The Progress of Glucose Monitoring-A Review of Invasive to Minimally and Non-Invasive Techniques, Devices and Sensors

Green synthesis of starch-capped Cu2O nanocubes and their application in the direct electrochemical detection of glucose

Glucose determination is an essential procedure in different fields, used in clinical analysis for the prevention and monitoring of diabetes. In this work, modified carbon paste electrodes with Cu₂O nanocubes (Cu₂O NCs) were developed to test electrochemical glucose detection. The synthesis of the Cu₂O NCs was achieved by a green method using starch as the capping agent, obtaining cubic-like morphologies and particle sizes from 227 to 123 nm with increasing amounts of the capping agent, as corroborated by electron microscopy analysis. Their crystalline structure and purity were determined by X-ray diffraction. The capability of starch as a capping agent was verified by Fourier-transform infrared spectroscopy, in which the presence of functional groups of this biopolymer in the Cu₂O NCs were identified. The electrochemical response to glucose oxidation was determined by cyclic voltammetry, obtaining a linear response of the electrical current as a function of glucose concentration in the range 100–700 μM, with sensitivities from 85.6 to 238.8 μA mM⁻¹ cm⁻², depending on the amount of starch used in the synthesis of the Cu₂O NCs.

Starch-capped Cu₂O nanocubes were used as an active electrochemical element to directly detect glucose.

Self-Powered Point-of-Care Device for Galvanic Cell-Based Sample Concentration Measurement

A novel self-powered point-of-care low-power electronics approach for galvanic cell-based sample concentration measurement is presented. The electronic system harvests and senses at the same time from the single cell. The system implements a solution that is suitable in those scenarios where extreme low power is generated from the fuel cell. The proposed approach implements a capacitive-based method to perform a non-linear sweep voltammetry to the cell, but without the need to implement a potentiostat amplifier for that purpose. It provides a digital-user readable result without the need for external non-self-powered devices or instruments compared with other solutions. The system conception was validated for a particular case. The scenario consisted of the measurement of a NaCl solution as the electrolyte, which was related to the conductivity of the sample. The electronic reader continuously measured the current with a transfer function gain of 1.012VmA⁻¹. The overall system exhibited a maximum coefficient of variation of 6.1%, which was an improvement compared with the state-of-the-art. The proof of concept of this electronics system was validated with a maximum power consumption of 5.8μW using commercial-off-the-self parts.

The contribution of the English NHS Diabetic Eye Screening Programme to reductions in diabetes-related blindness, comparisons within Europe, and future challenges

The aim of the English NHS Diabetic Eye Screening Programme (DESP) is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process, with a long-term aim of preventing blindness in people with diabetes.For the year 2009-2010, diabetic retinopathy (DR) was no longer the leading cause of blindness in the working age group. There have been further reductions in DR certifications for WHO severe vision impairment and blindness from 1,334 (5.5% of all certifications) in 2009/2010 to 840 (3.5% of all certifications) in 2018/2019. NHS DESP is a major contributor to this further reduction, but one must also take into account improvements in glycaemic and blood pressure control, timely laser treatment and vitrectomy surgery, improved monitoring techniques for glycaemic control, and vascular endothelial growth factor inhibitor injections for control of diabetic macular oedema. The latter have had a particular impact since first introduced in the UK in 2013.Current plans for NHS DESP include extension of screening intervals in low-risk groups and the introduction of optical coherence tomography as a second line of screening for those with screen positive maculopathy with two dimensional markers. Future challenges include the introduction of automated analysis for grading and new camera technologies.

Basic technology and proper usage of home health monitoring devices

Home health monitoring devices are consumer-grade devices that help to monitor the health of individuals at home. These devices are usually low-cost and easily procurable, and they can be operated by patients or their caretakers with minimal training. However, improper usage of these devices may provide erroneous results, which can lead to an unnecessary hospital visit or teleconsultation. In this article, we discuss the basic technology and proper usage of some of these devices, namely automatic blood pressure monitors, blood glucose monitors, body fat monitors, pulse oximeters, electrocardiographs, digital thermometers, and infrared thermometers. This brief document intends to help primary health care professionals and their patients use these devices.

CLEAR - Contact lens technologies of the future

Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.

Selectivity and Sensitivity of Near-Infrared Spectroscopic Sensing of β-Hydroxybutyrate, Glucose, and Urea in Ternary Aqueous Solutions

The next-generation artificial pancreas is under development with the goal to enhance tight glycemic control for people with type 1 diabetes. Such technology requires the integration of a chemical sensing unit combined with an insulin infusion device controlled by an algorithm capable of autonomous operation. The potential of near-infrared spectroscopic sensing to serve as the chemical sensing unit is explored by demonstrating the ability to quantify multiple metabolic biomarkers from a single near-infrared spectrum. Independent measurements of β-hydroxy-butyrate, glucose, and urea are presented based on analysis of near-infrared spectra collected over the combination spectral range of 5000-4000 cm^-1 for a set of 50 ternary aqueous standard solutions. Spectra are characterized by a 1 μAU root-mean-square (RMS) noise for 100% lines with a resolution of 4 cm^-1 and an optical path length of 1 mm. Calibration models created by the net analyte signal (NAS) and the partial least squares (PLS) methods provide selective measurements for each analyte with standard errors of prediction in the upper micromolar concentration range. The NAS method is used to determine both the selectivity and sensitivity for each analyte and their values are consistent with these standard errors of prediction. The NAS method is also used to characterize the background spectral variance associated with instrumental and environmental variations associated with buffer spectra collected over a multiday period.

