Effect on blood glucose monitoring of skin pressure exerted by an optical coherence tomography probe

Integrating a pressure sensor with an OCT handheld probe to facilitate imaging of microvascular information in skin tissue beds

Optical coherence tomography (OCT) and OCT angiography (OCTA) have been increasingly applied in skin imaging applications in dermatology, where the imaging is often performed with the OCT probe in contact with the skin surface. However, this contact mode imaging can introduce uncontrollable mechanical stress applied to the skin, inevitably complicating the interpretation of OCT/OCTA imaging results. There remains a need for a strategy for assessing local pressure applied on the skin during imaging acquisition. This study reports a handheld scanning probe integrated with built-in pressure sensors, allowing the operator to control the mechanical stress applied to the skin in real-time. With real time feedback information, the operator can easily determine whether the pressure applied to the skin would affect the imaging quality so as to obtain repeatable and reliable OCTA images for a more accurate investigation of skin conditions. Using this probe, imaging of palm skin was used in this study to demonstrate how the OCTA imaging would have been affected by different mechanical pressures ranging from 0 to 69 kPa. The results showed that OCTA imaging is relatively stable when the pressure is less than 11 kPa, and within this range, the change of vascular area density calculated from the OCTA imaging is below 0.13%. In addition, the probe was used to augment the OCT monitoring of blood flow changes during a reactive hyperemia experiment, in which the operator could properly control the amount of pressure applied to the skin surface and achieve full release after compression stimulation.

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.

Modern noninvasive methods for monitoring glucose levels in patients: a review

This paper presents the current state of the art of noninvasive glucose monitoring. In recent years, we can observe constant increase in the incidence of diabetes. About 40% of all performed blood tests apply to the glucose tests. Formerly, this lifestyle disease occurred mainly in rich countries, but now it is becoming more common in poorer countries. It is related to the increase in life expectancy, unhealthy diet, lack of exercise, and other factors. Untreated diabetes may cause many complications or even death. For this reason, daily control of glucose levels in people with this disorder is very important. Measurements with a traditional glucometer are connected with performing finger punctures several times a day, which is painful and uncomfortable for patients. Therefore, researches on other methods are ongoing. A method that would be fast, noninvasive and cheap could also enable testing the state of the entire population, which is necessary because of the number of people currently living with undiagnosed type 2 diabetes. Although the first glucometer was made in 1966, the first studies on glucose level measurement in tear film were documented as early as 1937. This shows how much a noninvasive method of diabetes control is needed. Since then, there have been more and more studies on alternative methods of glucose measurement, not only from tear fluid, but also from saliva, sweat, or transdermally.

Glucose Sensing Using Surface-Enhanced Raman-Mode Constraining

Diabetes mellitus is a chronic disease, and its management focuses on monitoring and lowering a patient's glucose level to prevent further complications. By tracking the glucose-induced shift in the surface-enhanced Raman-scattering (SERS) emission of mercaptophenylboronic acid (MPBA), we have demonstrated fast and continuous glucose sensing in the physiologically relevant range from 0.1 to 30 mM and verified the underlying mechanism using numerical simulations. Bonding of glucose to MPBA suppresses the "breathing" mode of MPBA at 1071 cm^-1 and energizes the constrained-bending mode at 1084 cm^-1, causing the dominant peak to shift from 1071 to 1084 cm^-1. MPBA-glucose bonding is also reversible, allowing continuous tracking of ambient glucose concentrations, and the MPBA-coated substrates showed very stable performance over a 30 day period, making the approach promising for long-term continuous glucose monitoring. Using Raman-mode-constrained, miniaturized SERS implants, we also successfully demonstrated intraocular glucose measurements in six ex vivo rabbit eyes within ±0.5 mM of readings obtained using a commercial glucose sensor.

Noninvasive blood glucose monitoring during oral intake of different sugars with optical coherence tomography in human subjects

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.

In vivo blood glucose quantification using Raman spectroscopy

We here propose a novel Raman spectroscopy method that permits the noninvasive measurement of blood glucose concentration. To reduce the effects of the strong background signals produced by surrounding tissue and to obtain the fingerprint Raman lines formed by blood analytes, a laser was focused on the blood in vessels in the skin. The Raman spectra were collected transcutaneously. Characteristic peaks of glucose (1125 cm^-1) and hemoglobin (1549 cm^-1) were observed. Hemoglobin concentration served as an internal standard, and the ratio of the peaks that appeared at 1125 cm^-1 and 1549 cm^-1 peaks was used to calculate the concentration of blood glucose. We studied three mouse subjects whose blood glucose levels became elevated over a period of 2 hours using a glucose test assay. During the test, 25 Raman spectra were collected transcutaneously and glucose reference values were provided by a blood glucose meter. Results clearly showed the relationship between Raman intensity and concentration. The release curves were approximately linear with a correlation coefficient of 0.91. This noninvasive methodology may be useful for the study of blood glucose in vivo.

