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Seo J, Kang J, Kim J, Han H, Park M, Shin M, Lee K. Smart Contact Lens for Colorimetric Visualization of Glucose Levels in the Body Fluid. ACS Biomater Sci Eng 2024. [PMID: 38778794 DOI: 10.1021/acsbiomaterials.4c00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Frequent blood glucose monitoring is a crucial routine for diabetic patients. Traditional invasive methods can cause discomfort and pain and even pose a risk of infection. As a result, researchers have been exploring noninvasive techniques. However, a limited number of products have been developed for the market due to their high cost. In this study, we developed a low-cost, highly accessible, and noninvasive contact lens-based glucose monitoring system. We functionalized the surface of the contact lens with boronic acid, which has a strong but reversible binding affinity to glucose. To achieve facile conjugation of boronic acid, we utilized a functional coating layer called poly(tannic acid). The functionalized contact lens binds to glucose in body fluids (e.g., tear) and releases it when soaked in an enzymatic cocktail, allowing for the glucose level to be quantified through a colorimetric assay. Importantly, the transparency and oxygen permeability of the contact lens, which are crucial for practical use, were maintained after functionalization, and the lenses showed high biocompatibility. Based on the analysis of colorimetric data generated by the smartphone application and ultraviolet-visible (UV-vis) spectra, we believe that this contact lens has a high potential to be used as a smart diagnostic tool for monitoring and managing blood glucose levels.
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Affiliation(s)
- Jeongin Seo
- Department of Chemistry and Green-Nano Materials Research Center, Kyungpook National University, Daegu 41566, South Korea
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Jumi Kang
- Department of Chemistry and Green-Nano Materials Research Center, Kyungpook National University, Daegu 41566, South Korea
| | - Jungwoo Kim
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University (SKKU), Suwon 16419, South Korea
| | - Hyeju Han
- Department of Chemistry and Green-Nano Materials Research Center, Kyungpook National University, Daegu 41566, South Korea
| | - Minok Park
- Energy Technologies Area, Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720, United States
| | - Mikyung Shin
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University (SKKU), Suwon 16419, South Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon 16419, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, South Korea
| | - Kyueui Lee
- Department of Chemistry and Green-Nano Materials Research Center, Kyungpook National University, Daegu 41566, South Korea
- KNU Institute of Basic Sciences and KNU G-LAMP Project Group, Kyungpook National University, Daegu 41566, South Korea
- Biomedical Research Institute, Kyungpook National University Hospital, Daegu 41940, South Korea
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2
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Åm MK, Teigen IA, Riaz M, Fougner AL, Christiansen SC, Carlsen SM. The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control. J Endocrinol Invest 2024; 47:513-521. [PMID: 37715091 PMCID: PMC10904408 DOI: 10.1007/s40618-023-02193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Diabetes mellitus type 1 is a chronic disease that implies mandatory external insulin delivery. The patients must monitor their blood glucose levels and administer appropriate insulin boluses to keep their blood glucose within the desired range. It requires a lot of time and endeavour, and many patients struggle with suboptimal glucose control despite all their efforts. MATERIALS AND METHODS This narrative review combines existing knowledge with new discoveries from animal experiments. DISCUSSION In the last decade, artificial pancreas (AP) devices have been developed to improve glucose control and relieve patients of the constant burden of managing their disease. However, a feasible and fully automated AP is yet to be developed. The main challenges preventing the development of a true, subcutaneous (SC) AP system are the slow dynamics of SC glucose sensing and particularly the delay in effect on glucose levels after SC insulin infusions. We have previously published studies on using the intraperitoneal space for an AP; however, we further propose a novel and potentially disruptive way to utilize the vasodilative properties of glucagon in SC AP systems. CONCLUSION This narrative review presents two lesser-explored viable solutions for AP systems and discusses the potential for improvement toward a fully automated system: A) using the intraperitoneal approach for more rapid insulin absorption, and B) besides using glucagon to treat and prevent hypoglycemia, also administering micro-boluses of glucagon to increase the local SC blood flow, thereby accelerating SC insulin absorption and SC glucose sensor site dynamics.
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Affiliation(s)
- M K Åm
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway.
| | - I A Teigen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Riaz
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A L Fougner
- Department of Engineering Cybernetics, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - S C Christiansen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - S M Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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3
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Wang LH, Marfil-Garza BA, Ernst AU, Pawlick RL, Pepper AR, Okada K, Epel B, Viswakarma N, Kotecha M, Flanders JA, Datta AK, Gao HJ, You YZ, Ma M, Shapiro AMJ. Inflammation-induced subcutaneous neovascularization for the long-term survival of encapsulated islets without immunosuppression. Nat Biomed Eng 2023:10.1038/s41551-023-01145-8. [PMID: 38052996 DOI: 10.1038/s41551-023-01145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/25/2023] [Indexed: 12/07/2023]
Abstract
Cellular therapies for type-1 diabetes can leverage cell encapsulation to dispense with immunosuppression. However, encapsulated islet cells do not survive long, particularly when implanted in poorly vascularized subcutaneous sites. Here we show that the induction of neovascularization via temporary controlled inflammation through the implantation of a nylon catheter can be used to create a subcutaneous cavity that supports the transplantation and optimal function of a geometrically matching islet-encapsulation device consisting of a twisted nylon surgical thread coated with an islet-seeded alginate hydrogel. The neovascularized cavity led to the sustained reversal of diabetes, as we show in immunocompetent syngeneic, allogeneic and xenogeneic mouse models of diabetes, owing to increased oxygenation, physiological glucose responsiveness and islet survival, as indicated by a computational model of mass transport. The cavity also allowed for the in situ replacement of impaired devices, with prompt return to normoglycemia. Controlled inflammation-induced neovascularization is a scalable approach, as we show with a minipig model, and may facilitate the clinical translation of immunosuppression-free subcutaneous islet transplantation.
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Affiliation(s)
- Long-Hai Wang
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY, USA
- Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Braulio A Marfil-Garza
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Alexander U Ernst
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY, USA
| | - Rena L Pawlick
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Pepper
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kento Okada
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY, USA
| | - Boris Epel
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA
- O2M Technologies, LLC, Chicago, IL, USA
| | | | | | | | - Ashim K Datta
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY, USA
| | - Hong-Jie Gao
- Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Ye-Zi You
- Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Minglin Ma
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY, USA.
| | - A M James Shapiro
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
- Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada.