Reactant/polymer hybrid films on p-n junction photodetectors for self-powered, non-invasive glucose biosensors

The portability of electronic-based biosensors is limited because of the use of batteries and/or solutions containing reactants such as enzymes for assay, which limits the utility of such biosensors in point-of-care (POC) testing. In this study, we report on the development of a self-powered biosensor composed of only portable components: a reactant-containing poly (ethylene glycol) (PEG) film for the colorimetric assay, and a self-powered n-InGaZnO/p-Si photodetector. The PEG film containing enzymes and color-developing agents was formed on a glass slide by spin coating. The self-powered biosensor was fabricated by placing the hybrid film on the p-n junction photodetector, and applied in non-invasive glucose detection (salivary glucose). Injection of the target-containing solution dissolved the PEG that led to the release of enzymes and color-developing agents, resulting in a colorimetric assay. The colorimetric assay could attenuate the light reaching the photodetector, thus facilitating target concentration verification by measuring the photocurrent. Our self-powered biosensor has two main advantages: (i) all components of the biosensor are portable and (ii) dilution of target concentration is avoided as the reagents are in the PEG film. Therefore, the self-powered biosensor, without solution-phase components, could be highly beneficial for creating portable, sensitive biosensors for POC testing.

Forecasting of Glucose Levels and Hypoglycemic Events: Head-to-Head Comparison of Linear and Nonlinear Data-Driven Algorithms Based on Continuous Glucose Monitoring Data Only

In type 1 diabetes management, the availability of algorithms capable of accurately forecasting future blood glucose (BG) concentrations and hypoglycemic episodes could enable proactive therapeutic actions, e.g., the consumption of carbohydrates to mitigate, or even avoid, an impending critical event. The only input of this kind of algorithm is often continuous glucose monitoring (CGM) sensor data, because other signals (such as injected insulin, ingested carbs, and physical activity) are frequently unavailable. Several predictive algorithms fed by CGM data only have been proposed in the literature, but they were assessed using datasets originated by different experimental protocols, making a comparison of their relative merits difficult. The aim of the present work was to perform a head-to-head comparison of thirty different linear and nonlinear predictive algorithms using the same dataset, given by 124 CGM traces collected over 10 days with the newest Dexcom G6 sensor available on the market and considering a 30-min prediction horizon. We considered the state-of-the art methods, investigating, in particular, linear black-box methods (autoregressive; autoregressive moving-average; and autoregressive integrated moving-average, ARIMA) and nonlinear machine-learning methods (support vector regression, SVR; regression random forest; feed-forward neural network, fNN; and long short-term memory neural network). For each method, the prediction accuracy and hypoglycemia detection capabilities were assessed using either population or individualized model parameters. As far as prediction accuracy is concerned, the results show that the best linear algorithm (individualized ARIMA) provides accuracy comparable to that of the best nonlinear algorithm (individualized fNN), with root mean square errors of 22.15 and 21.52 mg/dL, respectively. As far as hypoglycemia detection is concerned, the best linear algorithm (individualized ARIMA) provided precision = 64%, recall = 82%, and one false alarm/day, comparable to the best nonlinear technique (population SVR): precision = 63%, recall = 69%, and 0.5 false alarms/day. In general, the head-to-head comparison of the thirty algorithms fed by CGM data only made using a wide dataset shows that individualized linear models are more effective than population ones, while no significant advantages seem to emerge when employing nonlinear methodologies.

Noninvasive Monitoring of Glucose Using Near-Infrared Reflection Spectroscopy of Skin-Constraints and Effective Novel Strategy in Multivariate Calibration

For many years, successful noninvasive blood glucose monitoring assays have been announced, among which near-infrared (NIR) spectroscopy of skin is a promising analytical method. Owing to the tiny absorption bands of the glucose buried among a dominating variable spectral background, multivariate calibration is required to achieve applicability for blood glucose self-monitoring. The most useful spectral range with important analyte fingerprint signatures is the NIR spectral interval containing combination and overtone vibration band regions. A strategy called science-based calibration (SBC) has been developed that relies on a priori information of the glucose signal ("response spectrum") and the spectral noise, i.e., estimates of the variance of a sample population with negligible glucose dynamics. For the SBC method using transcutaneous reflection skin spectra, the response spectrum requires scaling due to the wavelength-dependent photon penetration depth, as obtained by Monte Carlo simulations of photon migration based on estimates of optical tissue constants. Results for tissue glucose concentrations are presented using lip NIR-spectra of a type-1 diabetic subject recorded under modified oral glucose tolerance test (OGTT) conditions. The results from the SBC method are extremely promising, as statistical calibrations show limitations under the conditions of ill-posed equation systems as experienced for tissue measurements. The temporal profile differences between the glucose concentration in blood and skin tissue were discussed in detail but needed to be further evaluated.

Plasmonic nanoparticles for colorimetric detection of nitrite and nitrate

Irregular and unknowingly use of chemical compounds is a serious threat to the environment, human health, and other living organisms attributable and intensified by the growing population and increasing demand for food. Nitrite and nitrate are among those compounds that are widely used in agricultural and industrial products. Therefore on-site, rapid, simple, and accurate monitoring of nitrite/nitrate is highly desirable. In this review, while emphasizing the importance of nitrite and nitrate in food chain safety and health of living organisms, their measurement methods, in particular, nanoplasmonic colorimetric sensors are comprehensively discussed based on the researches in this field. Nanoplasmonic-based sensors have proved to be successful in comparison with traditional methods due to their low cost, biocompatibility, high sensitivity and selectivity, and most importantly, the ability to visually detect and be used on-site to measure nitrite and nitrate. The design principle of nanoplasmonic sensors will be presented into two categories of aggregation- and etching-based detection followed by their applications in nitrite detection. The nitrate measurement will be discussed based on either direct detection of nitrate or indirect strategy in which nitrate is reduced to nitrite by enzymes or metals. Finally, the remaining challenges and prospects in this topic will be described and outlined.

3D Printed Contact Lenses

Although the manufacturing processes of contact lenses are well established, the use of additive manufacturing for their fabrication opens many new possibilities to explore. The current study demonstrates the fabrication of personalized smart contract lenses utilizing additive manufacturing. The study includes 3-dimensional (3D) modeling of contact lenses with the assistance of a computer aided designing tool based on standard commercial contact lens dimension, followed by the selection of the suitable materials and 3D printing of contact lenses. The 3D printing parameters were optimized to achieve the desired lens geometries, and a post processing treatment was performed to achieve a smooth surface finish. The study also presents functionalized contact lenses with built-in sensing abilities by utilizing microchannels at the contact lens edges. Tinted contact lenses were printed and nanopatterns were textured onto the contact lens surfaces through holographic laser ablation. 3D printed contact lenses have advantages over conventional contact lenses, offering customized ophthalmic devices and the capability to integrate with optical sensors for diagnostics.

