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He QY, Zhao JH, Du SM, Li DG, Luo ZW, You XQ, Liu J. Reverse iontophoresis generated by porous microneedles produces an electroosmotic flow for glucose determination. Talanta 2024; 267:125156. [PMID: 37703780 DOI: 10.1016/j.talanta.2023.125156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
Blood glucose level is a key indicator of a patient's health, notably the symptoms associated with diabetes. Painless and continuously monitored interstitial glucose is highly preferable for diabetes management. Microneedle arrays can be used as an effective but minimally invasive technique to break the skin barrier. Simultaneous reverse iontophoresis enables non-invasive interstitial fluid extraction from the intercellular matrix ≤25 mm under the skin's surface. Here, we describe an ion-conductive porous microneedle (PMN)-based glucose sensing device combined with reverse ion electroosmosis, in which glucose extraction can be significantly enhanced. Four novel benefits of ionophoresis are concurrently brought about by the charged PMN: (1) decreased transdermal resistance with the low invasive penetration of highly resistant stratum corneum; (2) a reduction of transdermal resistance through interconnectivity; (3) the movement of larger molecules through linked micropores; and (4) the production of an electroosmotic flow (EOF). The EOF generated by PMN is effectively extracted from the skin interstitial fluid for glucose concentration measurement. And this will likely contribute to the long-term home management of chronic diseases.
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Affiliation(s)
- Qi-Yao He
- School of Navigation, Jimei University, Xiamen, 361021 China; Fujian Provincial Key Laboratory of Oceanic Information Perception and Intelligent Processing, China
| | - Jia-Hao Zhao
- School of Marine Information Engineering,Jimei University, Xiamen, 361021 China
| | - Shi-Ming Du
- School of Mechanical and Automotive Engineering,Xiamen University of Technology, Xiamen, 361024 China
| | - De-Gui Li
- School of Marine Information Engineering,Jimei University, Xiamen, 361021 China; Fujian Provincial Key Laboratory of Oceanic Information Perception and Intelligent Processing, China
| | - Zhi-Wei Luo
- School of Mechanical and Automotive Engineering,Xiamen University of Technology, Xiamen, 361024 China
| | - Xue-Qiu You
- School of Marine Information Engineering,Jimei University, Xiamen, 361021 China; Fujian Provincial Key Laboratory of Oceanic Information Perception and Intelligent Processing, China.
| | - Jing Liu
- School of Marine Information Engineering,Jimei University, Xiamen, 361021 China; Fujian Provincial Key Laboratory of Oceanic Information Perception and Intelligent Processing, China.
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2
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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Insulin pumps in children - a systematic review. World J Clin Pediatr 2022; 11:463-484. [PMID: 36439904 PMCID: PMC9685680 DOI: 10.5409/wjcp.v11.i6.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus, particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues. Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development. Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.
AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care, and its advantages and disadvantages.
METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022, related to pump therapy in children and published in the English language.
RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.
CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
- Department of Pediatrics, University Medical Center, Dr. Sulaiman Al Habib Medical Group, Manama, Bahrain, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Chest Disease, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, The Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
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Li X, Huang X, Mo J, Wang H, Huang Q, Yang C, Zhang T, Chen H, Hang T, Liu F, Jiang L, Wu Q, Li H, Hu N, Xie X. A Fully Integrated Closed-Loop System Based on Mesoporous Microneedles-Iontophoresis for Diabetes Treatment. Adv Sci (Weinh) 2021; 8:e2100827. [PMID: 34081407 PMCID: PMC8373098 DOI: 10.1002/advs.202100827] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/07/2021] [Indexed: 05/13/2023]
Abstract
A closed-loop system that can mini-invasively track blood glucose and intelligently treat diabetes is in great demand for modern medicine, yet it remains challenging to realize. Microneedles technologies have recently emerged as powerful tools for transdermal applications with inherent painlessness and biosafety. In this work, for the first time to the authors' knowledge, a fully integrated wearable closed-loop system (IWCS) based on mini-invasive microneedle platform is developed for in situ diabetic sensing and treatment. The IWCS consists of three connected modules: 1) a mesoporous microneedle-reverse iontophoretic glucose sensor; 2) a flexible printed circuit board as integrated and control; and 3) a microneedle-iontophoretic insulin delivery component. As the key component, mesoporous microneedles enable the painless penetration of stratum corneum, implementing subcutaneous substance exchange. The coupling with iontophoresis significantly enhances glucose extraction and insulin delivery and enables electrical control. This IWCS is demonstrated to accurately monitor glucose fluctuations, and responsively deliver insulin to regulate hyperglycemia in diabetic rat model. The painless microneedles and wearable design endows this IWCS as a highly promising platform to improve the therapies of diabetic patients.
