Calibration of a subcutaneous amperometric glucose sensor implanted for 7 days in diabetic patients. Part 2. Superiority of the one-point calibration method

Calibration, i.e. the transformation in real time of the signal I(t) generated by the glucose sensor at time t into an estimation of glucose concentration G(t), represents a key issue for the development of a continuous glucose monitoring system. OBJECTIVE: To compare two calibration procedures. In the one-point calibration, which assumes that I(o) is negligible, S is simply determined as the ratio I/G, and G(t) = I(t)/S. The two-point calibration consists in the determination of a sensor sensitivity S and of a background current I(o) by plotting two values of the sensor signal versus the concomitant blood glucose concentrations. The subsequent estimation of G(t) is given by G(t) = (I(t)-I(o))/S. RESEARCH DESIGN AND METHODS: A glucose sensor was implanted in the abdominal subcutaneous tissue of nine type 1 diabetic patients during 3 (n = 2) and 7 days (n = 7). The one-point calibration was performed a posteriori either once per day before breakfast, or twice per day before breakfast and dinner, or three times per day before each meal. The two-point calibration was performed each morning during breakfast. RESULTS: The percentages of points present in zones A and B of the Clarke Error Grid were significantly higher when the system was calibrated using the one-point calibration. Use of two one-point calibrations per day before meals was virtually as accurate as three one-point calibrations. CONCLUSION: This study demonstrates the feasibility of a simple method for calibrating a continuous glucose monitoring system.     

Calibration in dogs of a subcutaneous miniaturized glucose sensor using a glucose meter for blood glucose determination.

The feasibility of calibrating a glucose sensor by using a wearable glucose meter for blood glucose determination and moderate variations of blood glucose concentration was assessed. Six miniaturized glucose sensors were implanted in the subcutaneous tissue of conscious dogs, and the parameters used for the in vivo calibration of the sensor (sensitivity coefficient and extrapolated current in the absence of glucose) were determined from values of blood glucose and sensor response obtained during glucose infusion. (1) Venous plasma glucose level and venous total blood glucose level were measured simultaneously on the same sample, using a Beckman analyser and a Glucometer II, respectively. The regression between plasma glucose (x) and whole blood glucose (y) was y = 1.12x-0.08 mM (n = 114 values, r = 0.96, p = 0.0001). The error grid analysis indicated that the use of a Glucometer II for blood glucose determination was appropriate in dogs. (2) The in vivo sensitivity coefficients were 0.57 +/- 0.11 nA mM-1 when determined from plasma glucose, and 0.51 +/- 0.07 nA mM-1 when determined from whole blood glucose (t = 1.53, p = 0.18, n.s.). The background currents were 0.88 +/- 0.57 nA when determined from plasma glucose, and 0.63 +/- 0.77 nA when determined from whole blood glucose (t = 0.82, p = 0.45, n.s.). (3) The regression equation of the estimation of the subcutaneous glucose level obtained from the two methods was y = 1.04x + 0.56 mM (n = 171 values, r = 0.98, p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Rise in background current over time in a subcutaneous glucose sensor in the rabbit: relevance to calibration and accuracy

In order to calibrate a continuous glucose monitor, accurate determination of the background current (I0) is necessary, in part because I0 could change over time. We compared two methods of I0 measurement: (1), extrapolation of sensor output data (as a function of glucose level) to the intercept at zero glucose and (2) direct measurement of the output of a blank anode with no enzyme coat. We implanted telemetric sensors subcutaneously in rabbits and measured their outputs during tri-level glucose clamps once per week for 5 weeks. The two methods yielded similar results. I0 rose substantially over time and this increase reached significance during week 3 by the direct method but not until week 5 by the extrapolation method. Using the direct method, I0 rose from 3.41 (0.60-8.48 nanoamperes (nA), median and range) during week 1 to 13.42 (9.1-14.3) during week 5. Using the extrapolation method, I0 rose from 0.57 (0-16.7) during week 1 to 15.3 (12.2-21.6) during week 5. We conclude that I0 can rise over time. If this rise went undetected and was assumed to be stable, a one-point calibration procedure would overestimate glycemia in the hypoglycemic range, i.e. fail to appreciate the severity of hypoglycemia. It is recommended that during validation of a chronic glucose sensor, I0 be measured sequentially over time.     