Application of Broadband Microwave Near-Field Sensors for Glucose Monitoring in Biological Media

The paper presents results of numerical simulation and experimental testing of a microwave sensor for non-invasive glucose monitoring. The sensor represents a conical horn with a conical conductor inside expanding toward the horn aperture. Such a sensor has a significantly wider passband in comparison with sensors of other designs. It is essential that the sensor geometry provides formation of an extended near-field zone with high electric field strength near the sensor aperture. A clear relationship between the dielectric permittivity of the phantom biological tissue and the frequency dependence of the parameter S11 of the sensor is observed at frequencies in the range from 1.4 to 1.7 GHz. This circumstance can be used to develop a procedure for measuring the glucose level in blood that correlates with the parameter S11 of the sensor. From the viewpoint of monitoring of the glucose content in blood, the most convenient body sensor location is on the hands or feet, in particular, wrists.

Intelligent automated drug administration and therapy: future of healthcare

In the twenty-first century, the collaboration of control engineering and the healthcare sector has matured to some extent; however, the future will have promising opportunities, vast applications, and some challenges. Due to advancements in processing speed, the closed-loop administration of drugs has gained popularity for critically ill patients in intensive care units and routine life such as personalized drug delivery or implantable therapeutic devices. For developing a closed-loop drug delivery system, the control system works with a group of technologies like sensors, micromachining, wireless technologies, and pharmaceuticals. Recently, the integration of artificial intelligence techniques such as fuzzy logic, neural network, and reinforcement learning with the closed-loop drug delivery systems has brought their applications closer to fully intelligent automatic healthcare systems. This review's main objectives are to discuss the current developments, possibilities, and future visions in closed-loop drug delivery systems, for providing treatment to patients suffering from chronic diseases. It summarizes the present insight of closed-loop drug delivery/therapy for diabetes, gastrointestinal tract disease, cancer, anesthesia administration, cardiac ailments, and neurological disorders, from a perspective to show the research in the area of control theory.

Blood Glucose Level Regression for Smartphone PPG Signals Using Machine Learning

Diabetes is a chronic illness that affects millions of people worldwide and requires regular monitoring of a patient’s blood glucose level. Currently, blood glucose is monitored by a minimally invasive process where a small droplet of blood is extracted and passed to a glucometer—however, this process is uncomfortable for the patient. In this paper, a smartphone video-based noninvasive technique is proposed for the quantitative estimation of glucose levels in the blood. The videos are collected steadily from the tip of the subject’s finger using smartphone cameras and subsequently converted into a Photoplethysmography (PPG) signal. A Gaussian filter is applied on top of the Asymmetric Least Square (ALS) method to remove high-frequency noise, optical noise, and motion interference from the raw PPG signal. These preprocessed signals are then used for extracting signal features such as systolic and diastolic peaks, the time differences between consecutive peaks (DelT), first derivative, and second derivative peaks. Finally, the features are fed into Principal Component Regression (PCR), Partial Least Square Regression (PLS), Support Vector Regression (SVR) and Random Forest Regression (RFR) models for the prediction of glucose level. Out of the four statistical learning techniques used, the PLS model, when applied to an unbiased dataset, has the lowest standard error of prediction (SEP) at 17.02 mg/dL.

Comparison of Fingertip vs Palm Site Sampling on Pain Perception, and Variation in Capillary Blood Glucose Level among Patients with Diabetes Mellitus

Introduction: Glycaemic status of the patient is often monitored using capillary blood glucose test which is fairly accurate. Traditional finger stick sampling is done to obtain sample, which can be painful and may be a barrier for repeated testing. The current study was conducted to compare fingertip and palm site sampling on pain perception, and variation in capillary blood glucose level. Methods: This study was conducted among 284 diabetic patients, who were selected by convenience sampling method. The data was collected by measuring capillary blood glucose levels from fingertip and palm site of the left hand at an interval of 10 minutes using a standard glucometer. The level of pain perceptions was measured with a numerical rating pain scale. Data analysis was accomplished using descriptive analysis, Mann-Whitney U test and Kruskal- Wallis test. Results: The level of pain perception at the palm site (2) was lesser than fingertip (3) which was significant at P < 0.001. 223 (78.52%) of the participants experienced more pain at fingertip than palm site, the difference in the measured capillary blood glucose level between fingertip [mean (SD): 226.65 (87.86)] and palm site [mean (SD): 225.65(92.13)] was minimum. The agreement of palm site was 90.7% in single measurement and 95.1% in average measurement. Conclusion: The present study concludes that, majority of the participants experienced less pain perception at the palm site sampling (alternate site sampling) than fingertip sampling with very minimal variation in the blood glucose level.

Probing blood plasma samples for the detection of diabetes using SERS aided by PCA and LDA multivariate data analyses

Fabrication of a SERS-active substrate using Langmuir–Blodgett and self-assembly techniques for the detection of diabetes from blood plasma samples.

Hypersensitized Metamaterials Based on a Corona-Shaped Resonator for Efficient Detection of Glucose

In this work, a new design for a real-time noninvasive metamaterial sensor, based on a corona-shaped resonator, is proposed. The sensor was designed numerically and fabricated experimentally in order to be utilized for efficient detection of glucose in aqueous solutions such as water and blood. The sensor was inspired by a corona in-plane-shaped design with the presumption that its circular structure might produce a broader interaction of the electromagnetic waves with the glucose samples. A clear shift in the resonance frequency was observed for various glucose samples, which implies that the proposed sensor has a good sensitivity and can be easily utilized to distinguish any glucose concentration, even though their dielectric coefficients are close. Results showed a superior performance in terms of resonance frequency shift (1.51 GHz) and quality factor (246) compared to those reported in the literature. The transmission variation level ∆|S21| was investigated for glucose concentration in both water and blood. The sensing mechanism was elaborated through the surface current, electric field and magnetic field distributions on the corona resonator. The proposed metamaterials sensor is considered to be a promising candidate for biosensor and medicine applications in human glycaemia monitoring.

