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de Jong LA, Li X, Emamipour S, van der Werf S, Postma MJ, van Dijk PR, Feenstra TL. Model and Empirical Data-Based Cost-Utility Studies of Continuous Glucose Monitoring in Individuals with Type 1 Diabetes: A Protocol of a Systematic Review on Methodology and Quality. PHARMACOECONOMICS - OPEN 2023; 7:1007-1013. [PMID: 37608071 PMCID: PMC10721749 DOI: 10.1007/s41669-023-00428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION This review aims to critically appraise differences in methodology and quality of model-based and empirical-data-based cost-utility studies to address key limitations, opportunities, and challenges to inform future cost-utility analyses of continuous glucose monitoring (CGM) in type 1 diabetes. This protocol is registered at PROSPERO (CRD42023391284). METHODS The review will be conducted in accordance with the PRISMA guideline for systematic reviews. Searches will be conducted in MEDLINE, Embase, Web of Science, Cochrane Library, and Econlit from 2000 to January 2023. Model and empirical data-based studies evaluating the cost-utility of any CGM system in type 1 diabetes will be considered for inclusion. Studies that only report on cost per life year or any other clinical outcome, or reporting only costs or only clinical outcomes studies in type 2 diabetes populations, and studies on bi-hormonal closed loops and do-it-yourself hybrid closed loop devices will be excluded. Two reviewers will independently screen each study for inclusion. Data on the intervention, population, model settings (such as perspective, time horizon), model type and structure, clinical outcomes used to populate the model, validation, and uncertainty will be extracted and qualitatively synthesised. Quality will be assessed using the Philips et al. 2006 (model-based studies) or Consensus Health Economic Criteria (empirical data-based studies) checklists. Model validation will be assessed using the AdViSHE checklist. DISCUSSION Now that CGM is being used more broadly in practice, critical appraisal of existing cost-utility methodology and quality is important to inform future cost-utility analyses of CGM in type 1 diabetes in various settings.
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Affiliation(s)
- L A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - X Li
- Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen Research Institute of Pharmacy (GRIP), Groningen, The Netherlands
| | - S Emamipour
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S van der Werf
- Central Medical Library, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - P R van Dijk
- Department of Endocrinology. University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T L Feenstra
- Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen Research Institute of Pharmacy (GRIP), Groningen, The Netherlands
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2
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Subcutaneous amperometric biosensors for continuous glucose monitoring in diabetes. Talanta 2022. [DOI: 10.1016/j.talanta.2022.124033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Besagarhally Shivappa S, Krishnegowda A. Spectrophotometric determination of glucose in human serum samples using para‐phenylenediamine and alpha‐naphthol as a chromogenic reagent. INT J CHEM KINET 2022. [DOI: 10.1002/kin.21605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fang J, Huang S, Liu F, He G, Li X, Huang X, Chen HJ, Xie X. Semi-Implantable Bioelectronics. NANO-MICRO LETTERS 2022; 14:125. [PMID: 35633391 PMCID: PMC9148344 DOI: 10.1007/s40820-022-00818-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
Developing techniques to effectively and real-time monitor and regulate the interior environment of biological objects is significantly important for many biomedical engineering and scientific applications, including drug delivery, electrophysiological recording and regulation of intracellular activities. Semi-implantable bioelectronics is currently a hot spot in biomedical engineering research area, because it not only meets the increasing technical demands for precise detection or regulation of biological activities, but also provides a desirable platform for externally incorporating complex functionalities and electronic integration. Although there is less definition and summary to distinguish it from the well-reviewed non-invasive bioelectronics and fully implantable bioelectronics, semi-implantable bioelectronics have emerged as highly unique technology to boost the development of biochips and smart wearable device. Here, we reviewed the recent progress in this field and raised the concept of "Semi-implantable bioelectronics", summarizing the principle and strategies of semi-implantable device for cell applications and in vivo applications, discussing the typical methodologies to access to intracellular environment or in vivo environment, biosafety aspects and typical applications. This review is meaningful for understanding in-depth the design principles, materials fabrication techniques, device integration processes, cell/tissue penetration methodologies, biosafety aspects, and applications strategies that are essential to the development of future minimally invasive bioelectronics.
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Affiliation(s)
- Jiaru Fang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Fanmao Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Gen He
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xiangling Li
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China.
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Acharya D, Das DK. Extended Kalman filter state estimation–based nonlinear explicit model predictive control design for blood glucose regulation of type 1 diabetic patient. Med Biol Eng Comput 2022; 60:1347-1361. [DOI: 10.1007/s11517-022-02511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
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Schlueter S, Freckmann G, Wernsing M, Roelver KM, Joerdening M, Holder M, Heinemann L, Lange K. Development and Psychometric Assessment of a Manufacturer Independent Knowledge Questionnaire on Real Time Continuous Glucose Monitoring for insulin-treated People with Diabetes. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1492-5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background To benefit from real-time continuous glucose monitoring (rtCGM), users need practical skills and in-depth knowledge to analyze the glucose data appropriately and adapt insulin therapy accordingly. To assess the user’s knowledge about rtCGM, a psychometric knowledge test was developed and evaluated.
Method Experts on the use of rtCGM systems defined central knowledge contents in a Delphi process and developed a knowledge test comprising 40 multiple-choice items. For test-statistical review, people with insulin-treated diabetes and members of diabetes teams answered the knowledge test.
Results The 122 diabetes team members (age 46 (11) years; mean (SD)) and the 111 people with insulin-treated diabetes (age 42 (14) years, diabetes duration 20 (14) years, users of insulin pumps 64 %, previous usage of rtCGM 38 %, HbA1c 8.0 % [95 % CI 7.7–8.3] (64 mmol/mol [60–67]) had different levels of experiences using rtCGM systems. The internal consistency (Cronbach’s alpha) of the knowledge test was 0.92 for the whole sample, for people with diabetes 0.94, and for diabetes team members 0.84. Item difficulty ranged between 0.12 and 0.88 in people with diabetes and between 0.27 and 0.97 among diabetes team members. On average, people with diabetes answered 24.1 (9.9) items correctly, diabetes team members 29.2 (5.2) (p < 0.001); people with diabetes and previous rtCGM-experience had a higher knowledge compared to people without previous experience (29.2 (6.2) vs. 21.0 (10.4) (p = 0.001)). The quality of glucose control (measured by HbA1c) of the people with diabetes was significantly associated with the sum-score of the questionnaire (rho = –0.48, p < 0.001).
Conclusion The “rtCGM-Profi-Check” knowledge test provides high internal consistency, high selectivity, and content validity. It is suitable for objective, reliable, and valid assessment of the indispensable knowledge of people with diabetes to use different rtCGM systems successfully. The questionnaire is manufacturer-independent and is suitable to evaluate the needs and success of rtCGM education among persons with diabetes.