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Cobelli C, Kovatchev B. Developing the UVA/Padova Type 1 Diabetes Simulator: Modeling, Validation, Refinements, and Utility. J Diabetes Sci Technol 2023; 17:1493-1505. [PMID: 37743740 PMCID: PMC10658679 DOI: 10.1177/19322968231195081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Arguably, diabetes mellitus is one of the best quantified human conditions. In the past 50 years, the metabolic monitoring technologies progressed from occasional assessment of average glycemia via HbA1c, through episodic blood glucose readings, to continuous glucose monitoring (CGM) producing data points every few minutes. The high-temporal resolution of CGM data enabled increasingly intensive treatments, from decision support assisting insulin injection or oral medication, to automated closed-loop control, known as the "artificial pancreas." Throughout this progress, mathematical models and computer simulation of the human metabolic system became indispensable for the technological progress of diabetes treatment, enabling every step, from assessment of insulin sensitivity via the now classic Minimal Model of Glucose Kinetics, to in silico trials replacing animal experiments, to automated insulin delivery algorithms. In this review, we follow these developments, beginning with the Minimal Model, which evolved through the years to become large and comprehensive and trigger a paradigm change in the design of diabetes optimization strategies: in 2007, we introduced a sophisticated model of glucose-insulin dynamics and a computer simulator equipped with a "population" of N = 300 in silico "subjects" with type 1 diabetes. In January 2008, in an unprecedented decision, the Food and Drug Administration (FDA) accepted this simulator as a substitute to animal trials for the pre-clinical testing of insulin treatment strategies. This opened the field for rapid and cost-effective development and pre-clinical testing of new treatment approaches, which continues today. Meanwhile, animal experiments for the purpose of designing new insulin treatment algorithms have been abandoned.
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Affiliation(s)
| | - Boris Kovatchev
- Center for Diabetes Technology,
University of Virginia, Charlottesville, VA, USA
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5
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Dalla Libera A, Toffanin C, Drecogna M, Galderisi A, Pillonetto G, Cobelli C. In silico design and validation of a time-varying PID controller for an artificial pancreas with intraperitoneal insulin delivery and glucose sensing. APL Bioeng 2023; 7:026105. [PMID: 37229215 PMCID: PMC10205143 DOI: 10.1063/5.0145446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease featured by the loss of beta cell function and the need for lifetime insulin replacement. Over the recent decade, the use of automated insulin delivery systems (AID) has shifted the paradigm of treatment: the availability of continuous subcutaneous (SC) glucose sensors to guide SC insulin delivery through a control algorithm has allowed, for the first time, to reduce the daily burden of the disease as well as to abate the risk for hypoglycemia. AID use is still limited by individual acceptance, local availability, coverage, and expertise. A major drawback of SC insulin delivery is the need for meal announcement and the peripheral hyperinsulinemia that, over time, contributes to macrovascular complications. Inpatient trials using intraperitoneal (IP) insulin pumps have demonstrated that glycemic control can be improved without meal announcement due to the faster insulin delivery through the peritoneal space. This calls for novel control algorithms able to account for the specificities of IP insulin kinetics. Recently, our group described a two-compartment model of IP insulin kinetics demonstrating that the peritoneal space acts as a virtual compartment and IP insulin delivery is virtually intraportal (intrahepatic), thus closely mimicking the physiology of insulin secretion. The FDA-accepted T1D simulator for SC insulin delivery and sensing has been updated for IP insulin delivery and sensing. Herein, we design and validate-in silico-a time-varying proportional integrative derivative controller to guide IP insulin delivery in a fully closed-loop mode without meal announcement.
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Affiliation(s)
- Alberto Dalla Libera
- Department of Woman and Child's Health, University of Padova, 35128 Padova, Italy
| | - Chiara Toffanin
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Martina Drecogna
- Department of Woman and Child's Health, University of Padova, 35128 Padova, Italy
| | | | - Gianluigi Pillonetto
- Department of Information Engineering, University of Padova, 35131 Padova, Italy
| | - Claudio Cobelli
- Department of Woman and Child's Health, University of Padova, 35128 Padova, Italy
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6
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High-Linearity Hydrogel-Based Capacitive Sensor Based on Con A–Sugar Affinity and Low-Melting-Point Metal. Polymers (Basel) 2022; 14:polym14204302. [PMID: 36297880 PMCID: PMC9610871 DOI: 10.3390/polym14204302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Continuous glucose monitoring (CGM) plays an important role in the treatment of diabetes. Affinity sensing based on the principle of reversible binding to glucose does not produce intermediates, and the specificity of concanavalin A (Con A) to glucose molecules helps to improve the anti-interference performance and long-term stability of CGM sensors. However, these affinity glucose sensors have some limitations in their linearity with a large detection range, and stable attachment of hydrogels to sensor electrodes is also challenging. In this study, a capacitive glucose sensor with high linearity and a wide detection range was proposed based on a glucose-responsive DexG–Con A hydrogel and a serpentine coplanar electrode made from a low-melting-point metal. The results show that within the glucose concentration range of 0–20 mM, the sensor can achieve high linearity (R2 = 0.94), with a sensitivity of 33.3 pF mM−1, and even with the larger glucose concentration range of 0–30 mM the sensor can achieve good linearity (R2 = 0.84). The sensor also shows resistance to disturbances of small molecules, good reversibility, and long-term stability. Due to its low cost, wide detection range, high linearity, good sensitivity, and biocompatibility, the sensor is expected to be used in the field of continuous monitoring of blood glucose.
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7
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Thabit H, Lal R, Leelarathna L. Automated insulin dosing systems: Advances after a century of insulin. Diabet Med 2021; 38:e14695. [PMID: 34547133 PMCID: PMC8763058 DOI: 10.1111/dme.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
The daily complexities of insulin therapy and glucose variability in type 1 diabetes still pose significant challenges, despite advancements in modern insulin analogues. Minimising hypoglycaemia and optimising time spent within target glucose range are recommended to reduce the risk of diabetes-related complications and distress. Access to structured education and adjuvant diabetes technologies, such as insulin pumps and glucose sensors, are recommended by National Institute for Health and Care Excellence (NICE) to enable people with type 1 diabetes achieve their glycaemic goals. One hundred years after the discovery of insulin, automated insulin dosing (AID, a.k.a. closed loop or artificial pancreas) systems are a reality with a number of systems available and being used in usual clinical practice. Evidence from randomised clinical trials and real-world prospective studies support efficacy, effectiveness and safety of AID systems. Qualitative evaluations reveal treatment satisfaction and positive effects on quality of life. Current insulin-only AID systems still require carbohydrate and activity announcement (hybrid closed loop) due to the inherent pharmacokinetic limitations of rapid-acting insulin analogies. Ultra-rapid acting insulin and adjunctive use of other therapies (e.g. glucagon, pramlitide) are being evaluated to achieve full closed loop. Open-source AID (OS-AID) systems have been developed by the diabetes community, driven by a desire for safety and to accelerate technological advancement. In addition to effectiveness and safety, real-world prospective studies suggest that OS-AID systems fulfil unmet needs of commercially approved systems. The development, ongoing challenges and expectations of AID are outlined in this review.