Simultaneous determination of functional coagulation factors and competitive (PIVKA-) inhibitors based on enzyme kinetics

For a plasma containing the competitive (PIVKA-) inhibitors induced by anticoagulant treatment the coagulation time t is related to the concentrations of functional coagulation factors S (substrates) and competitive inhibitors I by t = tmin + el/S + gamma I/S with tmin being the minimum possible coagulation time and e and gamma the sensitivities of the test procedure towards a change in the concentration of functional coagulation factors and competitive inhibitors, respectively. The calibration of the test procedure can be achieved by performing a series of dilutions on an inhibitor-free plasma (determination of tmin and e) and, after that, on a plasma of known inhibitor content (determination of gamma) in both cases recording the parametrizing straight line which results from multiplying the respective equation by S. The content of functional coagulation factors and competitive inhibitors in the plasmas of anticoagulated patients then can be determined simultaneously by treating the patient's plasma like in the calibration for gamma. The proposed method should allow the complete metrological characterization of thromboplastin time reagents without any need for reference thromboplastins.     

Optimizing insulin sensitivity assessment using the minimal model in chronic heart failure.

BACKGROUND: Minimal model analysis of the intravenous glucose tolerance test (IVGTT) has been used successfully to demonstrate that patients with chronic heart failure (CHF) are insulin-resistant. Continuing experience in minimal model methodology has raised questions about how best to assign basal glucose concentrations during such analyses. METHODS AND RESULTS: IVGTT data from randomly selected patients with CHF (n = 15) and controls (n = 15) were analysed using the minimal model, with the basal glucose concentration (G (b)) assigned the value of fasting plasma glucose concentration (G (fast)), or the value of plasma glucose concentration 180 minutes after the start of the IVGTT (G (180)). Insulin sensitivity (S (I)) was significantly higher with G (b) = G (fast), than with G (b) = G (180) (controls: 5.60 +/- 0.78 vs. 3.36 +/- 0.25/min/muU/ml x 10 (4), p = 0.0017; patients 4.19 +/- 0.54 vs. 2.36 +/- 0.15/min/microU/ml x 10 (4), p = 0.0004). At G (b) = G (fast), CHF patients showed a non-significant 25 % reduction in S (I) in comparison to controls (p = 0.15). In contrast, at G (b) = G (180), CHF patients showed a significant 30 % reduction of S (I) in comparison to controls (p = 0.0018). S (I) estimates derived at G (b) = G (fast) exhibited twice the variability of those estimated using G (b) = G (180) (coefficients of variation of S (I) in patients with CHF were 50.0 % and 24.8 %, respectively). CONCLUSION: In studies of patients with CHF, greater precision and discriminatory power of insulin sensitivity estimates is obtained when the basal glucose concentration is taken as the plasma glucose concentration 180 minutes after the start of the IVGTT.     

Novel micromachined silicon sensor for continuous glucose monitoring

The construction and the application properties of a micro-machined silicon sensor for continuous glucose monitoring are presented. The sensor uses the conventional enzymatic conversion of glucose with amperometric detection of H(2)O(2). The innovation is the precise diffusion control of the analyte through a porous silicon membrane into a silicon etched cavity containing the immobilised enzyme. A variation of the number and size of the membrane pores allows to adjust the linear range of the sensor to the respective requirement. The sensor was tested in vitro as well as in clinical studies, being supplied with interstitial fluid. The cavity sensor was designed for a linear range between 0.5 and 20 mM. A signal response time of below 30 s and a signal stability exceeding 1 week is shown. By using a double cavity sensor falsification of the glucose signal by interfering substances can be compensated. In clinical trials the sensor measured continuously in interstitial fluid for up to 18 h without any signal drift and with good correlation to blood glucose reference values.     