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Affiliation(s)
- Xiangling Li
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Xinshuo Huang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Jingshan Mo
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Hao Wang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Qiqi Huang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Cheng Yang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Tao Zhang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Hui‐Jiuan Chen
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Tian Hang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Fanmao Liu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Lelun Jiang
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Qianni Wu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- Zhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhouChina
| | - Hongbo Li
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Ning Hu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Xi Xie
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
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Reeve C, Cummings E, McLaughlin E, Smith S, Gadbois S. An Idiographic Investigation of Diabetic Alert Dogs' Ability to Learn From a Small Sample of Breath Samples From People With Type 1 Diabetes. Can J Diabetes 2019; 44:37-43.e1. [PMID: 31477521 DOI: 10.1016/j.jcjd.2019.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/22/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There is a growing market for diabetes-alert dogs but little has been published regarding their ability to reliably detect hypoglycemia. We aimed to determine whether 2 dogs could detect hypoglycemic breath samples from people with type 1 diabetes (T1D) and then transfer detection to novel hypoglycemic breath samples. METHODS Breath samples were collected from individuals with T1D during times of normo-, hypo- and hyperglycemia. Two dogs, previously trained (3 alternative forced choice) with breath samples from 3 different individuals with T1D, were presented with 3 breath samples from the same individual: 1 hypoglycemic, 1 normoglycemic and 1 hyperglycemic, and trained to identify the hypoglycemic sample using a "yes/no" procedure. The dogs' ability to transfer detection was then tested by presenting them with a novel sample set from the same individual. Then we tested whether 1 dog could transfer detection of the odour of hypoglycemia by presenting new samples from a different individual. RESULTS One dog was able to transfer detection of the odour of hypoglycemia to samples from the same individual (specificity 89%, sensitivity 62%), but a second dog was not. Results were inconclusive regarding the ability of 1 dog to transfer detection of the odour of hypoglycemia across 2 individuals. CONCLUSIONS The results suggest that some dogs can be trained to detect hypoglycemic breath of an individual with T1D, but detection may not transfer to novel samples from other individuals. Results should be interpreted with caution, as the dogs were trained with only a small number of breath samples before testing.
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Affiliation(s)
- Catherine Reeve
- Animal Welfare and Behaviour, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland; Canid and Reptile Behaviour and Olfaction Team, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Elizabeth Cummings
- IWK Health Centre, Dalhousie University Department of Pediatrics, Division of Endocrinology, Halifax, Nova Scotia, Canada
| | | | - Sonia Smith
- Canid and Reptile Behaviour and Olfaction Team, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Educational Psychology and Special Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Simon Gadbois
- Canid and Reptile Behaviour and Olfaction Team, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
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Pandey PC, Shukla S, Skoog SA, Boehm RD, Narayan RJ. Current Advancements in Transdermal Biosensing and Targeted Drug Delivery. Sensors (Basel) 2019; 19:E1028. [PMID: 30823435 PMCID: PMC6427209 DOI: 10.3390/s19051028] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/10/2023]
Abstract
In this manuscript, recent advancements in the area of minimally-invasive transdermal biosensing and drug delivery are reviewed. The administration of therapeutic entities through the skin is complicated by the stratum corneum layer, which serves as a barrier to entry and retards bioavailability. A variety of strategies have been adopted for the enhancement of transdermal permeation for drug delivery and biosensing of various substances. Physical techniques such as iontophoresis, reverse iontophoresis, electroporation, and microneedles offer (a) electrical amplification for transdermal sensing of biomolecules and (b) transport of amphiphilic drug molecules to the targeted site in a minimally invasive manner. Iontophoretic delivery involves the application of low currents to the skin as well as the migration of polarized and neutral molecules across it. Transdermal biosensing via microneedles has emerged as a novel approach to replace hypodermic needles. In addition, microneedles have facilitated minimally invasive detection of analytes in body fluids. This review considers recent innovations in the structure and performance of transdermal systems.
