K, Oxbøll AB, Søgaard MIV, Achiam MP, Jørgensen LN, Eiberg JP, Palm H, Sørensen HBD, Meyhof CS, Aasvang EK. Continuous Glucose Monitoring Reveals Perioperative Hypoglycemia in Most Patients With Diabetes Undergoing Major Surgery: A Prospective Cohort Study. Ann Surg 2023; 277:603-611. [PMID: 35129526 DOI: 10.1097/sla.0000000000005246] [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: 11/26/2022]
Abstract
OBJECTIVE To investigate the frequency and duration of hypo- and hyperglycemia, assessed by continuous glucose monitoring (CGM) during and after major surgery, in departments with implemented diabetes care protocols. SUMMARY BACKGROUND DATA Inadequate glycemic control in the perioperative period is associated with serious adverse events, but monitoring currently relies on point blood glucose measurements, which may underreport glucose excursions. METHODS Adult patients without (A) or with diabetes [non-insulin-treated type 2 (B), insulin-treated type 2 (C) or type 1 (D)] undergoing major surgery were monitored using CGM (Dexcom G6), with an electrochemical sensor in the interstitial fluid, during surgery and for up to 10 days postoperatively. Patients and health care staff were blinded to CGM values, and glucose management adhered to the standard diabetes care protocol. Thirty-day postoperative serious adverse events were recorded. The primary outcome was duration of hypoglycemia (glucose <70 mg/dL). Clinicaltrials.gov: NCT04473001. RESULTS Seventy patients were included, with a median observation time of 4.0 days. CGM was recorded in median 96% of the observation time. The median daily duration of hypoglycemia was 2.5 minutes without significant difference between the 4 groups (A-D). Hypoglycemic events lasting ≥15 minutes occurred in 43% of all patients and 70% of patients with type 1 diabetes. Patients with type 1 diabetes spent a median of 40% of the monitoring time in the normoglycemic range 70 to 180 mg/dL and 27% in the hyperglycemic range >250 mg/dL. Duration of preceding hypo- and hyperglycemia tended to be longer in patients with serious adverse events, compared with patients without events, but these were exploratory analyses. CONCLUSIONS Significant duration of both hypo- and hyperglycemia was detected in high proportions of patients, particularly in patients with diabetes, despite protocolized perioperative diabetes management.
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Affiliation(s)
- Christian J Carlsson
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Britt Oxbøll
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette I V Søgaard
- Department of Surgery & Transplantation, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthe-siology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars N Jørgensen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Vascular Surgery, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helge B D Sørensen
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Christian S Meyhof
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthe-siology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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3
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Fox LA, Balkman E, Englert K, Hossain J, Mauras N. Safety of using real-time sensor glucose values for treatment decisions in adolescents with poorly controlled type 1 diabetes mellitus: a pilot study. Pediatr Diabetes 2017; 18:271-276. [PMID: 27435145 PMCID: PMC5250611 DOI: 10.1111/pedi.12404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/15/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study explored the safety of using real-time sensor glucose (SG) data for treatment decisions in adolescents with poorly controlled type 1 diabetes. METHODS Ten adolescents with type 1 diabetes, HbA1c ≥9% on insulin pumps were admitted to the clinical research center and a continuous glucose sensor was inserted. Plasma glucose was measured at least hourly using Yellow Springs Instrument's (YSI) glucose analyzer. Starting at dinner, SG rather than YSI was used for treatment decisions unless YSI was <70 mg/dL (<3.9 mmol/L) or specific criteria indicating SG and YSI were very discordant were met. Participants were discharged after lunch the next day. RESULTS Ten participants (seven males; 15.2-17.8 year old) completed the study. The range of differences between high glucose correction doses using SG vs YSI for calculations was -2 (SG < YSI dose) to +1 (SG > YSI dose); this difference was two units in only 2 of 23 correction doses given (all SG < YSI dose). There were five episodes of mild hypoglycemia in two patients, two of which occurred after using SG for dose calculations. There was no severe hypoglycemia and no YSI glucose >350 mg/dL (19.4 mmol/L). Mean (±SE) pre- and postmeal YSI glucose were 163 ± 11 and 183 ± 12 mg/dL (9.1 ± 0.6 and 10.2 ± 0.7 mmol/L), respectively. CONCLUSION Use of real-time continuous glucose monitoring for treatment decisions was safe and did not result in significant over- or undertreatment. Use of SG for treatment decisions under supervised inpatient conditions is a suitable alternative to repeated fingerstick glucose monitoring. Outpatient studies using SG in real-time are needed.