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Affiliation(s)
- Sandra Schlueter
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
| | - Marita Wernsing
- Diabeteszentrum, Christliches Krankenhaus Quakenbrück gemeinnützige GmbH, Quakenbrück, Germany
| | - Klaus-Martin Roelver
- Diabeteszentrum, Christliches Krankenhaus Quakenbrück gemeinnützige GmbH, Quakenbrück, Germany
| | - Mia Joerdening
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
| | - Martin Holder
- Kinderklinik, Klinikum Stuttgart Olgahospital, Stuttgart, Germany
| | | | - Karin Lange
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
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Mondal S, Zehra N, Choudhury A, Iyer PK. Wearable Sensing Devices for Point of Care Diagnostics. ACS APPLIED BIO MATERIALS 2020; 4:47-70. [DOI: 10.1021/acsabm.0c00798] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Subrata Mondal
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Nehal Zehra
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Anwesha Choudhury
- Center for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Parameswar Krishnan Iyer
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
- Center for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
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8
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Real-time Monitoring of Biomarkers in Serum for Early Diagnosis of Target Disease. BIOCHIP JOURNAL 2020. [DOI: 10.1007/s13206-020-4102-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Liu GS, Kong Y, Wang Y, Luo Y, Fan X, Xie X, Yang BR, Wu MX. Microneedles for transdermal diagnostics: Recent advances and new horizons. Biomaterials 2020; 232:119740. [PMID: 31918227 PMCID: PMC7432994 DOI: 10.1016/j.biomaterials.2019.119740] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/21/2019] [Accepted: 12/25/2019] [Indexed: 12/16/2022]
Abstract
Point-of-care testing (POCT), defined as the test performed at or near a patient, has been evolving into a complement to conventional laboratory diagnosis by continually providing portable, cost-effective, and easy-to-use measurement tools. Among them, microneedle-based POCT devices have gained increasing attention from researchers due to the glorious potential for detecting various analytes in a minimally invasive manner. More recently, a novel synergism between microneedle and wearable technologies is expanding their detection capabilities. Herein, we provide an overview on the progress in microneedle-based transdermal biosensors. It covers all the main aspects of the field, including design philosophy, material selection, and working mechanisms as well as the utility of the devices. We also discuss lessons from the past, challenges of the present, and visions for the future on translation of these state-of-the-art technologies from the bench to the bedside.
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Affiliation(s)
- Gui-Shi Liu
- Guangdong Provincial Key Laboratory of Optical Fiber Sensing and Communications, College of Science & Engineering, Jinan University, Guangzhou, 510632, China
| | - Yifei Kong
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Yensheng Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Yunhan Luo
- Guangdong Provincial Key Laboratory of Optical Fiber Sensing and Communications, College of Science & Engineering, Jinan University, Guangzhou, 510632, China
| | - Xudong Fan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China.
| | - Bo-Ru Yang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, China.
| | - Mei X Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Abstract
BACKGROUND Intensive monitoring of blood glucose levels is crucial in diabetes management. This article presents a new device, the TensorTip Combo Glucometer (CoG), developed by Cnoga Medical Ltd, which enables to predict capillary tissue glucose concentration noninvasively. METHODS Noninvasive glucose readings usually provide irregular or disordered mathematical manifold over the measurement space. To establish a transfer function, which correctly correlates the noninvasive raw data and the actual invasive glucose level, we suggest a mathematical concept that employs a personal calibration procedure to associate glucose pattern and multiple optical signals derived from tissue response to light emission in the range of visible to IR. The traversed light is detected by a color image sensor to predict the tissue glucose concentration at the fingertip. This article presents the mathematical concept underlying the technology and the requirements for device operation. RESULTS The device was clinically evaluated and compared to standard invasive blood glucose monitoring devices in few medical centers and by home users. Based on consensus error grid analysis, more than 98% of the measurements of each study were in zones A (more than 81%) and B (more than 11%). Postmarketing evaluations showed high correlations comparing the CoG to other invasive reference devices. CONCLUSIONS The CoG device employs a unique mathematical approach to predict glucose concentrations based on multiple optical signals. The first clinical results indicate that the device may show appropriate agreement with reference methods to be used for pain-free glucose assessment in daily routine.
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Affiliation(s)
- Yosef (Joseph) Segman
- Cnoga Medical Ltd, Caesarea North
Industrial Park, Caesarea, Israel
- Yosef (Joseph) Segman, PhD, R&D, Cnoga
Medical Ltd, Caesarea North Industrial Park, 5th Tarshish St, POB 3188,
Caesarea, 3088900, Israel.
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11
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Reduction of measurement noise in a continuous glucose monitor by coating the sensor with a zwitterionic polymer. Nat Biomed Eng 2018; 2:894-906. [PMID: 30931173 PMCID: PMC6436621 DOI: 10.1038/s41551-018-0273-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continuous glucose monitors (CGMs), used by patients with diabetes mellitus, can autonomously track fluctuations in blood glucose over time. However, the signal produced by CGMs during the initial recording period following sensor implantation contains substantial noise, requiring frequent recalibration via fingerprick tests. Here, we show that coating the sensor with a zwitterionic polymer, found via a combinatorial-chemistry approach, significantly reduces signal noise and improves CGM performance. We evaluated the polymer-coated sensors in mice as well as in healthy and diabetic non-human primates, and show that the sensors accurately record glucose levels without the need for recalibration. We also show that the polymer-coated sensors significantly abrogated immune responses to the sensor, as indicated by histology, fluorescent whole-body imaging of inflammation-associated protease activity, and gene expression of inflammation markers. The polymer coating may allow CGMs to become standalone measuring devices.
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12
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Pleitez MA, Hertzberg O, Bauer A, Lieblein T, Glasmacher M, Tholl H, Mäntele W. Infrared reflectometry of skin: Analysis of backscattered light from different skin layers. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2017; 184:220-227. [PMID: 28500960 DOI: 10.1016/j.saa.2017.04.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 05/25/2023]
Abstract
We have recently reported infrared spectroscopy of human skin in vivo using quantum cascade laser excitation and photoacoustic or photothermal detection for non-invasive glucose measurement . Here, we analyze the IR light diffusely reflected from skin layers for spectral contributions of glucose. Excitation of human skin by an external cavity tunable quantum cascade laser in the spectral region from 1000 to 1245cm-1, where glucose exhibits a fingerprint absorption, yields reflectance spectra with some contributions from glucose molecules. A simple three-layer model of skin was used to calculate the scattering intensities from the surface and from shallow and deeper layers using the Boltzmann radiation transfer equation. Backscattering of light at wavelengths around 10μm from the living skin occurs mostly from the Stratum corneum top layers and the shallow layers of the living epidermis. The analysis of the polarization of the backscattered light confirms this calculation. Polarization is essentially unchanged; only a very small fraction (<3%) is depolarized at 90° with respect to the laser polarization set at 0°. Based on these findings, we propose that the predominant part of the backscattered light is due to specular reflectance and to scattering from layers close to the surface. Diffusely reflected light from deeper layers undergoing one or more scattering processes would appear with significantly altered polarization. We thus conclude that a non-invasive glucose measurement based on backscattering of IR light from skin would have the drawback that only shallow layers containing some glucose at concentrations only weakly related to blood glucose are monitored.