A multilayer membrane amperometric glucose sensor fabricated using planar techniques for large-scale production

This paper reports on a multilayer membrane amperometric glucose sensor fabricated using planar techniques. It is characterized by good reproducibility and suitable for large-scale production. The glucose sensor has 82 electrode sets formed on a single glass substrate, each with a platinum working electrode (WE), a platinum counter electrode (CE) and an Ag/AgCl reference electrode (RE). The electrode sets are coated with a membrane consisting of five layers: gamma-aminopropyltriethoxysilane (gamma-APTES), Nafion, glucose oxidase (GOX), gamma-APTES and perfluorocarbon polymer (PFCP), in that order. Tests have shown that the sensor has acceptably low dispersion (relative standard deviation, R.S.D.=42.9%, n=82), a wide measurement range (1.11-111 mM) and measurement stability over a 27-day period. Measurements of the glucose concentration in a control human urine sample demonstrated that the sensor has very low dispersion (R.S.D.=2.49%, n=10).     

A flexible and wearable glucose sensor based on functional polymers with soft-MEMS techniques

A novel biosensor for glucose measurement using functional polymers was fabricated and tested. The biosensor utilizes the physical and chemical functions of hydrophobic polydimethyl siloxane (PDMS) and hydrophilic 2-methacryloyloxyethyl phosphorylcholine (MPC) copolymerized with dodecyl methacrylate (DMA). The glucose sensor was constructed by immobilizing glucose oxidase (GOD) onto a flexible hydrogen peroxide electrode (Pt working electrode and Ag/AgCl counter/reference electrode). The electrodes were fabricated using microelectromechanical systems (MEMS) techniques onto those functional polymers. The sensor showed novel functions of flexibility and it was stretchable so that the sensor could normally work when it was released after expanding to 120% longer than that of normal length. Also, basic characteristics of the sensor were evaluated. The output current of the hydrogen peroxide electrode was linearly related to the hydrogen peroxide concentration in a range of 0.20-2.50 mmol/l, with a correlation coefficient of 0.998. GOD was then immobilized onto the surface of the sensor using MPC polymer. In this case, the current output of the glucose sensor related to the glucose level over a range of 0.06-2.00 mmol/l, with a correlation coefficient of 0.997. The calibration range includes the reported concentration of tear glucose in normal human subject (0.14 mmol/l).     

A novel microbial sensor using luminous bacteria.

A novel microbial sensor system that uses luminous bacteria was developed for the determination of both glucose and toxic compounds. The sensor system consisted of a membrane with luminous bacteria immobilized upon it and a photomultiplier. Measurements were based on the in vivo intensity of the light emitted by the bacteria, as this is affected by their environment. A linear relationship was observed between increased luminescence and concentrations of glucose between 0.05 mM and 0.55 mM. The relative standard deviation was 10% for 0.55 mM glucose (n = 10). Toxic compounds such as benzalkonium chloride, sodium dodecyl sulphate and chromium(VI) were also detected by measuring the decrease in luminescence in their presence.     

Construction of a glucose sensor based on a screen-printed electrode and a novel mediator pyocyanin from Pseudomonas aeruginosa

Pyocyanin is the blue phenazine pigment produced by Pseudomonas aeruginosa. Pyocyanin production using immobilized cells was investigated. The maximum production of pyocyanin was obtained using cells immobilized in kappa-carrageenan. Moreover, 0.01% PO4(3-), 0.2% Mg(2+), 0.001% Fe(2+), 1% glycerine, 0.8% leucine and 0.8% dl-alanine were also essential for pyocyanin production. Pyocyanin was purified by chloroform extraction and silica gel column chromatography. An amperometric biosensor system using a screen-printed electrode and pyocyanin as mediator were also developed for a more accurate determination of glucose concentration. Pyocyanin, which exists in the oxidated form, was reduced by the reaction between glucose oxidase and glucose. The reduced form was then converted back to the oxidized form by an oxidative reaction on the electrode. There was a linear relation ship between sensor output currents and glucose concentrations ranging from 1 to 20mM under the following conditions: -200 mV of the applied potential, pH 5.0, and 10 U of the immobilized enzyme. The coefficient of variation was below 3% (n = 5) for the glucose sensor.     