Demonstration of remote optical measurement configuration that correlates to glucose concentration in blood

An optical approach allowing the extraction and the separation of remote vibration sources has recently been proposed. The approach has also been applied for medical related applications as blood pressure and heart beats monitoring. In this paper we demonstrate its capability to monitor glucose concentration in blood stream. The technique is based on the tracking of temporal changes of reflected secondary speckle produced in human skin (wrist) when being illuminated by a laser beam. A temporal change in skin's vibration profile generated due to blood pulsation is analyzed for estimating the glucose concentration. Experimental tests that were carried out in order to verify the proposed approach showed good match with the change of the glucose level at the positive slope stage as it was obtained from conventional reference measurement.

Iris as a reflector for differential absorption low-coherence interferometry to measure glucose level in the anterior chamber

We present a method of glucose concentration detection in the anterior chamber with a differential absorption optical low-coherent interferometry (LCI) technique. Back-reflected light from the iris, passing through the anterior chamber twice, was selectively obtained with the LCI technique. Two light sources, one centered within (1625 nm) and the other centered outside (1310 nm) of a glucose absorption band were used for differential absorption measurement. In the eye model and pig eye experiments, we obtained a resolution glucose level of 26.8 mg∕dL and 69.6 mg∕dL, respectively. This method has a potential application for noninvasive detection of glucose concentration in aqueous humor, which is related to the glucose concentration in blood.

Characterizing dual wavelength polarimetry through the eye for monitoring glucose

Diabetes is an insidious disease that afflicts millions of people worldwide and typically requires the person with the disease to monitor their blood sugar level via finger or forearm sticks multiple times daily. Therefore, the ability to noninvasively measure glucose would be a significant advancement for the diabetic community. The use of optically polarized light passed through the anterior chamber of the eye is one proposed noninvasive approach for glucose monitoring. However, the birefringence of the cornea and the difficulty in coupling the light across the eye have been major drawbacks toward realizing this approach. A dual wavelength optical polarimetric approach has been proposed as a means to potentially overcome the birefringence noise but has never been fully characterized. Therefore, in this paper an optical model has been developed along with experiments performed on New Zealand White rabbit eyes for characterizing the light path and corneal birefringence at two different wavelengths as they are passed through the anterior chamber of the eye. The results show that, without index matching, it is possible to couple the light in and out of the eye but only across a very limited range otherwise the light does not come back out of the eye. It was also shown that there is potential to use a dual wavelength approach to accommodate the birefringence noise of the cornea in the presence of eye motion. These results will be used to help guide the final design of the polarimetric system for use in noninvasive monitoring of glucose in vivo.

Real-time, closed-loop dual-wavelength optical polarimetry for glucose monitoring

The development of a real-time, dual-wavelength optical polarimetric system to ultimately probe the aqueous humor glucose concentrations as a means of noninvasive diabetic glucose monitoring is the long-term goal of this research. The key impact of the work is the development of an approach for the reduction of the time-variant corneal birefringence due to motion artifact, which is still a limiting factor preventing the realization of such a device. Our dual-wavelength approach utilizes real-time, closed-loop feedback that employs a classical three-term feedback controller and efficiently reduces the effect of motion artifact that appears as a common noise source for both wavelengths. In vitro results are shown for the open-loop system, and although the dual-wavelength system helps to reduce the noise, it is shown that closed-loop control is necessary to bring the noise down to a sufficient level for physiological monitoring. Specifically, in vitro measurement results with the closed-loop dual-wavelength approach demonstrate a sensitivity of 12.8 mg/dl across the physiologic glucose range in the presence of time-variant test cell birefringence. Overall, it is shown that this polarimetric system has the potential to be used as a noninvasive measure of glucose for diabetes.

Glucose sensors: a review of current and emerging technology

Glucose monitoring technology has been used in the management of diabetes for three decades. Traditional devices use enzymatic methods to measure glucose concentration and provide point sample information. More recently continuous glucose monitoring devices have become available providing more detailed data on glucose excursions. In future applications the continuous glucose sensor may become a critical component of the closed loop insulin delivery system and, as such, must be selective, rapid, predictable and acceptable for continuous patient use. Many potential sensing modalities are being pursued including optical and transdermal techniques. This review aims to summarize existing technology, the methods for assessing glucose sensing devices and provide an overview of emergent sensing modalities.