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Affiliation(s)
- Miguel A Pleitez
- Institut für Biophysik; Goethe-Universität, Max-von-Laue-Straße 1, D-60438 Frankfurt am Main, Germany
| | - Otto Hertzberg
- DIEHL Stiftung & Co. KG, Stephanstraße 49, D-90478 Nürnberg, Germany.
| | - Alexander Bauer
- Institut für Biophysik; Goethe-Universität, Max-von-Laue-Straße 1, D-60438 Frankfurt am Main, Germany
| | - Tobias Lieblein
- Institut für Biophysik; Goethe-Universität, Max-von-Laue-Straße 1, D-60438 Frankfurt am Main, Germany
| | | | - Hans Tholl
- Diehl BGT Defence GmbH & Co. KG, Alte Nussdorfer Straße 13, D-88662 Überlingen, Germany
| | - Werner Mäntele
- Institut für Biophysik; Goethe-Universität, Max-von-Laue-Straße 1, D-60438 Frankfurt am Main, Germany.
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Das S, Pal S, Mitra M. Significance of Exhaled Breath Test in Clinical Diagnosis: A Special Focus on the Detection of Diabetes Mellitus. J Med Biol Eng 2016; 36:605-624. [PMID: 27853412 PMCID: PMC5083779 DOI: 10.1007/s40846-016-0164-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
Abstract
Analysis of volatile organic compounds (VOCs) emanating from human exhaled breath can provide deep insight into the status of various biochemical processes in the human body. VOCs can serve as potential biomarkers of physiological and pathophysiological conditions related to several diseases. Breath VOC analysis, a noninvasive and quick biomonitoring approach, also has potential for the early detection and progress monitoring of several diseases. This paper gives an overview of the major VOCs present in human exhaled breath, possible biochemical pathways of breath VOC generation, diagnostic importance of their analysis, and analytical techniques used in the breath test. Breath analysis relating to diabetes mellitus and its characteristic breath biomarkers is focused on. Finally, some challenges and limitations of the breath test are discussed.
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Affiliation(s)
- Souvik Das
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal 741235 India
| | - Saurabh Pal
- Department of Applied Physics, University of Calcutta, Kolkata, West Bengal 700009 India
| | - Madhuchhanda Mitra
- Department of Applied Physics, University of Calcutta, Kolkata, West Bengal 700009 India
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14
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Oei E, Samad N, Visser A, Chowdhury TA, Fan SL. Use of continuous glucose monitoring in patients with diabetes on peritoneal dialysis: poor correlation with HbA1c and high incidence of hypoglycaemia. Diabet Med 2016; 33:e17-20. [PMID: 26470840 DOI: 10.1111/dme.12988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Achieving adequate glycaemic control in patients with diabetes on peritoneal dialysis is challenging. Traditional assessment of glycaemia using HbA1c is difficult in such patients because of renal anaemia or carbamylation of haemoglobin, and significant glucose excursions may be masked. We describe three patients with diabetes on peritoneal dialysis with similar HbA1c levels, but with very different glucose profiles shown on continuous glucose monitoring. CASE REPORTS Patient 1 was treated with gliclazide, and had a number of solutions with high glucose concentration in his dialysis prescription. Continuous glucose monitoring showed glucose levels > 11 mmol/l for > 17 h per day, and < 4 mmol/l for 72 min per day with no symptoms. His HbA1c level was 61 mmol/mol (7.7%). Patient 2 was treated with insulin. Continuous glucose monitoring showed glucose levels > 11 mmol/mol for 3.8 h per day, and < 4 mmol/mol for 3.8 h per day. His HbA1c level was 59 mmol/mol (7.6%). Patient 3 was treated with pioglitazone and gliclazide, and glucose levels were > 11 mmol/l for 8 h per day and < 4 mmol/l for 1.6 h per day. His HbA1c was 62 mmol/mol (7.8%). None of the patients was aware of hypoglycaemia during the periods of low glucose recorded on continuous glucose monitoring. CONCLUSION Despite similar HbA1c levels, our three patients had very different glucose profiles. These cases highlight the fact that HbA1c is frequently inadequate in reflecting glucose control in patients with diabetes on peritoneal dialysis, and we suggest that intermittent continuous glucose monitoring may allow safer management of glycaemia in such patients.
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MESH Headings
- Blood Glucose/metabolism
- Blood Glucose Self-Monitoring
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Nephropathies/etiology
- Diabetic Nephropathies/therapy
- Gliclazide/therapeutic use
- Glycated Hemoglobin/metabolism
- Humans
- Hypoglycemia/chemically induced
- Hypoglycemia/epidemiology
- Hypoglycemic Agents/therapeutic use
- Incidence
- Insulin/therapeutic use
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Monitoring, Ambulatory
- Peritoneal Dialysis, Continuous Ambulatory
- Pioglitazone
- Thiazolidinediones/therapeutic use
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Affiliation(s)
- E Oei
- Department of Renal Medicine and Transplantation, Singapore General Hospital, Singapore
| | - N Samad
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - A Visser
- Department of Dietetics, Barts Health NHS Trust, London, UK
| | - T A Chowdhury
- Department of Diabetes and Metabolism, Barts Health NHS Trust, London, UK
| | - S L Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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Du X, Durgan CJ, Matthews DJ, Motley JR, Tan X, Pholsena K, Árnadóttir L, Castle JR, Jacobs PG, Cargill RS, Ward WK, Conley JF, Herman GS. Fabrication of a Flexible Amperometric Glucose Sensor Using Additive Processes. ECS JOURNAL OF SOLID STATE SCIENCE AND TECHNOLOGY : JSS 2015; 4:P3069-P3074. [PMID: 26634186 PMCID: PMC4664458 DOI: 10.1149/2.0101504jss] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study details the use of printing and other additive processes to fabricate a novel amperometric glucose sensor. The sensor was fabricated using a Au coated 12.7 μm thick polyimide substrate as a starting material, where micro-contact printing, electrochemical plating, chloridization, electrohydrodynamic jet (e-jet) printing, and spin coating were used to pattern, deposit, chloridize, print, and coat functional materials, respectively. We have found that e-jet printing was effective for the deposition and patterning of glucose oxidase inks with lateral feature sizes between ~5 to 1000 μm in width, and that the glucose oxidase was still active after printing. The thickness of the permselective layer was optimized to obtain a linear response for glucose concentrations up to 32 mM and no response to acetaminophen, a common interfering compound, was observed. The use of such thin polyimide substrates allow wrapping of the sensors around catheters with high radius of curvature ~250 μm, where additive and microfabrication methods may allow significant cost reductions.