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Affiliation(s)
- Prem C Pandey
- Department of Chemistry, Indian Institute of Technology (BHU), Varanasi 221005, India.
| | - Shubhangi Shukla
- Department of Chemistry, Indian Institute of Technology (BHU), Varanasi 221005, India.
| | - Shelby A Skoog
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27695, USA.
| | - Ryan D Boehm
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27695, USA.
| | - Roger J Narayan
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27695, USA.
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Lim ZW, Ping Y, Miserez A. Glucose-Responsive Peptide Coacervates with High Encapsulation Efficiency for Controlled Release of Insulin. Bioconjug Chem 2018; 29:2176-2180. [DOI: 10.1021/acs.bioconjchem.8b00369] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zhi Wei Lim
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Yuan Ping
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Ali Miserez
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551 Singapore
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Oviedo S, Vehí J, Calm R, Armengol J. A review of personalized blood glucose prediction strategies for T1DM patients. Int J Numer Method Biomed Eng 2017; 33:e2833. [PMID: 27644067 DOI: 10.1002/cnm.2833] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 06/06/2023]
Abstract
This paper presents a methodological review of models for predicting blood glucose (BG) concentration, risks and BG events. The surveyed models are classified into three categories, and they are presented in summary tables containing the most relevant data regarding the experimental setup for fitting and testing each model as well as the input signals and the performance metrics. Each category exhibits trends that are presented and discussed. This document aims to be a compact guide to determine the modeling options that are currently being exploited for personalized BG prediction.
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Affiliation(s)
- Silvia Oviedo
- Institut d'Informàtica i Aplicacions, Parc Científic i Tecnològic de la Universitat de Girona, 17003, Girona, Spain
| | - Josep Vehí
- Institut d'Informàtica i Aplicacions, Universitat de Girona, Campus Montilivi, Edifici P4, 17071, Girona, Spain
| | - Remei Calm
- Institut d'Informàtica i Aplicacions, Universitat de Girona, Campus Montilivi, Edifici P4, 17071, Girona, Spain
| | - Joaquim Armengol
- Institut d'Informàtica i Aplicacions, Universitat de Girona, Campus Montilivi, Edifici P4, 17071, Girona, Spain
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Grando MA, Groat D, Soni H, Boyle M, Bailey M, Thompson B, Cook CB. Characterization of Exercise and Alcohol Self-Management Behaviors of Type 1 Diabetes Patients on Insulin Pump Therapy. J Diabetes Sci Technol 2017; 11:240-246. [PMID: 27595712 PMCID: PMC5478020 DOI: 10.1177/1932296816663746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a lack of systematic ways to analyze how diabetes patients use their insulin pumps to self-manage blood glucose to compensate for alcohol ingestion and exercise. The objective was to analyze "real-life" insulin dosing decisions occurring in conjunction with alcohol intake and exercise among patients using insulin pumps. METHODS We recruited adult type 1 diabetes (T1D) patients on insulin pump therapy. Participants were asked to maintain their daily routines, including those related to exercising and consuming alcohol, and keep a 30-day journal on exercise performed and alcohol consumed. Thirty days of insulin pump data were downloaded. Participants' actual insulin dosing behaviors were compared against their self-reported behaviors in the setting of exercise and alcohol. RESULTS Nineteen T1D patients were recruited and over 4000 interactions with the insulin pump were analyzed. The analysis exposed variability in how subjects perceived the effects of exercise/alcohol on their blood glucose, inconsistencies between self-reported and observed behaviors, and higher rates of blood glucose control behaviors for exercise versus alcohol. CONCLUSION Compensation techniques and perceptions on how exercise and alcohol affect their blood glucose levels vary between patients. Improved individualized educational techniques that take into consideration a patient's unique life style are needed to help patients effectively apply alcohol and exercise compensation techniques.