Non-Invasive Blood Glucose Monitoring Technology: A Review

In recent years, with the rise of global diabetes, a growing number of subjects are suffering from pain and infections caused by the invasive nature of mainstream commercial glucose meters. Non-invasive blood glucose monitoring technology has become an international research topic and a new method which could bring relief to a vast number of patients. This paper reviews the research progress and major challenges of non-invasive blood glucose detection technology in recent years, and divides it into three categories: optics, microwave and electrochemistry, based on the detection principle. The technology covers medical, materials, optics, electromagnetic wave, chemistry, biology, computational science and other related fields. The advantages and limitations of non-invasive and invasive technologies as well as electrochemistry and optics in non-invasives are compared horizontally in this paper. In addition, the current research achievements and limitations of non-invasive electrochemical glucose sensing systems in continuous monitoring, point-of-care and clinical settings are highlighted, so as to discuss the development tendency in future research. With the rapid development of wearable technology and transdermal biosensors, non-invasive blood glucose monitoring will become more efficient, affordable, robust, and more competitive on the market.

Theoretical Simulation of the Near-Field Probe for Non-Invasive Measurements on Planar Layers with Biological Characteristics

The article presents the design of the near-field probe, which is a combined emitter (a combination of a symmetric dipole and an annular frame). The design of the probe allows forming a prolonged zone of the near-field. This effect can be used for in-depth penetration of the field in media with high absorption, without loss of information. Particular attention in this article is given to a detailed study of the interaction of the field created by this probe on plane-layered biological media. A theoretical analysis of the interaction of the electromagnetic field was carried out in a wide frequency band with a model plane-layer biological medium containing blood vessels of shallow depth using the proposed probe design. Conclusions are drawn about the depth of penetration of a useful signal into different media-analogs of biological tissue. This study is necessary to consider the possibility of using this probe for non-invasive measurements of blood glucose concentration. The studies were carried out using numerical simulation in the CST (Computer Simulation Technology) Microwave Studio environment. All biological tissues were simulated over a wide frequency range from 10 MHz to 10 GHz.

Improved Time in Range Over 1 Year Is Associated With Reduced Albuminuria in Individuals With Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes

OBJECTIVE

To investigate the association between treatment-induced change in continuous glucose monitoring (CGM) time in range (TIR) and albuminuria in persons with type 1 diabetes (T1D) treated with sensor-augmented insulin pumps (SAP).

RESEARCH DESIGN AND METHODS

Twenty-six out of 55 participants with albuminuria and multiple daily injection therapy (25% females; median 51 [interquartile range 46-63] years of age; glycated hemoglobin A_1c (HbA_1c) 75 [68-88] mmol/mol [9.0% (8.4-10.4%)]; and urinary albumin-to-creatinine ratio (UACR) 89 [37-250] mg/g) were in a randomized controlled trial assigned to SAP therapy for 1 year. Anthropometrics, CGM data, and blood and urine samples were collected every 3 months.

RESULTS

Mean change (95% CI) in percentage of TIR (%TIR) was 13.2% (6.2; 20.2), in HbA_1c was -14.4 (-17.4; -10.5) mmol/mol (-1.3% [-1.6; -1.0]), and in UACR was -15% (-38; 17) (all P < 0.05). UACR decreased by 19% (10; 28) per 10% increase in %TIR (P = 0.04), 18% (1; 30) per 10 mmol/mol decrease in HbA_1c (P = 0.07), and 31% per 10-mmHg decrease in mean arterial pressure (P < 0.001).

CONCLUSIONS

In this longitudinal study, treatment-induced increase in %TIR was significantly associated with decrease in albuminuria in T1D.

Microneedle-based bioassays

Disease diagnosis and therapeutic efficacy can be monitored via a number of established bioassays that sample body fluids to assess and monitor health conditions. Traditional bioassays generally include several steps and start with invasive body fluid extraction procedures. These steps are painful and often require specialized techniques and tailored equipment, as well as the supervision of professional medical personnel. Innovations in engineering alternative bioassays to address these shortcomings are thus desired. Microneedles (MNs) represent promising tools to sample body fluids, in view of their minimal invasiveness, painlessness, and uncomplicated implementation. Recent progress in microfabrication and materials engineering, including the development of hollow and solid MNs with uniquely optimized architectures and multi-functional materials, has positioned MN-based platforms as prime candidates for bioassay solutions. In this minireview, we summarize the studies of MN-based platforms for detection and diagnosis. We categorize the platforms based on three different mechanisms: MNs as body fluid reservoirs, MNs integrated with electrochemical assays, and MNs engineered with colorimetric analyses. A discussion of design principles for MN-based bioassay platforms is presented. We also discuss the challenges and opportunities associated with MN-based bioassays in future clinical applications.

Minimally Invasive Electrochemical Patch-Based Sensor System for Monitoring Glucose and Lactate in the Human Body-A Survey-Based Analysis of the End-User's Perspective

Background: Wearable electrochemical sensors that detect human biomarkers allow a comprehensive analysis of a person’s health condition. The “electronic smart patch system for wireless monitoring of molecular biomarkers for health care and well-being” (ELSAH) project aims to develop a minimally invasive sensor system that is capable of continuously monitoring glucose and lactate in the dermal interstitial fluid in real time. It is the objective of the present study to compare the intended ELSAH-patch specifications with the expectations and requirements of potential end-users at an early stage during the development phase. Methods: A questionnaire addressing different aspects of the ELSAH-patch was filled out by 383 respondents. Results: The participants stated a high general demand for such a system, and they would use the ELSAH-patch in different health care and physical fitness applications. The preferred terminal device for communication with the sensor would be the smartphone. An operating time of 24 hours would be sufficient for 55.8% of the users (95%-CI: 50.3–61.3%), while 43.5% of them (95%-CI: 38.0–48.9%) would prefer a lifetime of several days or more. The software should have a warning function, especially for critical health conditions. Since the measured personal data would be highly sensitive, the participants called for high standards for data security and privacy. Conclusion: In general, the participants’ responses on their expectations and requirements were well in line with the intended specifications of the ELSAH-patch system. However, certain technical aspects such as the lifetime, data security and accuracy require special attention during its development.