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Affiliation(s)
- Xiaosong Du
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Christopher J. Durgan
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - David J. Matthews
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, USA
| | - Joshua R. Motley
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Xuebin Tan
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, USA
| | - Kovit Pholsena
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Líney Árnadóttir
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | | | - Peter G. Jacobs
- Pacific Diabetes Technologies, Portland, Oregon 97201, USA
- Oregon Health & Science University, Portland, Oregon 97239, USA
| | | | | | - John F. Conley
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, USA
| | - Gregory S. Herman
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
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Stevens W, Gous N, Ford N, Scott LE. Feasibility of HIV point-of-care tests for resource-limited settings: challenges and solutions. BMC Med 2014; 12:173. [PMID: 25197773 PMCID: PMC4157150 DOI: 10.1186/s12916-014-0173-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/11/2014] [Indexed: 11/10/2022] Open
Abstract
Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted.
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Lunze K, Woitok A, Walter M, Brendel MD, Afify M, Tolba R, Leonhardt S. Analysis and modelling of glucose metabolism in diabetic Göttingen minipigs. Biomed Signal Process Control 2014. [DOI: 10.1016/j.bspc.2014.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Investigation on cardiovascular risk prediction using physiological parameters. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:272691. [PMID: 24489599 PMCID: PMC3893863 DOI: 10.1155/2013/272691] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. Early prediction of CVD is urgently important for timely prevention and treatment. Incorporation or modification of new risk factors that have an additional independent prognostic value of existing prediction models is widely used for improving the performance of the prediction models. This paper is to investigate the physiological parameters that are used as risk factors for the prediction of cardiovascular events, as well as summarizing the current status on the medical devices for physiological tests and discuss the potential implications for promoting CVD prevention and treatment in the future. The results show that measures extracted from blood pressure, electrocardiogram, arterial stiffness, ankle-brachial blood pressure index (ABI), and blood glucose carry valuable information for the prediction of both long-term and near-term cardiovascular risk. However, the predictive values should be further validated by more comprehensive measures. Meanwhile, advancing unobtrusive technologies and wireless communication technologies allow on-site detection of the physiological information remotely in an out-of-hospital setting in real-time. In addition with computer modeling technologies and information fusion. It may allow for personalized, quantitative, and real-time assessment of sudden CVD events.
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Vashist SK. Continuous Glucose Monitoring Systems: A Review. Diagnostics (Basel) 2013; 3:385-412. [PMID: 26824930 PMCID: PMC4665529 DOI: 10.3390/diagnostics3040385] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/10/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
There have been continuous advances in the field of glucose monitoring during the last four decades, which have led to the development of highly evolved blood glucose meters, non-invasive glucose monitoring (NGM) devices and continuous glucose monitoring systems (CGMS). Glucose monitoring is an integral part of diabetes management, and the maintenance of physiological blood glucose concentration is the only way for a diabetic to avoid life-threatening diabetic complications. CGMS have led to tremendous improvements in diabetic management, as shown by the significant lowering of glycated hemoglobin (HbA1c) in adults with type I diabetes. Most of the CGMS have been minimally-invasive, although the more recent ones are based on NGM techniques. This manuscript reviews the advances in CGMS for diabetes management along with the future prospects and the challenges involved.
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Affiliation(s)
- Sandeep Kumar Vashist
- HSG-IMIT-Institut für Mikro-und Informationstechnik, Georges-Koehler-Allee 103, 79100, Freiburg, Germany.
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Badhulika S, Paul RK, Rajesh, Terse T, Mulchandani A. Nonenzymatic Glucose Sensor Based on Platinum Nanoflowers Decorated Multiwalled Carbon Nanotubes-Graphene Hybrid Electrode. ELECTROANAL 2013. [DOI: 10.1002/elan.201300286] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Baj-Rossi C, Rezzonico Jost T, Cavallini A, Grassi F, De Micheli G, Carrara S. Continuous monitoring of Naproxen by a cytochrome P450-based electrochemical sensor. Biosens Bioelectron 2013; 53:283-7. [PMID: 24144559 DOI: 10.1016/j.bios.2013.09.058] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022]
Abstract
This paper reports the characterization of an electrochemical biosensor for the continuous monitoring of Naproxen based on cytochrome P450. The electrochemical biosensor is based on the drop-casting of multi-walled carbon-nanotubes (MWCNTs) and microsomal cytochrome P4501A2 (msCYP1A2) on a graphite screen-printed electrode (SPE). The proposed biosensor was employed to monitor Naproxen (NAP), a well-known anti-inflammatory compound, through cyclic voltammetry. The dynamic linear range for the amperometric detection of NAP had an upper limit of 300 µM with a corresponding limit of detection (LOD) of 16 ± 1 µM (S/N=3), which is included in NAP physiological range (9-300 µM). The MWCNT/msCYP1A2-SPE sensor was also calibrated for NAP detection in mouse serum that was previously extracted from mice, showing a slightly higher LOD (33 ± 18 µM). The stability of the msCYP1A2-based biosensor was assessed by longtime continuous cyclic voltammetric measurements. The ability of the sensor to monitor drug delivery was investigated by using a commercial micro-osmotic pump. Results show that the MWCNT/msCYP1A2-SPE sensor is capable of precisely monitoring the real-time delivery of NAP for 16 h. This work proves that the proposed electrochemical sensor might represent an innovative point-of-care solution for the personalization of drug therapies, as well as for pharmacokinetic studies in both animals and humans.
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Affiliation(s)
- C Baj-Rossi
- Laboratory of Integrated Systems, EPFL - École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Zhang Y, Wei H, Yang H, He Y, Wu G, Xie S, Zhu Z, He R. Noninvasive blood glucose monitoring during oral intake of different sugars with optical coherence tomography in human subjects. JOURNAL OF BIOPHOTONICS 2013; 6:699-707. [PMID: 23225583 DOI: 10.1002/jbio.201200128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 10/18/2012] [Accepted: 11/14/2012] [Indexed: 06/01/2023]
Abstract
The potential of OCT applied to noninvasive blood glucose monitoring has attracted significant efforts. In this work we investigated the feasibility of OCT in monitoring blood glucose during oral intake of different sugars in humans. Five groups of experiments were performed, in which different sugars were used. The OCT signal slope (OCTSS) changed with variation of blood glucose concentration (BGC). A good correlation between OCTSS and BGC was observed in these experiments. The averaged correlation coefficients R between OCTSS and BGC are 0.900, 0.836, 0.895 and 0.884, corresponding to oral administration of glucose, fructose, sucrose and mixed sugar, respectively. Our studies demonstrated the capability and accuracy of the OCT system in monitoring BGC noninvasively and it could become a powerful tool in daily blood glucose monitoring for patients.