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Affiliation(s)
- Hood Thabit
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine & Paediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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8
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Puglisi SC, Mackiewicz AL, Ardeshir A, Garzel LM, Christe KL. Comparison of Insulins Glargine and Degludec in Diabetic Rhesus Macaques ( Macaca mulatta) with CGM Devices. Comp Med 2021; 71:247-255. [PMID: 34034855 DOI: 10.30802/aalas-cm-20-000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treating and monitoring type 2 diabetes mellitus (T2DM) in NHP can be challenging. Multiple insulin and hypoglycemic therapies and management tools exist, but few studies demonstrate their benefits in a NHP clinical setting. The insulins glargine and degludec are long-acting insulins; their duration of action in humans exceeds 24 and 42 h, respectively. In the first of this study's 2 components, we evaluated whether insulin degludec could be dosed daily at equivalent units to glargine to achieve comparable blood glucose (BG) reduction in diabetic rhesus macaques (Macaca mulatta) with continuous glucose monitoring (CGM) devices. The second component assessed the accuracy of CGM devices in rhesus macaques by comparing time-stamped CGM interstitial glucose values, glucometer BG readings, and BG levels measured by using an automated clinical chemistry analyzer from samples that were collected at the beginning and end of each CGM device placement. The CGM devices collected a total of 21,637 glucose data points from 6 diabetic rhesus macaques that received glargine followed by degludec every 24 h for 1 wk each. Ultimately, glucose values averaged 29 mg/dL higher with degludec than with glargine. Glucose values were comparable between the CGM device, glucometer, and chemistry analyzer, thus validating that CGM devices as reliable for measuring BG levels in rhesus macaques. Although glargine was superior to degludec when given at the same dose (units/day), both are safe and effective treatment options. Glucose values from CGM, glucometers, and chemistry analyzers provided results that were analogous to BG values in rhesus macaques. Our report further highlights critical clinical aspects of using glargine as compared with degludec in NHP and the benefits of using CGM devices in macaques.
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Affiliation(s)
| | | | - Amir Ardeshir
- California National Primate Research Center, Davis, California
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9
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Fuglerud SS, Ellingsen R, Aksnes A, Hjelme DR. Investigation of the effect of clinically relevant interferents on glucose monitoring using near-infrared spectroscopy. JOURNAL OF BIOPHOTONICS 2021; 14:e202000450. [PMID: 33583135 DOI: 10.1002/jbio.202000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
Near infrared spectroscopy (NIR) is a promising technique for continuous blood glucose monitoring for diabetic patients. Four interferents, at physiological concentrations, were introduced to study how the glucose predictions varied with a standard multivariate calibration model. Lactate and ethanol were found to interfere strongly with the glucose predictions unless they were included in the calibration models. Lactate was mistaken for glucose and gave erroneously high glucose predictions, with a dose response of 0.46 mM/mM. The presence of ethanol resulted in too low glucose predictions, with a dose response of -0.43 mM/mM. Acetaminophen, a known interferent in the glucose monitoring devices used for diabetes management today, was not found to be an interferent in NIR spectroscopy, nor was caffeine. Thus, interferents that may appear in high concentrations, such as ethanol and lactate, must be included in the calibration or model building of future NIR-based glucose measurement devices for diabetes monitoring.
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Affiliation(s)
- Silje Skeide Fuglerud
- Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs University Hospital, Trondheim, Norway
| | - Reinold Ellingsen
- Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Aksnes
- Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dag Roar Hjelme
- Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Mridha AR, Dargaville TR, Dalton PD, Carroll L, Morris MB, Vaithilingam V, Tuch BE. Prevascularized Retrievable Hybrid Implant to Enhance Function of Subcutaneous Encapsulated Islets. Tissue Eng Part A 2020; 28:212-224. [PMID: 33081600 DOI: 10.1089/ten.tea.2020.0179] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Replacement of pancreatic β-cells is one of the most promising treatment options for treatment of type 1 diabetes (T1D), even though, toxic immunosuppressive drugs are required. In this study, we aim to deliver allogeneic β-cell therapies without antirejection drugs using a bioengineered hybrid device that contains microencapsulated β-cells inside 3D polycaprolactone (PCL) scaffolds printed using melt electrospin writing (MEW). Mouse β-cell (MIN6) pseudoislets and QS mouse islets are encapsulated in alginate microcapsules, without affecting viability and insulin secretion. Microencapsulated MIN6 cells are then seeded within 3D MEW scaffolds, and these hybrid devices implanted subcutaneously in streptozotocin-treated diabetic NOD/SCID and BALB/c mice. Similar to NOD/SCID mice, blood glucose levels (BGL) are lowered from 30.1 to 4.8 mM in 25-41 days in BALB/c. In contrast, microencapsulated islets placed in prevascularized MEW scaffold 3 weeks after implantation in BALB/c mice normalize BGL (<12 mM) more rapidly, lasting for 60-105 days. The lowering of glucose levels is confirmed by an intraperitoneal glucose tolerance test. Vascularity within the implanted grafts is demonstrated and quantified by 3D-doppler ultrasound, with a linear increase over 4 weeks (r = 0.65). Examination of the device at 5 weeks shows inflammatory infiltrates of neutrophils, macrophages, and B-lymphocytes on the MEW scaffolds, but not on microcapsules, which have infrequent profibrotic walling. In conclusion, we demonstrate the fabrication of an implantable and retrievable hybrid device for vascularization and enhancing the survival of encapsulated islets implanted subcutaneously in an allotransplantation setting without immunosuppression. This study provides proof-of-concept for the application of such devices for human use, but, will require modifications to allow translation to people with T1D. Impact statement The retrievable 3D printed PCL scaffold we have produced promotes vascularization when implanted subcutaneously and allows seeded microencapsulated insulin-producing cells to normalize blood glucose of diabetic mice for at least 2 months, without the need for antirejection drugs to be administered. The scaffold is scalable for possible human use, but will require modification to ensure that normalization of blood glucose levels can be maintained long term.
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Affiliation(s)
- Auvro R Mridha
- Discipline of Physiology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia.,Australian Foundation for Diabetes Research, Sydney, Australia.,Bosch Institute, The University of Sydney, Sydney, Australia
| | - Tim R Dargaville
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Paul D Dalton
- Department of Functional Materials in Medicine and Dentistry, University of Würzburg, Würzburg, Germany
| | - Luke Carroll
- Discipline of Physiology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia.,Australian Foundation for Diabetes Research, Sydney, Australia.,Now Based at NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Michael B Morris
- Discipline of Physiology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia.,Bosch Institute, The University of Sydney, Sydney, Australia
| | - Vijayaganapathy Vaithilingam
- Australian Foundation for Diabetes Research, Sydney, Australia.,Cell Biology Inspired Tissue Engineering (CBITE), MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Bernard E Tuch
- Discipline of Physiology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia.,Australian Foundation for Diabetes Research, Sydney, Australia
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11
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Jernelv IL, Hjelme DR, Aksnes A. Infrared measurements of glucose in peritoneal fluid with a tuneable quantum cascade laser. BIOMEDICAL OPTICS EXPRESS 2020; 11:3818-3829. [PMID: 33014568 PMCID: PMC7510913 DOI: 10.1364/boe.393617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Fast and accurate continuous glucose monitoring is needed in future systems for control of blood glucose levels in type 1 diabetes patients. Direct spectroscopic measurement of glucose in the peritoneal cavity is an attractive alternative to conventional electrochemical sensors placed subcutaneously. We demonstrate the feasibility of fast glucose measurements in peritoneal fluid using a fibre-coupled tuneable mid-infrared quantum cascade laser. Mid-infrared spectra (1200-925 cm-1) of peritoneal fluid samples from pigs with physiological glucose levels (32-426 mg/dL, or 1.8-23.7 mmol/L) were acquired with a tuneable quantum cascade laser employing both transmission and attenuated total reflection (ATR) spectroscopy. Using partial least-squares regression, glucose concentrations were predicted with mean absolute percentage errors (MAPEs) of 8.7% and 12.2% in the transmission and ATR configurations, respectively. These results show that highly accurate concentration predictions are possible with mid-infrared spectroscopy of peritoneal fluid, and represent a first step towards a miniaturised optical sensor for intraperitoneal continuous glucose monitoring.