Amperometric determination of laminarin using immobilized beta-1,3-glucanase

A novel sensor system equipped with a reactor packed with beads containing immobilized beta-1,3-glucanase and glucose oxidase was developed for the amperometric determination of laminarin concentration. The proposed sensor system consisted of a reactor, an oxygen electrode, a flow cell, a pump, a buffer tank, and a recorder. The measurement was performed with a flow injection system. The optimum conditions for the sensor system were as follows: transfer solution, pH 7.0; 0.1 M phosphate buffer solution; flow rate, 0.15 ml/min; and sample volume, 50 microl. The response was correlated to the laminarin concentration. The calibration curve was obtained between 50 and 0.5 mg/ml laminarin (R2 = 0.994). The detection limit was 50 microg/ml laminarin (the ratio of signal/noise = 3). The relative standard deviations were 2.0% (n = 15) and 2.5% (n = 15) for 0.4 and 1.0 mg/ml laminarin solutions, respectively. One assay was completed within 5 min. Results suggest that the sensor can be used not only for the analysis of seaweed and health-enhancing foods but also for monitoring the initial pollution of the marine environment.     

Development of a cataluminescence sensor for detecting benzene based on magnesium silicate hollow spheres

A novel and sensitive gas sensor was developed for the determination of benzene based on its cataluminescence (CTL) by oxidation in air on the surface of hollow magnesium silicate spheres. Luminescence characteristics and optimum conditions were investigated. Results indicated that the as‐prepared magnesium silicate hollow spheres exhibited outstanding CTL properties such as stable intensity, high signal/noise values, and short response and recovery times. Under optimized conditions, benzene exhibited a broad linear range of 1–4500 ppm, with a correlation coefficient of 0.9946 and a limit of detection (signal‐to‐noise ratio (S/N) = 3) of 0.6 ppm, which was below the standard permitted concentration. The relative standard deviation (RSD) for 100 ppm benzene was 4.3% (n = 6). Furthermore, the gas sensor system showed outstanding selectivity for benzene compared with nine other common volatile organic compounds (VOCs). The proposed gas sensor showed good characteristics of high selectivity, fast response time and long lifetime, which suggested the promising application of magnesium silicate hollow spheres as a novel highly efficient CTL sensing material. The mechanism for the improved performance was also discussed based on the experimental results. Copyright © 2014 John Wiley & Sons, Ltd.     

Direct Fick application for measurement of cardiac output in rat.

The direct Fick procedure for cardiac output determination in rat was validated by simultaneous comparison with electromagnetic flowmeter techniques. Significant coefficients of correlation were obtained between absolute cardiac output values (r = 0.789, P less than 0.001), increases (r = 0.768, P less than 0.001) and decreases (r = 0.672, P less than 0.01) in cardiac output detected by the two methods. As demonstrated in other species, cardiac output values of the Fick procedure in the rat were between 40 and 58% greater than respective electromagnetic flow probe values; however, percent changes in cardiac output obtained by the two methods were similar. The larger values of cardiac output obtained by the direct Fick method may be related, to a great extent, to the distribution of blood flow to the coronary and bronchial circulations. Fick cardiac output measurements were reproducible within rats, and the degree of variation in values among rats was similar to that obtained with the flowmeter procedure. The result indicate that the Fick meth od provides a valid estimation of cardiac output in the rat, with the ability to detect moderate changes (22-36%) in cardiac output.     