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Affiliation(s)
- Maria Adela Grando
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Maria Adela Grando, PhD, Department of Biomedical Informatics, Arizona State University, Mayo Clinic, Samuel C. Johnson Research Building, 13212 E Shea Blvd, Scottsdale, AZ 85259, USA.
| | - Danielle Groat
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Hiral Soni
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Mary Boyle
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Marilyn Bailey
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Levy BL, McCann TW, Finan DA. The Hypoglycaemia-Hyperglycaemia Minimizer System in the Management of Type 1 Diabetes. Eur Endocrinol 2016; 12:18-23. [PMID: 29632582 PMCID: PMC5813453 DOI: 10.17925/ee.2016.12.01.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/25/2016] [Indexed: 11/24/2022]
Abstract
Living with type 1 diabetes (T1D) presents many challenges in terms of daily living. Insulin users need to frequently monitor their blood glucose levels and take multiple injections per day and/or multiple boluses through an insulin infusion pump, with the consequences of failing to match the insulin dose to the body's needs resulting in hypoglycaemia and hyperglycaemia. The former can result in seizures, coma and even death; the latter can have both acute and long-term health implications. Many patients with T1D also fail to meet their treatment goals. In order to reduce the burdens of self-administering insulin, and improve efficacy and safety, there is a need to at least partially remove the patient from the loop via a closed-loop 'artificial pancreas’ system. The Hypoglycaemia-Hyperglycaemia Minimizer (HHM) System, comprising a continuous, subcutaneous insulin infusion pump, continuous glucose monitor (CGM) and closed-loop insulin dosing algorithm, is able to predict changes in blood glucose and adjust insulin delivery accordingly to help keep the patient at normal glucose levels. Early clinical data indicate that this system is feasible, effective and safe, and has the potential to dramatically improve the therapeutic outcomes and quality of life for people with T1D.
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10
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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] [What about the content of this article? (0)] [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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Kirubakaran V, Radhakrishnan TK, Sivakumaran N. Metaheuristic Patient Estimation Based Patient-Specific Fuzzy Aggregated Artificial Pancreas Design. Ind Eng Chem Res 2014. [DOI: 10.1021/ie5009647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V. Kirubakaran
- Department of Chemical Engineering and ‡Department of Instrumentation and
Control Engineering, National Institute of Technology, Tiruchirappalli 620015, India
| | - T. K. Radhakrishnan
- Department of Chemical Engineering and ‡Department of Instrumentation and
Control Engineering, National Institute of Technology, Tiruchirappalli 620015, India
| | - N. Sivakumaran
- Department of Chemical Engineering and ‡Department of Instrumentation and
Control Engineering, National Institute of Technology, Tiruchirappalli 620015, India
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Abstract
Intensive insulin therapy (IIT) has been shown to reduce micro- and macrovascular complications in patients with type 1 diabetes mellitus (T1DM). However, IIT is associated with a significant increase in severe hypoglycemic events, resulting in increased morbidity and mortality. Optimization of glycemic control without hypoglycemia (especially nocturnal) should be the next major goal for subjects on insulin treatment. The use of insulin pumps along with continuous glucose monitors (CGMs) has made it easier but requires significant resources and patient education. Research is ongoing to close the loop by integrating the pump and the CGM using different algorithms. The currently available closed-loop system is the threshold suspend. Steps needed to achieve a near-perfect closed-loop are (1) a control-to-range system that will reduce the incidence and/or severity of hyper- and/or hypoglycemia by adjusting the insulin dose and (2) a control-to-target system, a fully automated or hybrid system that sets target glucose levels to individual needs and maintains glucose levels throughout the day using insulin (unihormonal) alone or with other hormones such as glucagon or possibly pramlintide (bihormonal). Future research is also focusing on better insulin delivery devices (pumps), more accurate CGMs, better predictive algorithms, and ultra-rapid-acting insulin analogs to make the closed-loop system as physiological as possible.