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Affiliation(s)
| | - Dag Roar Hjelme
- Department of Electronic Systems, Norwegian University of Science and Technology (NTNU), O.S. Bragstads plass 2A, 7491 Trondheim, Norway
| | - Astrid Aksnes
- Department of Electronic Systems, Norwegian University of Science and Technology (NTNU), O.S. Bragstads plass 2A, 7491 Trondheim, Norway
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12
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Toroghi MK, Cluett WR, Mahadevan R. A Personalized Multiscale Modeling Framework for Dose Selection in Precision Medicine. Ind Eng Chem Res 2020. [DOI: 10.1021/acs.iecr.0c01070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Masood Khaksar Toroghi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
| | - William R. Cluett
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
| | - Radhakrishnan Mahadevan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
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13
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Lal RA, Ekhlaspour L, Hood K, Buckingham B. Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes. Endocr Rev 2019; 40:1521-1546. [PMID: 31276160 PMCID: PMC6821212 DOI: 10.1210/er.2018-00174] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an "artificial pancreas" that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.
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Affiliation(s)
- Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Laya Ekhlaspour
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Åm MK, Fougner AL, Ellingsen R, Hjelme DR, Bösch PC, Stavdahl Ø, Carlsen SM, Christiansen SC. Why intraperitoneal glucose sensing is sometimes surprisingly rapid and sometimes slow: A hypothesis. Med Hypotheses 2019; 132:109318. [DOI: 10.1016/j.mehy.2019.109318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/19/2019] [Indexed: 01/04/2023]
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Sang AX, Lal R, August A, Danzer E, Buckingham B, Mueller CM. Fluoroscopic-assisted laparoscopic retrieval of retained glucose sensor wire from the omentum. Clin Case Rep 2019; 7:1717-1720. [PMID: 31534734 PMCID: PMC6745354 DOI: 10.1002/ccr3.2348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/24/2019] [Indexed: 11/08/2022] Open
Abstract
We describe a case in which retained wires from a continuous glucose monitor were removed from the abdominal wall and peritoneum of a 6-year-old boy. We highlight a concern for continuous glucose monitor use in children and discuss surgical techniques used to retrieve tiny, mobile objects from complex body cavities.
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Affiliation(s)
- Adam X. Sang
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine & Department of PediatricsStanford University School of MedicineStanfordCalifornia
| | - Auriel August
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Enrico Danzer
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Bruce Buckingham
- Division of Endocrinology, Department of Medicine & Department of PediatricsStanford University School of MedicineStanfordCalifornia
| | - Claudia M. Mueller
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
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16
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Ernst AU, Wang L, Ma M. Interconnected Toroidal Hydrogels for Islet Encapsulation. Adv Healthc Mater 2019; 8:e1900423. [PMID: 31111686 DOI: 10.1002/adhm.201900423] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/30/2019] [Indexed: 11/07/2022]
Abstract
Islet encapsulation and transplantation promises to improve upon current treatments for type 1 diabetes mellitus, though several limitations remain. Macroscale devices have been designed for in vivo transplantation and retrieval, but traditional geometries do not support clinically adequate mass transfer of nutrients to and insulin from the encapsulated tissue. Microcapsule technologies have improved mass transfer properties, but their clinical translation remains challenging as their complete retrieval is difficult, should the graft become a safety concern. Here, the design, characterization and testing of a novel encapsulation structure, comprised of elastomer-reinforced interconnected toroidal hydrogels is reported. These donut-shaped hydrogels feature a high surface area, higher than conventional spherical capsules of the same volume, bestowing suitable mass transport conditions, while allowing interconnection and reversible deformation for intraperitoneal implantation and retrieval. Diabetes correction up to 12 weeks and complete retrieval is achieved in a diabetic mouse model, providing a proof-of-concept for the potential application as a type 1 diabetes cell replacement therapy.
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17
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Chakrabarty A, Gregory JM, Moore LM, Williams PE, Farmer B, Cherrington AD, Lord P, Shelton B, Cohen D, Zisser HC, Doyle FJ, Dassau E. A New Animal Model of Insulin-Glucose Dynamics in the Intraperitoneal Space Enhances Closed-Loop Control Performance. JOURNAL OF PROCESS CONTROL 2019; 76:62-73. [PMID: 31178632 PMCID: PMC6548466 DOI: 10.1016/j.jprocont.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Current artificial pancreas systems (AP) operate via subcutaneous (SC) glucose sensing and SC insulin delivery. Due to slow diffusion and transport dynamics across the interstitial space, even the most sophisticated control algorithms in on-body AP systems cannot react fast enough to maintain tight glycemic control under the effect of exogenous glucose disturbances caused by ingesting meals or performing physical activity. Recent efforts made towards the development of an implantable AP have explored the utility of insulin infusion in the intraperitoneal (IP) space: a region within the abdominal cavity where the insulin-glucose kinetics are observed to be much more rapid than the SC space. In this paper, a series of canine experiments are used to determine the dynamic association between IP insulin boluses and plasma glucose levels. Data from these experiments are employed to construct a new mathematical model and to formulate a closed-loop control strategy to be deployed on an implantable AP. The potential of the proposed controller is demonstrated via in-silico experiments on an FDA-accepted benchmark cohort: the proposed design significantly outperforms a previous controller designed using artificial data (time in clinically acceptable glucose range: 97.3±1.5% vs. 90.1±5.6%). Furthermore, the robustness of the proposed closed-loop system to delays and noise in the measurement signal (for example, when glucose is sensed subcutaneously) and deleterious glycemic changes (such as sudden glucose decline due to physical activity) is investigated. The proposed model based on experimental canine data leads to the generation of more effective control algorithms and is a promising step towards fully automated and implantable artificial pancreas systems.
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Affiliation(s)
- Ankush Chakrabarty
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | | | - L. Merkle Moore
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Philip E. Williams
- Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, TN
| | - Ben Farmer
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Alan D. Cherrington
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | | | | | - Don Cohen
- Physiologic Devices, Inc., Alpine, CA
| | - Howard C. Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
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18
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Navigating Two Roads to Glucose Normalization in Diabetes: Automated Insulin Delivery Devices and Cell Therapy. Cell Metab 2019; 29:545-563. [PMID: 30840911 DOI: 10.1016/j.cmet.2019.02.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/23/2022]
Abstract
Incredible strides have been made since the discovery of insulin almost 100 years ago. Insulin formulations have improved dramatically, glucose levels can be measured continuously, and recently first-generation biomechanical "artificial pancreas" systems have been approved by regulators around the globe. However, still only a small fraction of patients with diabetes achieve glycemic goals. Replacement of insulin-producing cells via transplantation shows significant promise, but is limited in application due to supply constraints (cadaver-based) and the need for chronic immunosuppression. Over the past decade, significant progress has been made to address these barriers to widespread implementation of a cell therapy. Can glucose levels in people with diabetes be normalized with artificial pancreas systems or via cell replacement approaches? Here we review the road ahead, including the challenges and opportunities of both approaches.