A New Approach to Determining Liquid Concentration Using Multiband Annular Ring Microwave Sensor and Polarity Correlator

This article presents a new approach to determining liquid concentration using a new microwave sensor and polarity correlator. The sensor design incorporates an annular ring resonator having inside three parallel lines, a trapezoid ground plane and a co-planar waveguide (CPW) tapered feeder, which altogether achieve multiple frequency bands. Multiple bands of interest are obtained at the lower end of the microwave spectrum, i.e., from 1–6 GHz, as this region is widely accepted in analyzing various liquid samples. The sensor size is 71 × 40 × 1.6 mm3 with material selection based on an economically available FR4 substrate. The sensor is realized and experimentally validated for its sensitivity by utilizing in-lab prepared aqueous solution samples. Further, liquid concentration is determined by adopting a polarity correlator, which is applied to the sensor’s responses obtained at different values.

Biosensors Based on Mechanical and Electrical Detection Techniques

Biosensors are powerful analytical tools for biology and biomedicine, with applications ranging from drug discovery to medical diagnostics, food safety, and agricultural and environmental monitoring. Typically, biological recognition receptors, such as enzymes, antibodies, and nucleic acids, are immobilized on a surface, and used to interact with one or more specific analytes to produce a physical or chemical change, which can be captured and converted to an optical or electrical signal by a transducer. However, many existing biosensing methods rely on chemical, electrochemical and optical methods of identification and detection of specific targets, and are often: complex, expensive, time consuming, suffer from a lack of portability, or may require centralised testing by qualified personnel. Given the general dependence of most optical and electrochemical techniques on labelling molecules, this review will instead focus on mechanical and electrical detection techniques that can provide information on a broad range of species without the requirement of labelling. These techniques are often able to provide data in real time, with good temporal sensitivity. This review will cover the advances in the development of mechanical and electrical biosensors, highlighting the challenges and opportunities therein.

Recent Advances of Conducting Polymers and Their Composites for Electrochemical Biosensing Applications

Conducting polymers (CPs) have been at the center of research owing to their metal-like electrochemical properties and polymer-like dispersion nature. CPs and their composites serve as ideal functional materials for diversified biomedical applications like drug delivery, tissue engineering, and diagnostics. There have also been numerous biosensing platforms based on polyaniline (PANI), polypyrrole (PPY), polythiophene (PTP), and their composites. Based on their unique properties and extensive use in biosensing matrices, updated information on novel CPs and their role is appealing. This review focuses on the properties and performance of biosensing matrices based on CPs reported in the last three years. The salient features of CPs like PANI, PPY, PTP, and their composites with nanoparticles, carbon materials, etc. are outlined along with respective examples. A description of mediator conjugated biosensor designs and enzymeless CPs based glucose sensing has also been included. The future research trends with required improvements to improve the analytical performance of CP-biosensing devices have also been addressed.

Low-cost portable microwave sensor for non-invasive monitoring of blood glucose level: novel design utilizing a four-cell CSRR hexagonal configuration

This article presents a novel design of portable planar microwave sensor for fast, accurate, and non-invasive monitoring of the blood glucose level as an effective technique for diabetes control and prevention. The proposed sensor design incorporates four cells of hexagonal-shaped complementary split ring resonators (CSRRs), arranged in a honey-cell configuration, and fabricated on a thin sheet of an FR4 dielectric substrate.The CSRR sensing elements are coupled via a planar microstrip-line to a radar board operating in the ISM band 2.4-2.5 GHz. The integrated sensor shows an impressive detection capability and a remarkable sensitivity of blood glucose levels (BGLs). The superior detection capability is attributed to the enhanced design of the CSRR sensing elements that expose the glucose samples to an intense interaction with the electromagnetic fields highly concentrated around the sensing region at the induced resonances. This feature enables the developed sensor to detect extremely delicate variations in the electromagnetic properties that characterize the varying-level glucose samples. The desired performance of the fabricated sensor is practically validated through in-vitro measurements using a convenient setup of Vector Network Analyzer (VNA) that records notable traces of frequency-shift responses when the sensor is loaded with samples of 70-120 mg/dL glucose concentrations. This is also demonstrated in the radar-driven prototype where the raw data collected at the radar receiving channel shows obvious patterns that reflect glucose-level variations. Furthermore, the differences in the sensor responses for tested glucose samples are quantified by applying the Principal Component Analysis (PCA) machine learning algorithm. The proposed sensor, beside its impressive detection capability of the diabetes-spectrum glucose levels, has several other favorable attributes including compact size, simple fabrication, affordable cost, non-ionizing nature, and minimum health risk or impact. Such attractive features promote the proposed sensor as a possible candidate for non-invasive glucose levels monitoring for diabetes as evidenced by the preliminary results from a proof-of-concept in-vivo experiment of tracking an individual's BGL by placing his fingertip onto the sensor. The presented system is a developmental platform towards radar-driven wearable continuous BGL monitors.

Development of a fluorometric measurement system used in biological samples upon the determination of iron (II) metal ion

2-thioxanthone thioacetic acid (TXSCH₂COOH, T), which has a fluorometric character, was used for new fluorometric system upon Fe(II) analysis in biological samples as the main target. T-BSA binary complex was firstly consisted with non-covalent interactions between T and BSA at the equilibrium concentration as 1.77 × 10^-4.M. T-BSA binary complex emission was increased at the ratio of 24.40% due to stabilization property of BSA (pH:7), compared with T emission intensity. Fluorescence emission spectroscopy was used for the all measurements because of an economic, a sensitive and a practical method compared with other spectroscopic analysis. T-BSA-Fe(II) triple complex was also obtained by adding Fe(II) ion to T-BSA binary complex solution. Its characterization was performed to be investigated with optimum excitation wavelength, buffer concentration, pH and temperature as 297 nm, 10^-3 M Tris HCl (10^-2M NaCI), pH:7.2 at 25 °C, respectively. The results of Fe(II) analysis in serum showed a certain response in fluorometric T-BSA-Fe(II) triple complex measurement system as 50.42 ± 5.8 µg/dL. The analyses of our fluorometric triple complex system were compared with the reference electrochemiluminescence method and similar results were obtained. Fluorometric measurements of T-BSA-Fe(II) triple complex, its characterization and Fe(II) analysis in this system have not been investigated in literature gives originality to our study.