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Affiliation(s)
- Viral N Shah
- 1 Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
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13
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Matsuda E, Brennan P. The effectiveness of continuous glucose monitoring for type 1 diabetic adolescents using continuous subcutaneous insulin infusion pumps: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Bothe MK, Dickens L, Reichel K, Tellmann A, Ellger B, Westphal M, Faisal AA. The use of reinforcement learning algorithms to meet the challenges of an artificial pancreas. Expert Rev Med Devices 2014; 10:661-73. [PMID: 23972072 DOI: 10.1586/17434440.2013.827515] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Melanie K Bothe
- Fresenius Kabi Deutschland GmbH, Else-Kröner-Strasse 1, 61352 Bad Homburg, Germany
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15
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Wilson RD, Bailey M, Boyle ME, Seifert KM, Cortez KY, Baker LJ, Hovan MJ, Stepanek J, Cook CB. Description and preliminary evaluation of a diabetes technology simulation course. J Diabetes Sci Technol 2013; 7:1561-6. [PMID: 24351182 PMCID: PMC3876334 DOI: 10.1177/193229681300700616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aim to provide data on a diabetes technology simulation course (DTSC) that instructs internal medicine residents in the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring system (CGMS) devices. METHODS The DTSC was implemented during calendar year 2012 and conducted in the institution's simulation center. It consisted of a set of prerequisites, a practicum, and completion of a web-based inpatient CSII-ordering simulation. DTSC participants included only those residents in the outpatient endocrinology rotation. Questionnaires were used to determine whether course objectives were met and to assess the satisfaction of residents with the course. Questionnaires were also administered before and after the endocrine rotation to gauge improvement in familiarity with CSII and CGMS technologies. RESULTS During the first year, 12 of 12 residents in the outpatient endocrinology rotation completed the DTSC. Residents reported that the course objectives were fully met. The mean satisfaction score with the course ranged from 4.0 to 4.9 (maximum, 5), with most variables rated above 4.5. Self-reported familiarity with the operation of CSII and CGMS devices increased significantly in the postrotation survey compared with that on the prerotation survey (both p < .01). CONCLUSIONS In this pilot program, simulation-based education increased the perceived familiarity of residents with CSII and CGMS technologies. In light of these preliminary findings, the course will continue to be offered, with further data accrual. Future work will involve piloting the DTSC approach among other types of providers, such as residents in other specialties or inpatient nursing staff.