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Affiliation(s)
- Larry A. Fox
- Nemours Children’s Health System, Jacksonville, FL
| | | | - Kim Englert
- Nemours Children’s Health System, Jacksonville, FL
| | - Jobayer Hossain
- Biostatistics Core, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Nelly Mauras
- Nemours Children’s Health System, Jacksonville, FL
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Chlup R, Krejci J, O'Connell M, Sebestova B, Plicka R, Jezova L, Brozova T, Doubravova B, Zalesakova H, Durajkova E, Vojtek J, Bartek J. Glucose concentrations in blood and tissue - a pilot study on variable time lag. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:527-34. [PMID: 25732978 DOI: 10.5507/bp.2015.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/28/2015] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of this pilot study was to acquire insight into the parameters of glycaemic control, especially, (1) the time delay (lag phase) between plasma and tissue glucose concentrations in relation to rise and fall in glucose levels and (2) the rate of glucose increase and decrease. METHODS Four healthy people (HP), 4 people with type 1diabetes (DM1) and 4 with type 2 diabetes (DM2) underwent concurrent glucose measurements by means of (1) the continuous glucose monitoring system (CGMS-Medtronic), Medtronic-Minimed, CA, USA, calibrated by the glucometer Calla, Wellion, Austria, and, (2) the Beckman II analyser to measure glucose concentrations in venous plasma. Samples were taken on 4 consecutive days in the fasting state and 4 times after consumption of 50 g glucose. Carelink Personal, MS Excel, Maple and Mat lab were applied to plot the evolution of glucose concentration and analyse the results. The time difference between increase and decrease was calculated for HP, DM 1 and DM 2. RESULTS In DM1and DM2, glucose tolerance testing (GTT) resulted in slower transport of glucose into subcutaneous tissue than in HP where the lag phase lasted up to 12 min. The maximum increase/decrease rates in DM1 and DM2 vs HP were 0.25 vs < 0.1 mmol/L/min. CONCLUSION CGMS is shown to provide reliable plasma glucose concentrations provided the system is calibrated during a steady state. The analysis of glucose change rates improves understanding of metabolic processes better than standard GTT.
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Affiliation(s)
- Rudolf Chlup
- Department of Physiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Internal Medicine II - Gastroenterology and Hepatology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc.,Institute of Neurology and Geriatrics, Moravsky Beroun
| | - Jan Krejci
- BVT Technologies, a.s., Strazek, Czech Republic
| | | | | | | | | | - Tereza Brozova
- BVT Technologies, a.s., Strazek, Czech Republic.,Heat Transfer and Fluid Flow Laboratory, Faculty of Mechanical Engineering, University of Technology, Brno
| | - Blanka Doubravova
- Institute of Neurology and Geriatrics, Moravsky Beroun.,BVT Technologies, a.s., Strazek, Czech Republic
| | - Hana Zalesakova
- Institute of Neurology and Geriatrics, Moravsky Beroun.,BVT Technologies, a.s., Strazek, Czech Republic
| | - Emilia Durajkova
- Institute of Neurology and Geriatrics, Moravsky Beroun.,BVT Technologies, a.s., Strazek, Czech Republic
| | - Jiri Vojtek
- BVT Technologies, a.s., Strazek, Czech Republic
| | - Josef Bartek
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University Olomouc
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Soliman A, DeSanctis V, Yassin M, Elalaily R, Eldarsy NE. Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups. Indian J Endocrinol Metab 2014; 18:274-282. [PMID: 24944918 PMCID: PMC4056122 DOI: 10.4103/2230-8210.131130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Continuous glucose monitoring (CGM) systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM) and CGM combines the benefits of both. Significant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes) especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin (HbA1C) in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO), gestational diabetes, cystic fibrosis, thalassemia major, acute coronary syndrome (ACS), and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min) glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatric, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Vincenzo DeSanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, 44121 Ferrara, Italy
| | - Mohamed Yassin
- Department of Hematology and Oncology, Alamal Hospital, Hamad Medical Center, Doha, Qatar
| | | | - Nagwa E Eldarsy
- Department of Pediatric, Alexandria University Children's Hospital, Alexandria, Egypt
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