Feasibility of precise and reliable glucose quantification in human whole blood samples by 1 tesla benchtop NMR

The standard procedure for blood glucose measurements is enzymatic testing. This method is cheap, but requires small samples of open blood with direct contact to the test medium. In principle, NMR provides non-contact analysis of body fluids, but high-field spectrometers are expensive and cannot be easily utilized under clinical conditions. Low-field NMR systems with permanent magnets are becoming increasingly smaller and more affordable. The studies presented here aim at exploring the capabilities of low-field NMR for measuring glucose concentrations in whole blood. For this purpose, a modern 1 T benchtop NMR spectrometer was used. Challenges arise from broad spectral lines, the glucose peak locations close to the water signal, low SNR and the interference with signals from other blood components. Whole blood as a sample comprises even more boundary conditions: crucial for reliable results are avoiding the separation of plasma and cells by gravitation and reliable reference values. First, the accuracy of glucose levels measured by NMR was tested using aqueous glucose solutions and commercially available bovine plasma. Then, 117 blood samples from oral glucose tolerance testing were measured with minimal preparation by simple pulse-acquire NMR experiments. The analysis itself is the key to achieve high precision, so several approaches were investigated: peak integration, orthogonal projection to latent structure analysis and support vector machine regression. Correlations between results from the NMR spectra and the routine laboratory automated analyzer revealed an RMSE of 7.90 mg/dL for the best model. 91.5% of the model output lies within the limits of the German Medical Association guidelines, which require the glucose measurement to be within 11% of the reference method. It is concluded that spectral quantification of glucose in whole blood samples by high-quality NMR spectrometers operating at 1 T is feasible with sufficient accuracy.

Therapeutic Advancements in the Management of Diabetes Mellitus with Special Reference to Nanotechnology

For improvisation of diabetic's quality of life, nanotechnology is facilitating the development of advanced glucose sensors as well as efficient insulin delivery systems. Our prime focus of the review is to highlight the advancement in diabetic research with special reference to nanotechnology at its interface. Recent studies are more focused on enhancing sensitivity, accuracy, and response by employing metal as well as nanoparticles based glucose sensors. Moreover, the review focuses on nanoscale based approaches i.e. closed-loop insulin delivery systems, which detect any fluctuation in blood glucose levels and allow controlled release of a drug, thus are also called self-regulating insulin release system. Additionally, this review summarizes the role of nanotechnology in the diagnosis and treatment of diabetic complications through little advancement in the existing techniques. To improve health, as well as the quality of life in diabetic's new sensing systems for blood glucose level evaluation and controlled administration of drugs through efficient drug delivery systems should be explored.

Ultrasound-modulated optical glucose sensing using a 1645 nm laser

Regular and frequent blood glucose monitoring is vital in managing diabetes treatment plans and preventing severe complications. Because current invasive techniques impede patient compliance and are not infection-free, many noninvasive methods have been proposed. Among them, optical methods have drawn much attention for their rich optical contrast, but their resolution is degraded in deep tissue. Here, we present an ultrasound-modulated optical sensing (UOS) technique to noninvasively monitor glucose that uses an infrared laser (1645 nm) and a single-element focused ultrasound transducer. Focused ultrasound waves can acoustically localize diffused photons in scattering media, and thus optical contrast can be represented with much enhanced spatial resolution. To maximize the signal-to-noise ratio, we compared the modulation depths of UOS signals in both continuous and burst ultrasound transmission modes. Finally, UOS measurements of various glucose concentrations are presented and compared with those acquired in phantoms with a conventional diffuse optical sensing method. The UOS measurements in a 20 mm thick tissue-mimicking phantom show 26.6% accuracy in terms of mean absolute relative difference (MARD), which indicates the great potential of the proposed technique as a noninvasive glucose sensor.

A Glucose Monitoring System With Remote Data Access

A cost-effective portable glucose monitoring system with remote data access based on a novel e-oscilloscope was developed using a glucose biofuel cell and a capacitor circuit interfaced to an ESP8266 microcontroller programmed to convert the charge/discharge rates of the capacitor functioning as a transducer. The capacitor charge/discharge rates were converted into glucose concentration readings that is monitored remotely. The glucose monitoring system comprise a glucose biofuel cell, a charge pump circuit, a capacitor and an ESP microcontroller. The anode was fabricated by modifying a gold microwire with nanoporous colloidal platinum (Au-co-Pt) and the cathode was constructed using a mesh dense network of multiwalled carbon nanotubes modified with bilirubin oxidase, respectively. The glucose monitoring system showed sensitivity of 1.18 Hz/mM · cm² with a correlation coefficient of 0.9939 with increasing glucose concentration from 1 mM to 25 mM. In addition, the glucose monitoring system exhibited optimal operation at a pH of 7.4 and 37 °C, which is ideal for physiological glucose monitoring.

An In-Vitro Study of Wireless Passive Inductor Integrated Cavity for Future long-term Implantable resonator-based Glucose Monitoring

In this paper, a label-free biosensor is developed for monitoring the glucose level in the solution. A wireless passive inductor integrated cavity (IIC)-based biosensor is studied. The proposed IIC consists of a passive spiral inductor integrated cavity resonator for continuous monitoring of capillary blood glucose. The proposed method is based on the cavity perturbation theory, where the solution with different glucose levels perturbs and interacts with the passive IIC-based biosensor. The variation in the effective permittivity ε_eff and permeability μ_eff of the cavity resonator due to different glucose levels changes the equivalent capacitance and inductance of the proposed IIC. In turn, the corresponding resonance frequency changes. The in-vitro measurements are performed on deionized water glucose solutions of various glucose concentrations within the range of 75 mg/dL to 250 mg/dL. The results demonstrate that the sensor's resonant frequency increases with the increase in glucose level in the solution with a sensitivity of 32 kHz/mgdL^-1.