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Affiliation(s)
- Rebecca D. Wilson
- Division of Education Administration, Mayo Clinic Hospital, Phoenix, Arizona
| | - Marilyn Bailey
- Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona
| | - Mary E. Boyle
- Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona
| | | | - Karla Y. Cortez
- Office of Leadership and Organization Development, Mayo Clinic Hospital, Phoenix, Arizona
| | | | | | - Jan Stepanek
- Division of Preventative, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona
- Division of Preventative, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona
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Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite SS, Deutschman C, Freire AX, Geehan D, Kohl B, Nasraway SA, Rigby M, Sands K, Schallom L, Taylor B, Umpierrez G, Mazuski J, Schunemann H. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40:3251-3276. [PMID: 23164767 DOI: 10.1097/ccm.0b013e3182653269] [Citation(s) in RCA: 372] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point. METHODS Where available, the literature was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to assess the impact of insulin infusions on outcome for general intensive care unit patients and those in specific subsets of neurologic injury, traumatic injury, and cardiovascular surgery. Elements that contribute to safe and effective insulin infusion therapy were determined through literature review and expert opinion. The majority of the literature supporting the use of insulin infusion therapy for critically ill patients lacks adequate strength to support more than weak recommendations, termed suggestions, such that the difference between desirable and undesirable effect of a given intervention is not always clear. RECOMMENDATIONS The article is focused on a suggested glycemic control end point such that a blood glucose ≥ 150 mg/dL triggers interventions to maintain blood glucose below that level and absolutely <180 mg/dL. There is a slight reduction in mortality with this treatment end point for general intensive care unit patients and reductions in morbidity for perioperative patients, postoperative cardiac surgery patients, post-traumatic injury patients, and neurologic injury patients. We suggest that the insulin regimen and monitoring system be designed to avoid and detect hypoglycemia (blood glucose ≤ 70 mg/dL) and to minimize glycemic variability.Important processes of care for insulin therapy include use of a reliable insulin infusion protocol, frequent blood glucose monitoring, and avoidance of finger-stick glucose testing through the use of arterial or venous glucose samples. The essential components of an insulin infusion system include use of a validated insulin titration program, availability of appropriate staffing resources, accurate monitoring technology, and standardized approaches to infusion preparation, provision of consistent carbohydrate calories and nutritional support, and dextrose replacement for hypoglycemia prevention and treatment. Quality improvement of glycemic management programs should include analysis of hypoglycemia rates, run charts of glucose values <150 and 180 mg/dL. The literature is inadequate to support recommendations regarding glycemic control in pediatric patients. CONCLUSIONS While the benefits of tight glycemic control have not been definitive, there are patients who will receive insulin infusion therapy, and the suggestions in this article provide the structure for safe and effective use of this therapy.
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Gan MJ, Albanese-O'Neill A, Haller MJ. Type 1 diabetes: current concepts in epidemiology, pathophysiology, clinical care, and research. Curr Probl Pediatr Adolesc Health Care 2012; 42:269-91. [PMID: 23046732 DOI: 10.1016/j.cppeds.2012.07.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease mediated by a combination of genetic and environmental triggers resulting in lymphocytic infiltration of pancreatic islets, destruction of beta cells, and lifelong dependency on exogenous insulin. Although T1D is prevalent (1 in 300) and its incidence is steadily increasing worldwide (3% per year), the exact gene-environment interactions precipitating the disease remain unknown. Living with T1D is challenging for patients, families, and caregivers. Because of the relative paucity of pediatric endocrinologists, general pediatricians and other subspecialists may occasionally be faced with the task of managing diabetes-related complaints. Herein, we provide a comprehensive review of the natural history, pathophysiology, and contemporary management of T1D. In addition, recent advances in T1D research are discussed.
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Affiliation(s)
- Mary Joyce Gan
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
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18
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Chu MKL, Chen J, Gordijo CR, Chiang S, Ivovic A, Koulajian K, Giacca A, Wu XY, Sun Y. In vitro and in vivo testing of glucose-responsive insulin-delivery microdevices in diabetic rats. Lab Chip 2012; 12:2533-2539. [PMID: 22565220 DOI: 10.1039/c2lc40139h] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We have developed glucose-responsive implantable microdevices for closed-loop delivery of insulin and conducted in vivo testing of these devices in diabetic rats. The microdevices consist of an albumin-based bioinorganic membrane that utilizes glucose oxidase (GOx), catalase (CAT) and manganese dioxide (MnO(2)) nanoparticles to convert a change in the environmental glucose level to a pH stimulus, which regulates the volume of pH-sensitive hydrogel nanoparticles and thereby the permeability of the membrane. The membrane is integrated with microfabricated PDMS (polydimethylsiloxane) structures to form compact, stand-alone microdevices, which do not require tethering wires or tubes. During in vitro testing, the microdevices showed glucose-responsive insulin release over multiple cycles at clinically relevant glucose concentrations. In vivo, the microdevices were able to counter hyperglycemia in diabetic rats over a one-week period. The in vitro and in vivo testing results demonstrated the efficacy of closed-loop biosensing and rapid response of the 'smart' insulin delivery devices.