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Espona-Noguera A, Etxebarria-Elezgarai J, Saenz Del Burgo L, Cañibano-Hernández A, Gurruchaga H, Blanco FJ, Orive G, Hernández RM, Benito-Lopez F, Ciriza J, Basabe-Desmonts L, Pedraz JL. Type 1 Diabetes Mellitus reversal via implantation of magnetically purified microencapsulated pseudoislets. Int J Pharm 2019; 560:65-77. [PMID: 30742984 DOI: 10.1016/j.ijpharm.2019.01.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/13/2023]
Abstract
Microencapsulation of pancreatic islets for the treatment of Type I Diabetes Mellitus (T1DM) generates a high quantity of empty microcapsules, resulting in high therapeutic graft volumes that can enhance the host's immune response. We report a 3D printed microfluidic magnetic sorting device for microcapsules purification with the objective to reduce the number of empty microcapsules prior transplantation. In this study, INS1E pseudoislets were microencapsulated within alginate (A) and alginate-poly-L-lysine-alginate (APA) microcapsules and purified through the microfluidic device. APA microcapsules demonstrated higher mechanical integrity and stability than A microcapsules, showing better pseudoislets viability and biological function. Importantly, we obtained a reduction of the graft volume of 77.5% for A microcapsules and 78.6% for APA microcapsules. After subcutaneous implantation of induced diabetic Wistar rats with magnetically purified APA microencapsulated pseudoislets, blood glucose levels were restored into normoglycemia (<200 mg/dL) for almost 17 weeks. In conclusion, our described microfluidic magnetic sorting device represents a great alternative approach for the graft volume reduction of microencapsulated pseudoislets and its application in T1DM disease.
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Affiliation(s)
- A Espona-Noguera
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - J Etxebarria-Elezgarai
- BIOMICs-microfluidics Research Group, Microfluidics Cluster UPV/EHU, University of the Basque Country, Spain
| | - L Saenz Del Burgo
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - A Cañibano-Hernández
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - H Gurruchaga
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - F J Blanco
- INIBIC-Hospital Universitario La Coruña, La Coruña, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), La Coruña, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), BTI Biotechnology Institute, Vitoria-Gasteiz, Spain
| | - Rosa M Hernández
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - F Benito-Lopez
- AMMa LOAC Research Group, Microfluidics Cluster UPV/EHU, University of the Basque Country, Spain
| | - J Ciriza
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - L Basabe-Desmonts
- BIOMICs-microfluidics Research Group, Microfluidics Cluster UPV/EHU, University of the Basque Country, Spain; Basque Foundation of Science, IKERBASQUE, Spain.
| | - J L Pedraz
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain.
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20
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Effect of sensor location on continuous intraperitoneal glucose sensing in an animal model. PLoS One 2018; 13:e0205447. [PMID: 30300416 PMCID: PMC6177183 DOI: 10.1371/journal.pone.0205447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/25/2018] [Indexed: 12/02/2022] Open
Abstract
Background In diabetes research, the development of the artificial pancreas has been a major topic since continuous glucose monitoring became available in the early 2000’s. A prerequisite for an artificial pancreas is fast and reliable glucose sensing. However, subcutaneous continuous glucose monitoring carries the disadvantage of slow dynamics. As an alternative, we explored continuous glucose sensing in the peritoneal space, and investigated potential spatial differences in glucose dynamics within the peritoneal cavity. As a secondary outcome, we compared the glucose dynamics in the peritoneal space to the subcutaneous tissue. Material and methods Eight-hour experiments were conducted on 12 anesthetised non-diabetic pigs. Four commercially available amperometric glucose sensors (FreeStyle Libre, Abbott Diabetes Care Ltd., Witney, UK) were inserted in four different locations of the peritoneal cavity and two sensors were inserted in the subcutaneous tissue. Meals were simulated by intravenous infusions of glucose, and frequent arterial blood and intraperitoneal fluid samples were collected for glucose reference. Results No significant differences were discovered in glucose dynamics between the four quadrants of the peritoneal cavity. The intraperitoneal sensors responded faster to the glucose excursions than the subcutaneous sensors, and the time delay was significantly smaller for the intraperitoneal sensors, but we did not find significant results when comparing the other dynamic parameters.
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Sánchez-Peña R, Colmegna P, Garelli F, De Battista H, García-Violini D, Moscoso-Vásquez M, Rosales N, Fushimi E, Campos-Náñez E, Breton M, Beruto V, Scibona P, Rodriguez C, Giunta J, Simonovich V, Belloso WH, Cherñavvsky D, Grosembacher L. Artificial Pancreas: Clinical Study in Latin America Without Premeal Insulin Boluses. J Diabetes Sci Technol 2018; 12:914-925. [PMID: 29998754 PMCID: PMC6134619 DOI: 10.1177/1932296818786488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial. METHODS A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller. RESULTS For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported. CONCLUSIONS The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.
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Affiliation(s)
- Ricardo Sánchez-Peña
- Instituto Tecnológico de Buenos Aires, Buenos Aires, Argentina
- National Scientific and Technical Research Council, Buenos Aires, Argentina
- Ricardo Sánchez-Peña, PhD, National Scientific and Technical Research Council (CONICET), Instituto Tecnológico de Buenos Aires (ITBA), Av Madero 399, Buenos Aires, C1106ACD, Argentina.