Noninvasive, wearable, and tunable electromagnetic multisensing system for continuous glucose monitoring, mimicking vasculature anatomy

Painless, needle-free, and continuous glucose monitoring sensors are needed to enhance the life quality of diabetic patients. To that extent, we propose a first-of-its-kind, highly sensitive, noninvasive continuous glycemic monitoring wearable multisensor system. The proposed sensors are validated on serum, animal tissues, and animal models of diabetes and in a clinical setting. The noninvasive measurement results during human trials reported high correlation (>0.9) between the system's physical parameters and blood glucose levels, without any time lag. The accurate real-time responses of the sensors are attributed to their unique vasculature anatomy-inspired tunable electromagnetic topologies. These wearable apparels wirelessly sense hypo- to hyperglycemic variations with high fidelity. These components are designed to simultaneously target multiple body locations, which opens the door for the development of a closed-loop artificial pancreas.

Recent advances of electrochemical and optical enzyme-free glucose sensors operating at physiological conditions

Diabetes is a pathological condition that requires the continuous monitoring of glucose level in the blood. Its control has been tremendously improved by the application of point-of-care devices. Conventional enzyme-based sensors with electrochemical and optical transduction systems can successfully measure the glucose concentration in human blood, but they suffer from the low stability of the enzyme. Non-enzymatic wearable electrochemical and optical sensors, with low-cost, high stability, point-of-care testing and online monitoring of glucose levels in biological fluids, have recently been developed and can help to manage and control diabetes worldwide. Advances in nanoscience and nanotechnology have enabled the development of novel nanomaterials that can be implemented for the use in enzyme-free systems to detect glucose. This review summarizes recent developments of enzyme-free electrochemical and optical glucose sensors, as well as their respective wearable and commercially available devices, capable of detecting glucose at physiological pH conditions without the need to pretreat the biological fluids. Additionally, the evolution of electrochemical glucose sensor technology and a couple of widely used optical detection systems along with the glucose detection mechanism is also discussed. Finally, this review addresses limitations and challenges of current non-enzymatic electrochemical, optical, and wearable glucose sensor technologies and highlights opportunities for future research directions.

Adaptive Boosting Based Personalized Glucose Monitoring System (PGMS) for Non-Invasive Blood Glucose Prediction with Improved Accuracy

In this paper, we present an architecture of a personalized glucose monitoring system (PGMS). PGMS consists of both invasive and non-invasive sensors on a single device. Initially, blood glucose is measured invasively and non-invasively, to train the machine learning models. Then, paired data and corresponding errors are divided scientifically into six different clusters based on blood glucose ranges as per the patient’s diabetic conditions. Each cluster is trained to build the unique error prediction model using an adaptive boosting (AdaBoost) algorithm. Later, these error prediction models undergo personalized calibration based on the patient’s characteristics. Once, the errors in predicted non-invasive values are within the acceptable error range, the device gets personalized for a patient to measure the blood glucose non-invasively. We verify PGMS on two different datasets. Performance analysis shows that the mean absolute relative difference (MARD) is reduced exceptionally to 7.3% and 7.1% for predicted values as compared to 25.4% and 18.4% for measured non-invasive glucose values. The Clarke error grid analysis (CEGA) plot for non-invasive predicted values shows 97% data in Zone A and 3% data in Zone B for dataset 1. Moreover, for dataset 2 results echoed with 98% and 2% in Zones A and B, respectively.

Reliability of the Dexcom G6 Continuous Glucose Monitor During Hyperbaric Oxygen Exposure

Background: People with diabetes-related ulcers may benefit from hyperbaric oxygen (HBO₂) therapy and from continuous glucose monitors (CGM). Although blood glucose (BG) meters based on glucose oxidase (GO) report erroneously low values at high pO₂, BG meters based on glucose dehydrogenase (GD) do not. We therefore examined the performance of a GO-based CGM system in comparison to GO-based and GD-based BG systems in normobaric air (NBAir), hyperbaric air (HBAir), and HBO₂ environments. Materials and Methods: Twenty-six volunteers without diabetes mellitus (DM) wore Dexcom G6 CGM systems and provided periodic blood samples before, during, and after a standard HBO₂ treatment consisting of three 30-min intervals of HBO₂ separated by two 5-min intervals of HBAir. Accuracy of the CGM and GO-based BG meter were assessed by comparisons with the GD-based values. Results: The mean absolute relative difference for the CGM system was 15.96% and for the GO-based meter was 8.52%. Compared to NBAir, HBO₂ exposure resulted in significantly higher CGM values (+3.76 mg/dL, P < 0.001) and significantly lower GO-based meter values (-10.38 mg/dL, P < 0.001). Pre-HBO₂ and post-HBO₂ values obtained in NBAir were also significantly different when measured by CGM (+4.13 mg/dL, P = 0.015) or the GO-based meter (-9.04 mg/dL, P < 0.001). Conclusions: In volunteers without DM, HBO₂ exposure results in statistically significant differences in glucose measurements obtained with GO-based devices, but not a GD-based device. Standard HBO₂ treatment results in statistically significant effects on glucose concentrations. These differences are of unlikely clinical significance.

Noninvasive blood glucose detection using a quantum cascade laser

A Quantum Cascade Laser (QCL) was invented in the late 90s as a promising mid-infrared light source and it has contributed to the fields of industry, military, medicine, and biology. The room temperature operation, watt-level output power, compact size, and wide tuning capability of this laser advanced the field of noninvasive blood glucose detection with the use of transmission, absorption, and photoacoustic spectroscopy. This review provides a complete overview of the recent progress and technical details of these spectroscopy techniques, using QCL as an infrared light source for detecting blood glucose concentrations in diabetic patients.