Tonometric biosensor with a differential pressure sensor for chemo-mechanical measurement of glucose

A tonometric biosensor for glucose was constructed using a chemo-mechanical reaction unit and a differential pressure sensor. The reaction unit was fabricated by using both liquid and gas cells separated by an enzyme diaphragm membrane, in which glucose oxidase was immobilized onto the single (gas cell) side of the dialysis membrane. By applying glucose solution (0, 25.0, 50.0, 100, 150 and 200 mmol/l) into the liquid cell of the chemo-mechanical reaction unit, the pressure in the gas cell decreased continuously with a steady de-pressure slope because the oxygen consumption in the gas cell was induced by the glucose oxidase (GOD) enzyme reaction at the enzyme side of the porous diaphragm membrane. The steady de-pressure slope in the gas cell showed the linear relationship with the glucose concentration in the liquid cell between 25.0 and 200.0 mmol/l (correlation coefficient of 0.998). A substrate regeneration cycle coupling GOD with l-ascorbic acid (AsA: 0, 1.0, 3.0, 10.0 and 50.0 mmol/l; as reducing reagent system) was applied to the chemo-mechanical reaction unit in order to amplify the output signal of the tonometric biosensor. 3.0 mmol/l concentration of AsA could optimally amplify the sensor signal more than 2.5 times in comparison with that of non-AsA reagent.     

Glucose sensor with improved haemocompatibilty

A new biocompatible copolymer has been synthesised and used in an electrochemical enzyme-based glucose sensor. The copolymer incorporates three segments including a monomer with an electrically neutral phosphorylcholine head group that is able to reject protein adsorption and two segments that increase the affinity to polyurethane substrate. Peel and solution circulation tests showed that this material has high attachment to polyurethane. With the new copolymer as the outermost layer and the polyurethane as the diffusion-limiting membrane, the sensor showed extended linearity up to 50 mM glucose and stable output in bovine serum for 70 h. During in vivo tests, the sensor exhibited a steady current signal and a rapid transient response when the glucose concentration was raised. These results imply that the haemocompatibility of the glucose sensor coated with the new copolymer has been improved, which is crucial for a sensor used for clinical real-time monitoring. The material may also be suitable for application to other implantable devices.     

In-vivo behaviour of hypodermically implanted microfabricated glucose sensors

The in-vivo behaviour of microfabricated GOD (glucose oxidase)/H2O2 glucose sensor implanted subcutaneously in normal anaesthetized rats has been studied. The sensor consists of a planar, three-electrode microcell, an enzyme membrane (glucose oxidase and bovine serum albumin cross-linked with glutaraldehyde) and an outer diffusion limiting polyurethane membrane. The sensor behaviour during hyperglycaemic (13.8 mM and 11.2 mM), euglycaemic (7.8 mM) and hypoglycaemic (3.5 mM) plateau levels was determined. The values of the in-vivo sensitivity (0.64 +/- 0.05 nA/mM) and background current (1.25 +/- 0.4 nA) were determined using a two-point calibration method and then used to calculate apparent subcutaneous glucose concentrations. The results show the presence of a good correlation between all the plasma glucose levels (G) and the apparent subcutaneous tissue concentrations (G'), with G' = 0.997.G - 0.066, r = 0.9782.     

New type of glucose sensor based on enzymatic conversion of gel volume into liquid column length

A way to convert the volume change of a biochemo-mechanical gel into the change in liquid column length was developed. Our trial sensor device consisted of a small compartment for incorporating the gel, a flow channel with a filled dye solution, and a poly(dimethylsiloxane) (PDMS) diaphragm by which the gel and the dye solution were separated. A lightly cross-linked N-isopropylacrylamide (NIPAAm)/acrylic acid (AA) copolymer gel with immobilized glucose oxidase was used as a sensing element. It was found that a change in the gel volume caused by the immobilized enzyme reaction was accurately converted into a change of the column length (Deltal) with the help of the PDMS diaphragm. By use of a cylindrical gel (diameter approximately 2 and thickness approximately 1 mm), the time curve of Deltal varied depending upon glucose concentration over a range of 0.2-50 mM; in particular, it is of importance that semilogarithmic plots of Deltal (in mm) against glucose concentration (in mM) can be used as a calibration curve. For glucose solutions of mM order, 1 min was enough to determine the concentrations, whereas 10 min was required for concentrations of microM order. When the measurement time was limited within 10 min, the lower detection limit was 200 microM. The response was affected by buffering capacity of the samples, but this was controllable through reduction of the sample volume. These results indicate that the present way can be used for the determination of glucose concentration.     