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Affiliation(s)
- Yuqing Zhang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou 510631, Guangdong Province, China
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Frontino G, Meschi F, Bonfanti R, Rigamonti A, Battaglino R, Favalli V, Bonura C, Ferro G, Chiumello G. Future Perspectives in Glucose Monitoring Sensors. EUROPEAN ENDOCRINOLOGY 2013; 9:6-11. [PMID: 30349603 DOI: 10.17925/ee.2013.09.01.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/14/2013] [Indexed: 11/24/2022]
Abstract
The prevalence of diabetes is increasing. improved glucose control is fundamental to reduce both long-term micro- and macrovascular complications and short-term complications, such as diabetic ketoacidosis and severe hypoglycemia. Frequent blood glucose monitoring is an essential part of diabetes management. However, almost all available blood glucose monitoring devices are invasive. This determines a reduced patient compliance, which in turn reflects negatively on glucose control. Therefore, there is a need to develop noninvasive glucose monitoring devices that will reduce the need of invasive procedures, thus increasing patient compliance and consequently improving quality of life and health of patients with diabetes.
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Affiliation(s)
- Giulio Frontino
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Franco Meschi
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Roseila Battaglino
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Favalli
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Clara Bonura
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Giusy Ferro
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Chiumello
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
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Blood glucose control algorithms for type 1 diabetic patients: A methodological review. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2012.09.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rendell M, Saiprasad S, Trepp-Carrasco AG, Drincic A. The future of inpatient diabetes management: glucose as the sixth vital sign. Expert Rev Endocrinol Metab 2013; 8:195-205. [PMID: 30736179 DOI: 10.1586/eem.13.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes is an ever increasing health problem in our society. Due to associated small and large vessel conditions, patients with diabetes are two- to four-fold more likely to require hospitalization than nondiabetic individuals. Furthermore, hyperglycemia in hospitalized patients results in increased susceptibility to wound infections, worse outcomes postcardiac and cerebrovascular events, longer hospital length of stay and increased inpatient mortality. Several studies suggest that tight control of glucose levels yields improvement in these factors. Conversely, other studies have suggested increased mortality after tight glucose management, perhaps as a result of an increased incidence of hypoglycemic events. The most reasonable approach to control of hyperglycemia is to normalize glucose levels as much as possible without triggering hypoglycemia. In the hospital, insulin therapy of hyperglycemia is preferred due to the ability to flexibly manage glucose levels without side effects associated with many alternative antidiabetic agents. Due to the increasing burden of inpatient diabetes, and the detrimental effects of both hyper and hypoglycemia, the authors predict that blood-glucose levels will become the sixth vital sign to be frequently monitored in hospitalized patients and controlled in a narrow range. The future is in the use of insulin pumps controlled by continuous glucose monitors. This technology is complex and has not yet become standard. The development of future inpatient diabetes care will depend on adaptation of hospital systems to advance the new technology.
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Affiliation(s)
- Marc Rendell
- a Creighton Diabetes Center, 601 North 30th Street, Omaha, NE 68131, USA.
- b The Rose Salter Medical Research Foundation, 660 South 85th Street, Omaha, NE 68114, USA
| | - Saraswathi Saiprasad
- c Department of Internal Medicine, Creighton University School of Medicine, 601 North 30th Street, Omaha, NE 68131, USA
| | - Alejandro G Trepp-Carrasco
- d Department of Endocrinology and Metabolism, Creighton University School of Medicine, 601 North 30th Street, Omaha, NE 68131, USA
| | - Andjela Drincic
- e Department of Endocrinology, The University of Nebraska School of Medicine, Nebraska Medical Center, Omaha, NE 68198-5527, USA
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Regittnig W, Lindpointner S, Korsatko S, Tutkur D, Bodenlenz M, Pieber TR. Periodic extraction of interstitial fluid from the site of subcutaneous insulin infusion for the measurement of glucose: a novel single-port technique for the treatment of type 1 diabetes patients. Diabetes Technol Ther 2013; 15:50-9. [PMID: 23126579 PMCID: PMC3540899 DOI: 10.1089/dia.2012.0173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Treatment of type 1 diabetes patients could be simplified if the site of subcutaneous insulin infusion could also be used for the measurement of glucose. This study aimed to assess the agreement between blood glucose concentrations and glucose levels in the interstitial fluid (ISF) that is extracted from the insulin infusion site during periodic short-term interruptions of continuous subcutaneous insulin infusion (CSII). SUBJECTS AND METHODS A perforated cannula (24 gauge) was inserted into subcutaneous adipose tissue of C-peptide-negative type 1 diabetes subjects (n=13) and used alternately to infuse rapid-acting insulin (100 U/mL) and to extract ISF glucose during a fasting period and after ingestion of a standard oral glucose load (75 g). RESULTS Although periodically interrupted for extracting glucose (every hour for approximately 10 min), insulin infusion with the cannula was adequate to achieve euglycemia during fasting and to restore euglycemia after glucose ingestion. Furthermore, the ISF-derived estimates of plasma glucose levels agreed well with plasma glucose concentrations. Correlation coefficient and median absolute relative difference values were found to be 0.95 and 8.0%, respectively. Error grid analysis showed 99.0% of all ISF glucose values within clinically acceptable Zones A and B (83.5% Zone A, 15.5% Zone B). CONCLUSIONS Results show that ISF glucose concentrations measured at the insulin infusion site during periodic short-term interruptions of CSII closely reflect blood glucose levels, thus suggesting that glucose monitoring and insulin delivery may be performed alternately at the same tissue site. A single-port device of this type could be used to simplify and improve glucose management in diabetes.
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Affiliation(s)
- Werner Regittnig
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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28
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Bazin G, Zhu JXX. Glucose-sensitivity of core-shell microspheres and their crystalline colloidal arrays. Sci China Chem 2012. [DOI: 10.1007/s11426-012-4779-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kiang TK, Schmitt V, Ensom MH, Chua B, Häfeli UO. Therapeutic Drug Monitoring in Interstitial Fluid: A Feasibility Study Using a Comprehensive Panel of Drugs. J Pharm Sci 2012; 101:4642-52. [DOI: 10.1002/jps.23309] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 07/23/2012] [Accepted: 08/10/2012] [Indexed: 11/09/2022]
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Italian contributions to the development of continuous glucose monitoring sensors for diabetes management. SENSORS 2012. [PMID: 23202020 PMCID: PMC3545591 DOI: 10.3390/s121013753] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Monitoring glucose concentration in the blood is essential in the therapy of diabetes, a pathology which affects about 350 million people around the World (three million in Italy), causes more than four million deaths per year and consumes a significant portion of the budget of national health systems (10% in Italy). In the last 15 years, several sensors with different degree of invasiveness have been proposed to monitor glycemia in a quasi-continuous way (up to 1 sample/min rate) for relatively long intervals (up to 7 consecutive days). These continuous glucose monitoring (CGM) sensors have opened new scenarios to assess, off-line, the effectiveness of individual patient therapeutic plans from the retrospective analysis of glucose time-series, but have also stimulated the development of innovative on-line applications, such as hypo/hyper-glycemia alert systems and artificial pancreas closed-loop control algorithms. In this review, we illustrate some significant Italian contributions, both from industry and academia, to the growth of the CGM sensors research area. In particular, technological, algorithmic and clinical developments performed in Italy will be discussed and put in relation with the advances obtained in the field in the wider international research community.