Nanostructured nickel oxide electrodes for non-enzymatic electrochemical glucose sensing

Nanostructured nickel (Ni) and nickel oxide (NiO) electrodes were fabricated on Ni foils using the glancing angle deposition (GLAD) technique. Cyclic voltammetry and amperometry showed the electrodes enable non-enzymatic electrochemical determination of glucose in strongly alkaline media. Under optimized conditions of NaOH concentration and working potential (~ 0.50 V vs. Ag/AgCl), the GLAD electrodes performed far better than bare Ni foil electrodes, with the GLAD NiO electrode showing an outstanding sensitivity (4400 μA mM^-1 cm^-2), superior detection limit (7 nM), and wide dynamic range (0.5 μM-9 mM), with desirable selectivity and reproducibility. Based on their performance at a low concentration, the GLAD NiO electrodes were also used to quantify glucose in artificial urine and sweat samples which have significantly lower glucose levels than blood. The GLAD NiO electrodes showed negligible response to the common interferents in glucose measurement (uric acid, dopamine, serotonin, and ascorbic acid), and they were not poisoned by high amounts of sodium chloride. Graphical abstract The figures depict (A) SEM image of vertical post-GLAD NiO electrodes used for non-enzymatic electrochemical glucose monitoring, and (B) calibration plots of the three different electrodes.

Review of Non-invasive Glucose Sensing Techniques: Optical, Electrical and Breath Acetone

Annual deaths in the U.S. attributed to diabetes are expected to increase from 280,210 in 2015 to 385,840 in 2030. The increase in the number of people affected by diabetes has made it one of the major public health challenges around the world. Better management of diabetes has the potential to decrease yearly medical costs and deaths associated with the disease. Non-invasive methods are in high demand to take the place of the traditional finger prick method as they can facilitate continuous glucose monitoring. Research groups have been trying for decades to develop functional commercial non-invasive glucose measurement devices. The challenges associated with non-invasive glucose monitoring are the many factors that contribute to inaccurate readings. We identify and address the experimental and physiological challenges and provide recommendations to pave the way for a systematic pathway to a solution. We have reviewed and categorized non-invasive glucose measurement methods based on: (1) the intrinsic properties of glucose, (2) blood/tissue properties and (3) breath acetone analysis. This approach highlights potential critical commonalities among the challenges that act as barriers to future progress. The focus here is on the pertinent physiological aspects, remaining challenges, recent advancements and the sensors that have reached acceptable clinical accuracy.

An IoT-Based Glucose Monitoring Algorithm to Prevent Diabetes Complications

Diabetes mellitus (DM) is a metabolic disorder characterized by blood glucose levels above normal limits. The impact of this disease on the population has increased in recent years. It is already a public health problem worldwide and one of the leading causes of death. Recently, several proposals have been developed for better and regular monitoring of glucose. However, theses proposals do not discard erroneous readings and they are not able to anticipate a critical condition. In this work, we propose an algorithm based on the double moving average supported by an IoT architecture to prevent possible complications in elderly patients. The algorithm uses historical readings to construct a series. Given a number of periods, it is possible to calculate averages of different subsets and trends for the next periods and, in this way, the prognosis is obtained. With the prognosis, it is possible to notify the doctor and relatives in advance about a possible critical condition in the patient. The aim of our work is to validate the architecture and prognosis algorithm used for elderly persons. Tests of the algorithm and the architecture were performed with different readings and it was shown that the system generated corresponding notifications before the glucose values were higher than those defined by the WHO (World Health Organization), thus avoiding unnecessary alarms.

Real-Time Noninvasive Measurement of Glucose Concentration Using a Modified Hilbert Shaped Microwave Sensor

We developed a microwave glucose sensor based on the modified first-order Hilbert curve design and measured glucose concentration in aqueous solutions by using a real-time microwave near-field electromagnetic interaction technique. We observed S₂₁ transmission parameters of the sensor at resonant frequencies depend on the glucose concentration. We could determine the glucose concentration in the 0-250 mg/dL concentration range at an operating frequency of near 6 GHz. The measured minimum detectable signal was 0.0156 dB/(mg/dL) and the measured minimum detectable concentration was 1.92 mg/dL. The simulation result for the minimum detectable signal and the minimum detectable concentration was 0.0182 dB/(mg/dL) and 1.65 mg/dL, respectively. The temperature instability of the sensor for human glycemia in situ measurement range (27-34 °C for fingers and 36-40 °C for body temperature ranges) can be improved by the integration of the temperature sensor in the microwave stripline platform and the obtained data can be corrected during signal processing. The microwave signal-temperature dependence is almost linear with the same slope for a glucose concentration range of 50-150 mg/dL. The temperature correlation coefficient is 0.05 dB/°C and 0.15 dB/°C in 27-34 °C and 36-40 °C temperature range, respectively. The presented system has a cheap, easy fabrication process and has great potential for non-invasive glucose monitoring.

System accuracy assessments with a blood glucose meter with combined glucose and ß-hydroxybutyrate measurement capabilities

Background: We evaluated the Wellion Galileo GLU/KET blood and ketone (ß-Hydroxybutyrate, ß-OHB) meter to demonstrate that it meets ISO15107:2015 regulatory approval criteria. Research Design and Methods: A total of 100 subjects (52 female, age: 30 to 84 years, diabetes: 10 type 1/90 type 2) with blood glucose levels distributed over the entire measurement range as required by the ISO15197 protocol were tested (double determinations with 3 strip lots and two devices). A similar test protocol was followed to test ß-OHB strip performance (reference devices: YSI 2300plus for glucose and STANBIO ß-HOB LiquiColor TestKit for ß-OHB). Precision was tested for glucose with 3 blood glucose concentrations (ß-OHB: 2 control solutions). Results: All glucose test-strip lots met the strict ISO acceptance criteria. Mean absolute relative difference (MARD) was 4.9% and all data pairs were in zone A of the consensus error grid. The ß-OHB test-strips also met the pre-defined acceptance criteria. Within-run and between-run precision was calculated to be 2.3% and 0.7% for the glucose strips (3.7%/0.8% for the ketone strips). Conclusions: When tested according to the ISO15197:2015 guideline, the device showed very accurate measurement performance for glucose and ß-OHB testing and fully met regulatory accuracy approval criteria.