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Affiliation(s)
- Michael K L Chu
- Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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19
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Majidi S, Maahs DM. Update on care of children with type 1 diabetes. Adv Pediatr 2012; 59:303-27. [PMID: 22789584 DOI: 10.1016/j.yapd.2012.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Shideh Majidi
- Department of Pediatrics, Children's Hospital Colorado, Aurora, 80045, USA
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20
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Matsuda E, Brennan P. The effectiveness of continuous subcutaneous insulin pumps with continuous glucose monitoring in outpatient adolescents with type 1 diabetes: A systematic review. ACTA ACUST UNITED AC 2012; 10:1-10. [DOI: 10.11124/jbisrir-2012-170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ma K, Yuen JM, Shah NC, Walsh JT, Glucksberg MR, Van Duyne RP. In vivo, transcutaneous glucose sensing using surface-enhanced spatially offset Raman spectroscopy: multiple rats, improved hypoglycemic accuracy, low incident power, and continuous monitoring for greater than 17 days. Anal Chem 2011; 83:9146-52. [PMID: 22007689 PMCID: PMC3229825 DOI: 10.1021/ac202343e] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This paper presents the latest progress on quantitative, in vivo, transcutaneous glucose sensing using surface enhanced spatially offset Raman spectroscopy (SESORS). Silver film over nanosphere (AgFON) surfaces were functionalized with a mixed self-assembled monolayer (SAM) and implanted subcutaneously in Sprague-Dawley rats. The glucose concentration was monitored in the interstitial fluid of six separate rats. The results demonstrated excellent accuracy and consistency. Remarkably, the root-mean-square error of calibration (RMSEC) (3.6 mg/dL) and the root-mean-square error of prediction (RMSEP) (13.7 mg/dL) for low glucose concentration (<80 mg/dL) is lower than the current International Organization Standard (ISO/DIS 15197) requirements. Additionally, our sensor demonstrated functionality up 17 days after implantation, including 12 days under the laser safety level for human skin exposure with only one time calibration. Therefore, our SERS based sensor shows promise for the challenge of reliable continuous glucose sensing systems for optimal glycemic control.
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Affiliation(s)
- Ke Ma
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Jonathan M. Yuen
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Nilam C. Shah
- Chemistry Department, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Joseph T. Walsh
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Matthew R. Glucksberg
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Richard P. Van Duyne
- Chemistry Department, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208
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Cengiz E, Sherr JL, Weinzimer SA, Tamborlane WV. New-generation diabetes management: glucose sensor-augmented insulin pump therapy. Expert Rev Med Devices 2011; 8:449-58. [PMID: 21728731 DOI: 10.1586/erd.11.22] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetes is one of the most common chronic disorders with an increasing incidence worldwide. Technologic advances in the field of diabetes have provided new tools for clinicians to manage this challenging disease. For example, the development of continuous subcutaneous insulin infusion systems have allowed for refinement in the delivery of insulin, while continuous glucose monitors provide patients and clinicians with a better understanding of the minute to minute glucose variability, leading to the titration of insulin delivery based on this variability when applicable. Merging of these devices has resulted in sensor-augmented insulin pump therapy, which became a major building block upon which the artificial pancreas (closed-loop systems) can be developed. This article summarizes the evolution of sensor-augmented insulin pump therapy until present day and its future applications in new-generation diabetes management.
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Affiliation(s)
- Eda Cengiz
- Pediatric Endocrinology and Diabetes, Yale School of Medicine, New Haven, CT 06520, USA.