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Minh TDC, Blake DR, Galassetti PR. The clinical potential of exhaled breath analysis for diabetes mellitus. Diabetes Res Clin Pract 2012; 97:195-205. [PMID: 22410396 PMCID: PMC3384765 DOI: 10.1016/j.diabres.2012.02.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/02/2012] [Accepted: 02/12/2012] [Indexed: 01/15/2023]
Abstract
Various compounds in present human breath have long been loosely associated with pathological states (including acetone smell in uncontrolled diabetes). Only recently, however, the precise measurement of exhaled volatile organic compounds (VOCs) and aerosolized particles was made possible at extremely low concentrations by advances in several analytical methodologies, described in detail in the international literature and each suitable for specific subsets of exhaled compounds. Exhaled gases may be generated endogenously (in the pulmonary tract, blood, or peripheral tissues), as metabolic by-products of human cells or colonizing micro-organisms, or may be inhaled as atmospheric pollutants; growing evidence indicates that several of these molecules have distinct cell-to-cell signaling functions. Independent of origin and physiological role, exhaled VOCs are attractive candidates as biomarkers of cellular activity/metabolism, and could be incorporated in future non-invasive clinical testing devices. Indeed, several recent studies reported altered exhaled gas profiles in dysmetabolic conditions and relatively accurate predictions of glucose concentrations, at least in controlled experimental conditions, for healthy and diabetic subjects over a broad range of glycemic values. Optimization of this methodology and validation in large-scale trials under a wider range of conditions is needed to determine its true potential to transition into practical clinical use.
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Affiliation(s)
- Timothy Do Chau Minh
- Department of Pharmacology, University of California, Irvine, Irvine, CA 92697-1385, United States.
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Langendam M, Luijf YM, Hooft L, Devries JH, Mudde AH, Scholten RJPM. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev 2012; 1:CD008101. [PMID: 22258980 PMCID: PMC6486112 DOI: 10.1002/14651858.cd008101.pub2] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose is essential to optimise glycaemic control in type 1 diabetes mellitus. Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels to provide semi-continuous information about glucose levels, which identifies fluctuations that would not have been identified with conventional self-monitoring. Two types of CGM systems can be defined: retrospective systems and real-time systems. Real-time systems continuously provide the actual glucose concentration on a display. Currently, the use of CGM is not common practice and its reimbursement status is a point of debate in many countries. OBJECTIVES To assess the effects of CGM systems compared to conventional self-monitoring of blood glucose (SMBG) in patients with diabetes mellitus type 1. SEARCH METHODS We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for the identification of studies. Last search date was June 8, 2011. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing retrospective or real-time CGM with conventional self-monitoring of blood glucose levels or with another type of CGM system in patients with type 1 diabetes mellitus. Primary outcomes were glycaemic control, e.g. level of glycosylated haemoglobin A1c (HbA1c) and health-related quality of life. Secondary outcomes were adverse events and complications, CGM derived glycaemic control, death and costs. DATA COLLECTION AND ANALYSIS Two authors independently selected the studies, assessed the risk of bias and performed data-extraction. Although there was clinical and methodological heterogeneity between studies an exploratory meta-analysis was performed on those outcomes the authors felt could be pooled without losing clinical merit. MAIN RESULTS The search identified 1366 references. Twenty-two RCTs meeting the inclusion criteria of this review were identified. The results of the meta-analyses (across all age groups) indicate benefit of CGM for patients starting on CGM sensor augmented insulin pump therapy compared to patients using multiple daily injections of insulin (MDI) and standard monitoring blood glucose (SMBG). After six months there was a significant larger decline in HbA1c level for real-time CGM users starting insulin pump therapy compared to patients using MDI and SMBG (mean difference (MD) in change in HbA1c level -0.7%, 95% confidence interval (CI) -0.8% to -0.5%, 2 RCTs, 562 patients, I(2)=84%). The risk of hypoglycaemia was increased for CGM users, but CIs were wide and included unity (4/43 versus 1/35; RR 3.26, 95% CI 0.38 to 27.82 and 21/247 versus 17/248; RR 1.24, 95% CI 0.67 to 2.29). One study reported the occurrence of ketoacidosis from baseline to six months; there was however only one event. Both RCTs were in patients with poorly controlled diabetes.For patients starting with CGM only, the average decline in HbA1c level six months after baseline was also statistically significantly larger for CGM users compared to SMBG users, but much smaller than for patients starting using an insulin pump and CGM at the same time (MD change in HbA1c level -0.2%, 95% CI -0.4% to -0.1%, 6 RCTs, 963 patients, I(2)=55%). On average, there was no significant difference in risk of severe hypoglycaemia or ketoacidosis between CGM and SMBG users. The confidence interval however, was wide and included a decreased as well as an increased risk for CGM users compared to the control group (severe hypoglycaemia: 36/411 versus 33/407; RR 1.02, 95% CI 0.65 to 1.62, 4 RCTs, I(2)=0% and ketoacidosis: 8/411 versus 8/407; RR 0.94, 95% CI 0.36 to 2.40, 4 RCTs, I(2)=0%).Health-related quality of life was reported in five of the 22 studies. In none of these studies a significant difference between CGM and SMBG was found. Diabetes complications, death and costs were not measured.There were no studies in pregnant women with diabetes type 1 and in patients with hypoglycaemia unawareness. AUTHORS' CONCLUSIONS There is limited evidence for the effectiveness of real-time continuous glucose monitoring (CGM) use in children, adults and patients with poorly controlled diabetes. The largest improvements in glycaemic control were seen for sensor-augmented insulin pump therapy in patients with poorly controlled diabetes who had not used an insulin pump before. The risk of severe hypoglycaemia or ketoacidosis was not significantly increased for CGM users, but as these events occurred infrequent these results have to be interpreted cautiously.There are indications that higher compliance of wearing the CGM device improves glycosylated haemoglobin A1c level (HbA1c) to a larger extent.
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Affiliation(s)
- Miranda Langendam
- Dutch Cochrane Centre, AcademicMedical Center, Amsterdam, Netherlands.