A novel non-enzymatic ECL sensor for glucose using palladium nanoparticles supported on functional carbon nanotubes

A novel non-enzymatic electrochemiluminescence (ECL) sensor based on palladium nanoparticles (PdNPs)–functional carbon nanotubes (FCNTs) was discovered for glucose detection. PdNPs were homogeneously modified on FCNTs using a facile spontaneous redox reaction method. Their morphologies were characterized by transmission electron microscopy (TEM). Based on ECL experimental results, the PdNPs–FCNTs–Nafion film modified electrode displayed high electrocatalytic activity towards the oxidation of glucose. The free radicals generated by the glucose oxidation reacted with the luminol anion (LH⁻), and enhanced the ECL signal. Under the optimized conditions, the linear response of ECL intensity to glucose concentration was valid in the range from 0.5 to 40 μmol L⁻¹ (r² = 0.9974) with a detection limit (S/N = 3) of 0.09 μmol L⁻¹. In addition, the modified electrode presented high resistance towards the poisoning of chloride ion, high selectivity and long-term stability. In order to verify the sensor reliability, it was applied to the determination of glucose in glucose injection samples. The results indicated that the proposed approach provided a highly sensitive, more facile method with good reproducibility for glucose determination, promising the development of a non-enzymatic ECL glucose sensor.     

Glucose sensor using immobilized whole cells of Pseudomonas fluorescens

Summary Whole cells of Pseudomonas fluorescens which utilized mainly glucose were immobilized in collagen membrane. The microbial electrode consisted of a bacteria-collagen membrane and an oxygen electrode was developed for the determination of glucose. When the electrode was inserted in a sample solution containing glucose, the current of the electrode decreased markedly with time until a steady state was reached. The response time of the electrode was 10 min by the steady state method. A linear relationship was observed between the steady state current and the concentration of glucose below 20 mg l ^–1. The minimum concentration for determination was 2 mg of glucose per liter. The reproducibility of the current was examined using the same sample solution. The current was reproducible within ±6% of the relative error when a sample solution containing 10 mg {ie343-1} of glucose was employed. The standard deviation was 0.6 mg {ie343-2} in 20 experiments. The reusability of the glucose sensor was examined using the same sample solution (10 mg {ie343-3}). No decrease in current output was observed over a two week period and 150 assays. Glucose in molasses was determined with an average relative error of 10% by the microbial electrode sensor.     

Glucose gradient differences in subcutaneous tissue of healthy volunteers assessed with ultraslow microdialysis and a nanolitre glucose sensor

The abdominal subcutaneous interstitium is easily accessible for monitoring glucose for Diabetes Mellitus research and management. The available glucose sensing devices demand frequent blood sampling by finger pricking for calibration. Moreover, there is controversy about the exact relationship between the levels of glucose in the subcutis and blood. In the present study ultra-slow microdialysis was applied for subcutaneous fluid sampling, allowing continuous measurement of glucose in an equilibrated fluid using a nanolitre size sensor. The present method avoids in vivo calibration. During an oral glucose tolerance test glucose levels were measured simultaneously in blood, in adipose tissue and loose connective tissue layers of the abdominal subcutis in seven healthy subjects. Fasting glucose levels (mM) were 2.52 +/- 0.77 in adipose tissue and 4.67 +/- 0.17 in blood, this difference increasing to 6.40 +/- 1.57 and 11.59 +/- 1.52 at maximal glucose concentration. Moreover, the kinetics of glucose in blood and adipose tissue were different. In contrast, connective tissue glucose levels differed insignificantly (4.71 +/- 0.21 fasting and 11.70 +/- 1.96 at maximum) from those in blood and correlated well (r2 = 0.962). Ultra-slow microdialysis combined with a nanolitre glucose sensor could be of benefit to patients in intensive diabetes therapy. Frequent blood sampling for in vivo calibration can be avoided by monitoring glucose in the abdominal subcutaneous loose connective tissue, rather than in the adipose tissue.