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23
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Keenan DB, Grosman B, Clark HW, Roy A, Weinzimer SA, Shah RV, Mastrototaro JJ. Continuous glucose monitoring considerations for the development of a closed-loop artificial pancreas system. J Diabetes Sci Technol 2011; 5:1327-36. [PMID: 22226249 PMCID: PMC3262698 DOI: 10.1177/193229681100500603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Commercialization of a closed-loop artificial pancreas system that employs continuous subcutaneous insulin infusion and interstitial fluid glucose sensing has been encumbered by state-of-the-art technology. Continuous glucose monitoring (CGM) devices with improved accuracy could significantly advance development efforts. However, the current accuracy of CGM devices might be adequate for closed-loop control. METHODS The influence that known CGM limitations have on closed-loop control was investigated by integrating sources of sensor inaccuracy with the University of Virginia Padova Diabetes simulator. Non-glucose interference, physiological time lag and sensor error measurements, selected from 83 Enlite™ glucose sensor recordings with the Guardian® REAL-Time system, were used to modulate simulated plasma glucose signals. The effect of sensor accuracy on closed-loop controller performance was evaluated in silico, and contrasted with closed-loop clinical studies during the nocturnal control period. RESULTS Based on n = 2472 reference points, a mean sensor error of 14% with physiological time lags of 3.28 ± 4.62 min (max 13.2 min) was calculated for simulation. Sensor bias reduced time in target for both simulation and clinical experiments. In simulation, additive error increased time <70 mg/dl and >180 mg/dl by 0.2% and 5.6%, respectively. In-clinic, the greatest low blood glucose index values (max = 5.9) corresponded to sensor performance. CONCLUSION Sensors have sufficient accuracy for closed-loop control, however, algorithms are necessary to effectively calibrate and detect erroneous calibrations and failing sensors. Clinical closed-loop data suggest that control with a higher target of 140 mg/dl during the nocturnal period could significantly reduce the risk for hypoglycemia.
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Affiliation(s)
- D Barry Keenan
- Medtronic MiniMed, Northridge, California 91325, USA. barry.keenan@ medtronic.com
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Ritter SC, Milanick MA, Meissner KE. Encapsulation of FITC to monitor extracellular pH: a step towards the development of red blood cells as circulating blood analyte biosensors. Biomed Opt Express 2011; 2:2012-2021. [PMID: 21750776 PMCID: PMC3130585 DOI: 10.1364/boe.2.002012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/17/2011] [Accepted: 06/17/2011] [Indexed: 05/29/2023]
Abstract
A need exists for a long-term, minimally-invasive system to monitor blood analytes. For certain analytes, such as glucose in the case of diabetics, a continuous system would help reduce complications. Current methods suffer significant drawbacks, such as low patient compliance for the finger stick test or short lifetime (i.e., 3-7 days) and required calibrations for continuous glucose monitors. Red blood cells (RBCs) are potential biocompatible carriers of sensing assays for long-term monitoring. We demonstrate that RBCs can be loaded with an analyte-sensitive fluorescent dye. In the current study, FITC, a pH-sensitive fluorescent dye, is encapsulated within resealed red cell ghosts. Intracellular FITC reports on extracellular pH: fluorescence intensity increases as extracellular pH increases because the RBC rapidly equilibrates to the pH of the external environment through the chloride-bicarbonate exchanger. The resealed ghost sensors exhibit an excellent ability to reversibly track pH over the physiological pH range with a resolution down to 0.014 pH unit. Dye loading efficiency varies from 30% to 80%. Although complete loading is ideal, it is not necessary, as the fluorescence signal is an integration of all resealed ghosts within the excitation volume. The resealed ghosts could serve as a long-term (>1 to 2 months), continuous, circulating biosensor for the management of diseases, such as diabetes.
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Affiliation(s)
- Sarah C. Ritter
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Mark A. Milanick
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Kenith E. Meissner
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
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