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Nagaraja P, Honnur Krishna, Shivakumar A, Shrestha AK. Development of quantitative enzymatic method and its validation for the assay of glucose in human serum. Clin Biochem 2012; 45:139-43. [DOI: 10.1016/j.clinbiochem.2011.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 11/13/2011] [Accepted: 11/19/2011] [Indexed: 10/14/2022]
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Vashist SK, Zheng D, Al-Rubeaan K, Luong JH, Sheu FS. Technology behind commercial devices for blood glucose monitoring in diabetes management: A review. Anal Chim Acta 2011; 703:124-36. [DOI: 10.1016/j.aca.2011.07.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 10/18/2022]
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36
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Wu Q, Wang L, Yu H, Wang J, Chen Z. Organization of glucose-responsive systems and their properties. Chem Rev 2011; 111:7855-75. [PMID: 21902252 DOI: 10.1021/cr200027j] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Qian Wu
- State Key Laboratory of Chemical Engineering, Department of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
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Muchmore D, Sharp M, Vaughn D. Benefits of blinded continuous glucose monitoring during a randomized clinical trial. J Diabetes Sci Technol 2011; 5:676-80. [PMID: 21722582 PMCID: PMC3192633 DOI: 10.1177/193229681100500321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Real-time, personal continuous glucose monitoring (CGM) is a validated technology that can help patients improve glycemic control. Blinded CGM is a promising technology for obtaining retrospective data in clinical research where the quantity and quality of blood glucose information is important. This study was designed to investigate the use of novel procedures to enhance data capture from blinded CGM. METHODS Following a 4-week run-in, 46 patients with type 1 diabetes were randomized to one of two prandial insulins for a 12-week treatment period, after which they were crossed over to the alternate treatment for 12 weeks. Continuous glucose monitoring was implemented at the end of run-in (practice only) and during the last 2 weeks of each treatment period. Eighty percent of 288 possible daily glucose values were required for at least three days. Continuous glucose monitoring was extended for an additional week if these criteria were not met, and patients were allowed to insert sensors at home when necessary. Continuous glucose monitoring results were compared to reference eight-point self-monitoring of blood glucose (SMBG). RESULTS Higher than expected sensor failure rate was approximately 25%. During run-in, 12 of 45 attempted profiles failed adequacy criteria. However, treatment periods had only 1 of 82 attempted profiles considered inadequate (6 cases required an additional week of CGM). Using SMBG as reference, 93.7% of 777 CGM values were in Clarke error grid zones A+B. CONCLUSIONS With appropriate training, adequate practice, and opportunity to repeat blinded CGM as needed, nearly 100% of attempted profiles can be obtained successfully.
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Yan Q, Major TC, Bartlett RH, Meyerhoff ME. Intravascular glucose/lactate sensors prepared with nitric oxide releasing poly(lactide-co-glycolide)-based coatings for enhanced biocompatibility. Biosens Bioelectron 2011; 26:4276-82. [PMID: 21592764 DOI: 10.1016/j.bios.2011.04.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 11/18/2022]
Abstract
Intravenous amperometric needle-type enzymatic glucose/lactate sensors intended for continuous monitoring are prepared with a novel nitric oxide (NO) releasing layer to improve device hemocompatibility. To create an underlying NO release coating, the sensors with immobilized enzymes (either glucose oxidase or lactate oxidase) are prepared with a thin layer of poly(lactide-co-glycolide) (PLGA) loaded with lipophilic diazeniumdiolate species that slowly release NO via a proton driven reaction. An outer thin layer (ca. 30 μm) of PurSil (polyurethane/dimethylsiloxane copolymer) limits the flux of glucose and lactate to the inner layer of enzyme, to provide the desired linear amperometric response. A 30 μm coating of PLGA containing 33 wt% of the appropriate NO donor (N-diazeniumdiolated dibutylhexanediamine, DBHD/N₂O₂) can release NO at a physiologically relevant rate > 1 × 10⁻¹⁰mol min⁻¹ cm⁻² for at least 7 days without influencing the analytical performance of the glucose/lactate sensors. In vitro, the sensors exhibit relatively stable amperometric response over a one-week period with high selectivity over interferences (e.g., ascorbic acid) required for blood monitoring applications. Glucose sensors implanted in the veins of rabbits for 8h exhibit significantly enhanced hemocompatibility for the NO release sensors vs. corresponding controls (without NO release in same animals), with greatly reduced thrombus formation on their surfaces. Further, the analytical performance of the NO release glucose sensors are superior to controls placed in the veins of the same animals, with a greater accuracy in measuring blood glucose levels as evaluated using a Clarke error grid type analysis.
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Affiliation(s)
- Qinyi Yan
- Department of Chemistry, The University of Michigan, Ann Arbor, MI 48109-1055, USA
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Weidemaier K, Lastovich A, Keith S, Pitner JB, Sistare M, Jacobson R, Kurisko D. Multi-day pre-clinical demonstration of glucose/galactose binding protein-based fiber optic sensor. Biosens Bioelectron 2011; 26:4117-23. [PMID: 21549586 DOI: 10.1016/j.bios.2011.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 11/27/2022]
Abstract
We report here the first pre-clinical demonstration of continuous glucose tracking by fluorophore-labeled and genetically engineered glucose/galactose binding protein (GGBP). Acrylodan-labeled GGBP was immobilized in a hydrogel matrix at the tip of a small diameter optical fiber contained in a stainless steel needle. The fiber optic biosensors were inserted subcutaneously into Yucatan and Yorkshire swine, and the sensor response to changing glucose levels was monitored at intervals over a 7-day period. Sensor mean percent error on day 7 was 16.4±5.0% using a single daily reference blood glucose value to calibrate the sensor. The GGBP sensor's susceptibility to common interferents was tested in a well-plate system using human sera. No significant interference was observed from the tested interferents except for tetracycline at the drug's maximum plasma concentration. The robust performance of the GGBP-based fiber optic sensor in swine models and resistance to interferents indicates the potential of this technology for continuous glucose monitoring in humans.
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Kouris I, Tsirmpas C, Mougiakakou SG, Iliopoulou D, Koutsouris D. E-Health towards ecumenical framework for personalized medicine via Decision Support System. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:2881-5. [PMID: 21095976 DOI: 10.1109/iembs.2010.5626308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of the present manuscript is to present the advances performed in medicine using a Personalized Decision Support System (PDSS). The models used in Decision Support Systems (DSS) are examined in combination with Genome Information and Biomarkers to produce personalized result for each individual. The concept of personalize medicine is described in depth and application of PDSS for Cardiovascular Diseases (CVD) and Type-1 Diabetes Mellitus (T1DM) are analyzed. Parameters extracted from genes, biomarkers, nutrition habits, lifestyle and biological measurements feed DSSs, incorporating Artificial Intelligence Modules (AIM), to provide personalized advice, medication and treatment.