| | - Patricio Colmegna
- National Scientific and Technical Research Council, Buenos Aires, Argentina
- University of Virginia, Charlottesville, VA, USA
- Universidad Nacional de Quilmes, Bernal, Buenos Aires, Argentina
| | - Fabricio Garelli
- National Scientific and Technical Research Council, Buenos Aires, Argentina
- Universidad Nacional de La Plata, La Plata, Buenos Aires Argentina
| | - Hernán De Battista
- National Scientific and Technical Research Council, Buenos Aires, Argentina
- Universidad Nacional de La Plata, La Plata, Buenos Aires Argentina
| | - Demián García-Violini
- Instituto Tecnológico de Buenos Aires, Buenos Aires, Argentina
- National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Marcela Moscoso-Vásquez
- Instituto Tecnológico de Buenos Aires, Buenos Aires, Argentina
- National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Nicolás Rosales
- Universidad Nacional de La Plata, La Plata, Buenos Aires Argentina
| | - Emilia Fushimi
- National Scientific and Technical Research Council, Buenos Aires, Argentina
- Universidad Nacional de La Plata, La Plata, Buenos Aires Argentina
| | | | - Marc Breton
- University of Virginia, Charlottesville, VA, USA
| | - Valeria Beruto
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paula Scibona
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Javier Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Scholten K, Meng E. A review of implantable biosensors for closed-loop glucose control and other drug delivery applications. Int J Pharm 2018; 544:319-334. [DOI: 10.1016/j.ijpharm.2018.02.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
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Dassau E, Renard E, Place J, Farret A, Pelletier MJ, Lee J, Huyett LM, Chakrabarty A, Doyle FJ, Zisser HC. Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study. Diabetes Obes Metab 2017; 19:1698-1705. [PMID: 28474383 PMCID: PMC5742859 DOI: 10.1111/dom.12999] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/15/2023]
Abstract
AIMS To compare intraperitoneal (IP) to subcutaneous (SC) insulin delivery in an artificial pancreas (AP). RESEARCH DESIGN AND METHODS Ten adults with type 1 diabetes participated in a non-randomized, non-blinded sequential AP study using the same SC glucose sensing and Zone Model Predictive Control (ZMPC) algorithm adjusted for insulin clearance. On first admission, subjects underwent closed-loop control with SC delivery of a fast-acting insulin analogue for 24 hours. Following implantation of a DiaPort IP insulin delivery system, the identical 24-hour trial was performed with IP regular insulin delivery. The clinical protocol included 3 unannounced meals with 70, 40 and 70 g carbohydrate, respectively. Primary endpoint was time spent with blood glucose (BG) in the range of 80 to 140 mg/dL (4.4-7.7 mmol/L). RESULTS Percent of time spent within the 80 to 140 mg/dL range was significantly higher for IP delivery than for SC delivery: 39.8 ± 7.6 vs 25.6 ± 13.1 ( P = .03). Mean BG (mg/dL) and percent of time spent within the broader 70 to 180 mg/dL range were also significantly better for IP insulin: 151.0 ± 11.0 vs 190.0 ± 31.0 ( P = .004) and 65.7 ± 9.2 vs 43.9 ± 14.7 ( P = .001), respectively. Superiority of glucose control with IP insulin came from the reduced time spent in hyperglycaemia (>180 mg/dL: 32.4 ± 8.9 vs 53.5 ± 17.4, P = .014; >250 mg/dL: 5.9 ± 5.6 vs 23.0 ± 11.3, P = .0004). Higher daily doses of insulin (IU) were delivered with the IP route (43.7 ± 0.1 vs 32.3 ± 0.1, P < .001) with no increased percent time spent <70 mg/dL (IP: 2.5 ± 2.9 vs SC: 4.1 ± 5.3, P = .42). CONCLUSIONS Glycaemic regulation with fully-automated AP delivering IP insulin was superior to that with SC insulin delivery. This pilot study provides proof-of-concept for an AP system combining a ZMPC algorithm with IP insulin delivery.
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MESH Headings
- Adult
- Algorithms
- Blood Glucose/analysis
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/therapy
- Female
- France
- Glycated Hemoglobin/analysis
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infusions, Parenteral
- Infusions, Subcutaneous
- Insulin Infusion Systems/adverse effects
- Insulin Lispro/administration & dosage
- Insulin Lispro/adverse effects
- Insulin Lispro/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/therapeutic use
- Male
- Middle Aged
- Pancreas, Artificial/adverse effects
- Pilot Projects
- Proof of Concept Study
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Affiliation(s)
- Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Jérôme Place
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Anne Farret
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Marie-José Pelletier
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
| | - Justin Lee
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Lauren M. Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Ankush Chakrabarty
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Howard C. Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
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Wang B, Sun G, Qiao W, Liu Y, Qiao J, Ye W, Wang H, Wang X, Lindquist R, Wang Y, Xiao YF. Long-term blood glucose monitoring with implanted telemetry device in conscious and stress-free cynomolgus monkeys. J Endocrinol Invest 2017; 40:967-977. [PMID: 28365864 PMCID: PMC5559582 DOI: 10.1007/s40618-017-0651-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/05/2017] [Indexed: 12/12/2022]
Abstract
AIMS Continuous blood glucose monitoring, especially long-term and remote, in diabetic patients or research is very challenging. Nonhuman primate (NHP) is an excellent model for metabolic research, because NHPs can naturally develop Type 2 diabetes mellitus (T2DM) similarly to humans. This study was to investigate blood glucose changes in conscious, moving-free cynomolgus monkeys (Macaca fascicularis) during circadian, meal, stress and drug exposure. MATERIALS AND METHODS Blood glucose, body temperature and physical activities were continuously and simultaneously recorded by implanted HD-XG telemetry device for up to 10 weeks. RESULTS AND DISCUSSION Blood glucose circadian changes in normoglycemic monkeys significantly differed from that in diabetic animals. Postprandial glucose increase was more obvious after afternoon feeding. Moving a monkey from its housing cage to monkey chair increased blood glucose by 30% in both normoglycemic and diabetic monkeys. Such increase in blood glucose declined to the pre-procedure level in 30 min in normoglycemic animals and >2 h in diabetic monkeys. Oral gavage procedure alone caused hyperglycemia in both normoglycemic and diabetic monkeys. Intravenous injection with the stress hormones, angiotensin II (2 μg/kg) or norepinephrine (0.4 μg/kg), also increased blood glucose level by 30%. The glucose levels measured by the telemetry system correlated significantly well with glucometer readings during glucose tolerance tests (ivGTT or oGTT), insulin tolerance test (ITT), graded glucose infusion (GGI) and clamp. CONCLUSION Our data demonstrate that the real-time telemetry method is reliable for monitoring blood glucose remotely and continuously in conscious, stress-free, and moving-free NHPs with the advantages highly valuable to diabetes research and drug discovery.
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Affiliation(s)
- B Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - G Sun
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - W Qiao
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - Y Liu
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - J Qiao
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - W Ye
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - H Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - X Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - R Lindquist
- Data Sciences International, St. Paul, MN, USA
| | - Y Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China
| | - Y-F Xiao
- Crown Bioscience, Inc., Taicang, Jiangsu Province, The People's Republic of China.
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Sekido K, Sekido T, Kaneko A, Hosokawa M, Sato A, Sato Y, Yamazaki M, Komatsu M. Careful readings for a flash glucose monitoring system in nondiabetic Japanese subjects: individual differences and discrepancy in glucose concentrarion after glucose loading [Rapid Communication]. Endocr J 2017; 64:827-832. [PMID: 28740044 DOI: 10.1507/endocrj.ej17-0193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The FreeStyle Libre Flash Glucose Monitoring System (FGM), which can continuously measure glucose concentration in the interstitial fluid glucose (FGM-ISFG), has been in clinical use worldwide. However, it is not clear how accurately FGM-ISFG reflects plasma glucose concentration (PG). In the present study, we examined the clinical utility of FGM by oral glucose tolerance test (OGTT). In eight healthy volunteers (3 males; mean age, 41.8 y) wearing FGM sensors for 14 days, OGTT was performed during days 1-7 and days 8-14, and then both FGM-ISFG and PG were compared. Parkes error grid analysis indicated that all of 65 FGM-ISFG values were within Zone A (no effect on clinical action) and Zone B (little or no effect on clinical outcome). However, in OGTT, the mean FGM-ISFG was higher than the mean actual PG at 30, 60, and 90 minutes after loading (155.5 vs. 139.2 mg/dL, 166.2 vs. 139.2 mg/dL, 149.5 vs. 138.2 mg/dL, respectively; p<0.05). Moreover, the area under the curve of FGM-ISFG was also significantly larger than that of PG (17,626.2 vs. 15,195.0 min·mg/dL; p<0.05). In four of eight subjects, FGM-ISFG tended to be higher than PG in both OGTTs, and the greatest difference between the two values was 58 mg/dL. FGM is useful for glycemic control, whereas it is not appropriate to change therapeutic regimens based on the judgment of nocturnal hypoglycemia and postprandial hyperglycemia by FGM-ISFG. Careful attention is required for proper application of FGM.