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Affiliation(s)
- Ioannis Kouris
- School of Electrical and Computer Engineering, National Technical University of Athens, 9 Heroon Polytechneiou Str., 15780 Zografou, Greece.
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Judge K, Morrow L, Lastovich AG, Kurisko D, Keith SC, Hartsell J, Roberts B, McVey E, Weidemaier K, Win K, Hompesch M. Continuous glucose monitoring using a novel glucose/galactose binding protein: results of a 12-hour feasibility study with the becton dickinson glucose/galactose binding protein sensor. Diabetes Technol Ther 2011; 13:309-17. [PMID: 21299393 DOI: 10.1089/dia.2010.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM This study evaluated the performance characteristics of a prototype Becton Dickinson (BD) (Franklin Lakes, NJ) glucose/galactose binding protein (GGBP) sensor placed intradermally (BD-ID) or subcutaneously (BD-SC) for continuous glucose monitoring. MATERIALS AND METHODS The performance characteristics of the prototype BD GGBP sensor after intradermal or subcutaneous placement were assessed, and its accuracy was compared with that of a glucose oxidase (GOx)-based sensor and a standard laboratory method (YSI STAT2300 analyzer, Yellow Springs Instrument, Yellow Springs, OH) under glucose clamp conditions and during an off-clamp meal challenge in 40 patients with type 1 or 2 diabetes in a 12-h feasibility study. RESULTS BD-ID and BD-SC sensors performed as well as or better than the GOx-based sensor (differences in median absolute percentage error 2-4 points in hyperglycemic and euglycemic regions, ≥ 10 points in the hypoglycemic region). For glucose values ≤ 100 mg/dL, the percentage of measurement values in consensus error plot Zone A was substantially higher with the GGBP sensors than the GOx-based sensor. CONCLUSIONS The BD prototype sensor demonstrated competitive accuracy relative to a GOx-based sensor and a YSI blood standard with a single calibration and minimal warm-up. Current development work is focused on the design and manufacture of a commercially feasible device that will include marked enhancements to device robustness and longevity.
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Affiliation(s)
- Kevin Judge
- BD Technologies , Research Triangle Park, North Carolina, USA.
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Häfeli UO, Ensom MH, Kiang TK, Stoeber B, Chua BA, Pudek M, Schmitt V. Comparison of vancomycin concentrations in blood and interstitial fluid: a possible model for less invasive therapeutic drug monitoring. ACTA ACUST UNITED AC 2011; 49:2123-5. [DOI: 10.1515/cclm.2011.727] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 09/01/2011] [Indexed: 01/07/2023]
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Rossetti P, Bondia J, Vehí J, Fanelli CG. Estimating plasma glucose from interstitial glucose: the issue of calibration algorithms in commercial continuous glucose monitoring devices. SENSORS (BASEL, SWITZERLAND) 2010; 10:10936-52. [PMID: 22163505 PMCID: PMC3231079 DOI: 10.3390/s101210936] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 09/22/2010] [Accepted: 11/25/2010] [Indexed: 11/30/2022]
Abstract
Evaluation of metabolic control of diabetic people has been classically performed measuring glucose concentrations in blood samples. Due to the potential improvement it offers in diabetes care, continuous glucose monitoring (CGM) in the subcutaneous tissue is gaining popularity among both patients and physicians. However, devices for CGM measure glucose concentration in compartments other than blood, usually the interstitial space. This means that CGM need calibration against blood glucose values, and the accuracy of the estimation of blood glucose will also depend on the calibration algorithm. The complexity of the relationship between glucose dynamics in blood and the interstitial space, contrasts with the simplistic approach of calibration algorithms currently implemented in commercial CGM devices, translating in suboptimal accuracy. The present review will analyze the issue of calibration algorithms for CGM, focusing exclusively on the commercially available glucose sensors.
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Affiliation(s)
- Paolo Rossetti
- Instituto Universitario de Automática e Informática Industrial, Universidad Politécnica de Valencia, Camino de Vera, s/n, 46022 Valencia, Spain; E-Mail:
- Dipartimento di Medicina Interna, Scienze Endocrine e Metaboliche, Università degli Studi di Perugia, Perugia, Italy; E-Mail: or
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universidad Politécnica de Valencia, Camino de Vera, s/n, 46022 Valencia, Spain; E-Mail:
| | - Josep Vehí
- Institut d’Informatica i Aplicacions, Universitat de Girona/Campus Montilivi, Girona, Spain; E-Mail:
| | - Carmine G. Fanelli
- Dipartimento di Medicina Interna, Scienze Endocrine e Metaboliche, Università degli Studi di Perugia, Perugia, Italy; E-Mail: or
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Mougiakakou SG, Bartsocas CS, Bozas E, Chaniotakis N, Iliopoulou D, Kouris I, Pavlopoulos S, Prountzou A, Skevofilakas M, Tsoukalis A, Varotsis K, Vazeou A, Zarkogianni K, Nikita KS. SMARTDIAB: a communication and information technology approach for the intelligent monitoring, management and follow-up of type 1 diabetes patients. ACTA ACUST UNITED AC 2010; 14:622-33. [PMID: 20123578 DOI: 10.1109/titb.2009.2039711] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
SMARTDIAB is a platform designed to support the monitoring, management, and treatment of patients with type 1 diabetes mellitus (T1DM), by combining state-of-the-art approaches in the fields of database (DB) technologies, communications, simulation algorithms, and data mining. SMARTDIAB consists mainly of two units: 1) the patient unit (PU); and 2) the patient management unit (PMU), which communicate with each other for data exchange. The PMU can be accessed by the PU through the internet using devices, such as PCs/laptops with direct internet access or mobile phones via a Wi-Fi/General Packet Radio Service access network. The PU consists of an insulin pump for subcutaneous insulin infusion to the patient and a continuous glucose measurement system. The aforementioned devices running a user-friendly application gather patient's related information and transmit it to the PMU. The PMU consists of a diabetes data management system (DDMS), a decision support system (DSS) that provides risk assessment for long-term diabetes complications, and an insulin infusion advisory system (IIAS), which reside on a Web server. The DDMS can be accessed from both medical personnel and patients, with appropriate security access rights and front-end interfaces. The DDMS, apart from being used for data storage/retrieval, provides also advanced tools for the intelligent processing of the patient's data, supporting the physician in decision making, regarding the patient's treatment. The IIAS is used to close the loop between the insulin pump and the continuous glucose monitoring system, by providing the pump with the appropriate insulin infusion rate in order to keep the patient's glucose levels within predefined limits. The pilot version of the SMARTDIAB has already been implemented, while the platform's evaluation in clinical environment is being in progress.
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Affiliation(s)
- Stavroula G Mougiakakou
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens 15780, Greece.
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