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Affiliation(s)
- Keiko Sekido
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Sekido
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsuko Kaneko
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Manami Hosokawa
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ai Sato
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshihiko Sato
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Yamazaki
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Drug Discovery Science, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuhisa Komatsu
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Wang B, Qiao W, Ye W, Wang X, Liu Y, Wang YJ, Xiao YF. Comparison of Continuous Glucose Monitoring between Dexcom G4 Platinum and HD-XG Systems in Nonhuman Primates (Macaca Fascicularis). Sci Rep 2017; 7:9596. [PMID: 28851965 PMCID: PMC5575167 DOI: 10.1038/s41598-017-09806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/28/2017] [Indexed: 01/26/2023] Open
Abstract
Timely knowing glucose level helps diabetic patients to manage the disease, including decisions about food, physical activity and medication. This study compared two continuous glucose monitoring systems in conscious and moving-free nonhuman primates (NHPs, Macaca fascicularis). Each normoglycemic or diabetic monkey was implanted with one Dexcom G4 Platinum subcutaneously or one HD-XG glucose sensor arterially for glucose monitoring. The glucose levels measured by both telemetry devices significantly correlated with the glucometer readings. The data of oral glucose tolerance test (oGTT) showed that the glucose levels measured by either Dexcom G4 Platinum or HD-XG transmitter were very similar to glucometer readings. However, compared to HD-XG transmitter or glucometer, Dexcom G4 Platinum detected a decreased glucose peak of ivGTT with approximately 10 min delay due to interstitial glucose far behind blood glucose change. Our data showed the advantages of the telemetry systems are: (1) consecutive data collection (day and night); (2) no bleeding; (3) no anesthesia (moving freely); (4) recording natural response without physical restriction and stress; (5) less labor intensity during ivGTT and other tests; (6) quick outcomes without lab tests. This article summarized and compared the differences of the general characteristics of two continuous glucose monitoring systems in diabetic research.
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Affiliation(s)
- Bingdi Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Wei Qiao
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Weiwei Ye
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Xiaoli Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Yongqiang Liu
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Yixin Jim Wang
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China
| | - Yong-Fu Xiao
- Crown Bioscience, Inc., Taicang, Jiangsu Province, China.
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Christiansen SC, Fougner AL, Stavdahl Ø, Kölle K, Ellingsen R, Carlsen SM. A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach. Diabetes Ther 2017; 8:489-506. [PMID: 28503717 PMCID: PMC5446388 DOI: 10.1007/s13300-017-0263-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. METHODS Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach. RESULTS Most studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20-40%, and hypoglycemia is still present 1-4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5-10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. The maximum blood insulin level is reached after 45 min and the maximum glucose-lowering effect is observed after 1.5-2 h, while the glucose-lowering effect lasts for at least 5 h. CONCLUSIONS Although using a double SC AP leads to significant improvements in glucose control, the SC approach has severe limitations that hamper further progress towards a robust AP.
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Affiliation(s)
- Sverre Christian Christiansen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anders Lyngvi Fougner
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Øyvind Stavdahl
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Konstanze Kölle
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Reinold Ellingsen
- Department of Electronic Systems, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven Magnus Carlsen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Westenfelder C, Gooch A, Hu Z, Ahlstrom J, Zhang P. Durable Control of Autoimmune Diabetes in Mice Achieved by Intraperitoneal Transplantation of "Neo-Islets," Three-Dimensional Aggregates of Allogeneic Islet and "Mesenchymal Stem Cells". Stem Cells Transl Med 2017; 6:1631-1643. [PMID: 28467694 PMCID: PMC5689775 DOI: 10.1002/sctm.17-0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Novel interventions that reestablish endogenous insulin secretion and thereby halt progressive end-organ damage and prolong survival of patients with autoimmune Type 1 diabetes mellitus (T1DM) are urgently needed. While this is currently accomplished with allogeneic pancreas or islet transplants, their utility is significantly limited by both the scarcity of organ donors and life-long need for often-toxic antirejection drugs. Coadministering islets with bone marrow-derived mesenchymal stem cells (MSCs) that exert robust immune-modulating, anti-inflammatory, anti-apoptotic, and angiogenic actions, improves intrahepatic islet survival and function. Encapsulation of insulin-producing cells to prevent immune destruction has shown both promise and failures. Recently, stem cell-derived insulin secreting β-like cells induced euglycemia in diabetic animals, although their clinical use would still require encapsulation or anti-rejection drugs. Instead of focusing on further improvements in islet transplantation, we demonstrate here that the intraperitoneal administration of islet-sized "Neo-Islets" (NIs), generated by in vitro coaggregation of allogeneic, culture-expanded islet cells with high numbers of immuno-protective and cyto-protective MSCs, resulted in their omental engraftment in immune-competent, spontaneously diabetic nonobese diabetic (NOD) mice. This achieved long-term glycemic control without immunosuppression and without hypoglycemia. In preparation for an Food and Drug Administration-approved clinical trial in dogs with T1DM, we show that treatment of streptozotocin-diabetic NOD/severe combined immunodeficiency mice with identically formed canine NIs produced durable euglycemia, exclusively mediated by dog-specific insulin. We conclude that this novel technology has significant translational relevance for canine and potentially clinical T1DM as it effectively addresses both the organ donor scarcity (>80 therapeutic NI doses/donor pancreas can be generated) and completely eliminates the need for immunosuppression. Stem Cells Translational Medicine 2017;6:1631-1643.
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Affiliation(s)
- Christof Westenfelder
- Department of Medicine, Division of Nephrology, University of Utah and VA Medical Centers, Salt Lake City, Utah, USA
| | - Anna Gooch
- SymbioCellTech, LLC, Salt Lake City, Utah, USA
| | - Zhuma Hu
- SymbioCellTech, LLC, Salt Lake City, Utah, USA
| | | | - Ping Zhang
- SymbioCellTech, LLC, Salt Lake City, Utah, USA
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Fokkert MJ, van Dijk PR, Edens MA, Abbes S, de Jong D, Slingerland RJ, Bilo HJG. Performance of the FreeStyle Libre Flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res Care 2017; 5:e000320. [PMID: 28243449 PMCID: PMC5316912 DOI: 10.1136/bmjdrc-2016-000320] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/02/2017] [Accepted: 01/22/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the FreeStyle Libre Flash continuous glucose monitoring (FSL-CGM) system against established central laboratory methods. RESEARCH DESIGN AND METHODS 20 subjects (8 type 1 diabetes mellitus, 12 type 2 diabetes mellitus) were analyzed. FSL-CGM sensor measurements (inserted in arm and abdomen) were compared with capillary blood glucose results analyzed with StatStrip as semigold standard. The glucose response after a standardized oral glucose load was measured by FSL-CGM and capillary samples analyzed by perchloric acid hexokinase (PCA-HK) method, StatStrip and FSL test strip (FSLC), and a commonly used CGM system (iPro2). RESULTS FSL-CGM arm sensor readings showed 85.5% of paired readings falling within Clarke Error Grid (ISO 15197:2013) zone A when compared with StatStrip. For FSL-CGM abdomen and FSLC, these percentages were 64% and 98%, respectively. The overall correlation of FSL-CGM in the arm and the StatStrip indicates a performance with lower results with the FSL-CGM in the arm than expected based on the StatStrip in the lower glucose ranges, and higher results than expected in the higher ranges. Following a standardized glucose load, a slower rise in glucose level was observed for FSL-CGM arm as compared with PCA-HK, StatStrip, FSLC, and iPro2 during the first 45-60 min after glucose load ingestion. CONCLUSIONS Certain matters need attention while using the FSL-CGM in daily life including the observed lower values in the lower ranges, and the underestimation of the effect of a meal on glucose response. These effects of such deviations can partly be overcome by optimizing the available user instructions. TRIAL REGISTRATION NUMBER TC5348; results.
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Affiliation(s)
- M J Fokkert
- Department of Clinical Chemistry , Isala , Zwolle , The Netherlands
| | - P R van Dijk
- Isala, Diabetes Center, Zwolle, The Netherlands; Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - M A Edens
- Department Innovation and Science , Isala , Zwolle , The Netherlands
| | - S Abbes
- Department of Clinical Chemistry , Isala , Zwolle , The Netherlands
| | - D de Jong
- Department Innovation and Science , Isala , Zwolle , The Netherlands
| | - R J Slingerland
- Department of Clinical Chemistry , Isala , Zwolle , The Netherlands
| | - H J G Bilo
- Isala, Diabetes Center, Zwolle, The Netherlands; Department of Internal Medicine, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kohnert KD, Heinke P, Zander E, Vogt L, Salzsieder E. Glycemic Key Metrics and the Risk of Diabetes-Associated Complications. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2016. [DOI: 10.1515/rjdnmd-2016-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPrevention of diabetes-associated complications is closely linked to preventing and controlling hyperglycemia. Glycated hemoglobin (HbA1c), a glucose metric and a risk factor for chronic complications, is not reliable under certain clinical conditions, does not capture glyemic variability and glucose dynamics. There is evidence that glycemic variability is an independent predictor variable of hypoglycemia and a potential risk marker for vascular diabetes complications. Despite advanced glucose monitoring methods, monitoring of glucose with blood glucose meters remains indispensible as an adjunct to HbA1c measurements, because it gives direct feedback on short-term changes in glucose levels. Optimized diabetes treatment and prevention or delay of diabetes complications needs both key glucose control metrics on a daily basis, involving fasting, preprandial, and postprandial glucose levels as well as advanced, user-friendly monitoring methods. The broad application of systems for continuous glucose monitoring in clinical settings is partly hampered by lacking measures generally accepted for analysis of glucose profiles and as standards for reporting of glucose data. We performed a literature search, using PubMed and Scopus and included relevant literature published online up to March 1, 2016. In this review, we discuss the importance of several glucose measures for primary and secondary prevention of diabetes complications and possibilities for evaluation of monitored glucose data with special consideration of glycemic variability, glucose dynamics, and the utility of continuous glucose monitoring.
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Affiliation(s)
| | - Peter Heinke
- 1Institute of Diabetes “Gerhardt Katsch”, Karlsburg, Germany
| | - Eckhard Zander
- 2Clinic for Diabetes and Metabolic Diseases, Karlsburg, Germany
| | - Lutz Vogt
- 3Diabetes Service Center, Karlsburg, Germany
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Huyett LM, Mittal R, Zisser HC, Luxon ES, Yee A, Dassau E, Doyle FJ, Burnett DR. Preliminary Evaluation of a Long-Term Intraperitoneal Glucose Sensor With Flushing Mechanism. J Diabetes Sci Technol 2016; 10:1192-4. [PMID: 26993253 PMCID: PMC5032950 DOI: 10.1177/1932296816640542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Alex Yee
- Theranova, LLC, San Francisco, CA, USA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
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32
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Taylor M, Gregory R, Tomlins P, Jacob D, Hubble J, Sahota T. Closed-loop glycaemic control using an implantable artificial pancreas in diabetic domestic pig ( Sus scrofa domesticus ). Int J Pharm 2016; 500:371-8. [DOI: 10.1016/j.ijpharm.2015.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 01/30/2023]
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Stavdahl Ø, Fougner AL, Kölle K, Christiansen SC, Ellingsen R, Carlsen SM. The Artificial Pancreas: A Dynamic Challenge. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ifacol.2016.07.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huyett LM, Dassau E, Zisser HC, Doyle FJ. Design and Evaluation of a Robust PID Controller for a Fully Implantable Artificial Pancreas. Ind Eng Chem Res 2015; 54:10311-10321. [PMID: 26538805 PMCID: PMC4627627 DOI: 10.1021/acs.iecr.5b01237] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 11/28/2022]
Abstract
Treatment of type 1 diabetes mellitus could be greatly improved by applying a closed-loop control strategy to insulin delivery, also known as an artificial pancreas (AP). In this work, we outline the design of a fully implantable AP using intraperitoneal (IP) insulin delivery and glucose sensing. The design process utilizes the rapid glucose sensing and insulin action offered by the IP space to tune a PID controller with insulin feedback to provide safe and effective insulin delivery. The controller was tuned to meet robust performance and stability specifications. An anti-reset windup strategy was introduced to prevent dangerous undershoot toward hypoglycemia after a large meal disturbance. The final controller design achieved 78% of time within the tight glycemic range of 80-140 mg/dL, with no time spent in hypoglycemia. The next step is to test this controller design in an animal model to evaluate the in vivo performance.
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Affiliation(s)
- Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
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Kohnert KD, Heinke P, Vogt L, Salzsieder E. Utility of different glycemic control metrics for optimizing management of diabetes. World J Diabetes 2015; 6:17-29. [PMID: 25685275 PMCID: PMC4317309 DOI: 10.4239/wjd.v6.i1.17] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/26/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin (HbA1c). Despite its importance as an indicator for the development of diabetic complications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between HbA1c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to HbA1c in routine diabetes care is self-monitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring (CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generally accepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.
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van Dijk PR, Logtenberg SJJ, Gans ROB, Bilo HJG, Kleefstra N. Intraperitoneal insulin infusion: treatment option for type 1 diabetes resulting in beneficial endocrine effects beyond glycaemia. Clin Endocrinol (Oxf) 2014; 81:488-97. [PMID: 25041605 DOI: 10.1111/cen.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/11/2014] [Accepted: 07/03/2014] [Indexed: 11/28/2022]
Abstract
Continuous intraperitoneal insulin infusion (CIPII) is a treatment option for patients with type 1 diabetes mellitus who fail to reach adequate glycaemic control despite intensive subcutaneous (SC) insulin therapy. CIPII has clear advantages over SC insulin administration in terms of pharmacokinetic and pharmacodynamic properties and has been shown to improve glycaemic regulation. Due to the delivery of insulin predominantly in the portal vein, as opposed to systemically, CIPII offers a unique research model to investigate the effects of insulin on endocrine and metabolic parameters in vivo. The aim of the present article is to provide an overview of the literature with respect to the effects of CIPII on glucose management, quality of life, complications and costs, with additional focus on metabolic and endocrine aspects. Finally, future use and research objectives are discussed.
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