Andreas Caduff

First human experiments with a novel non-invasive, non-optical continuous glucose monitoring system

This paper describes a non-invasive continuous glucose monitoring system based on impedance spectroscopy. Changes in the glucose concentrations can be monitored by varying the frequency in the radio band over a range, optimised to measure the impact of glucose on the impedance pattern. A number of clinical-experimental studies (hyperglycaemic excursions) were performed with healthy subjects in order to prove the applicability of this approach. The sensor used in these experiments is the size of a wristwatch and holds an open resonant circuit coupled to the skin and a circuit, performing an impedance measurement. In most cases, the experiments showed a good correlation between changes in blood glucose and the sensor recordings. A detailed description of the trials is presented. The results of this first series of experiments can be considered as a proof of concept for this novel non-invasive monitoring approach. Nevertheless, partly due to the indirect measurement, a considerable number of questions remain to be clarified.

Electrode polarization in dielectric measurements: a review

In this review, we present an overview of the state of the art concerning the fundamental properties of electrode polarization (EP) of interest in the measurement of high conductivity samples and its implications for both dielectric (DS) and impedance spectroscopy (IS). Initially a detailed description of what constitutes EP is provided and the problems that it induces. Then, we review some of the more popular models that have been used to describe the physical phenomena behind the formation of the ionic double layer. Following this we shall enumerate the common strategies used historically to correct its influence on the measured signals in DS or in IS. Finally we also review recent attempts to employ fractal electrodes to bypass the effects of EP and to offer some physical explanation as to the limitations of their use.

Dielectric spectroscopy study of specific glucose influence on human erythrocyte membranes

Time domain dielectric spectroscopy has been used to study spherical erythrocytes, suspended in diluted phosphate buffered saline (PBS) buffers at varying concentrations of D- and L-glucose at 25°C. The osmolarity for each glucose solution was adapted, equalling that of a 63% PBS (183 mOsm). The strong effect of the electrode polarization was corrected using the fractal approach in time domain. For analysis of the dielectric properties of suspensions of erythrocytes, the Maxwell–Wagner model is used for small volume fractions. Values of the permittivity and conductivity of the cell membrane were obtained from a fitting procedure according to the one-shell model. The non-monotonic and specific response of membrane electric properties on D-glucose concentrations were observed, with a dramatic decrease around 12 mM. No changes of membrane properties have been observed in the presence of increasing concentrations of L-glucose, the biologically inactive enantiomer of D-glucose. The effect is thus specific to D-glucose. The possible mechanism of specific cell reaction to D-glucose is discussed in this paper.

Non-invasive glucose monitoring in patients with Type 1 diabetes: a Multisensor system combining sensors for dielectric and optical characterisation of skin.

In vivo variations of blood glucose (BG) are affecting the biophysical characteristics (e.g. dielectric and optical) of skin and underlying tissue (SAUT) at various frequencies. However, the skin impedance spectra for instance can also be affected by other factors, perturbing the glucose related information, factors such as temperature, skin moisture and sweat, blood perfusion as well as body movements affecting the sensor-skin contact. In order to be able to correct for such perturbing factors, a Multisensor system was developed including sensors to measure the identified factors. To evaluate the quality of glucose monitoring, the Multisensor was applied in 10 patients with Type 1 diabetes. Glucose was administered orally to induce hyperglycaemic excursions at two different study visits. For analysis of the sensor signals, a global multiple linear regression model was derived. The respective coefficients of the variables were determined from the sensor signals of this first study visit (R(2)=0.74, MARD=18.0%--mean absolute relative difference). The identical set of modelling coefficients of the first study visit was re-applied to the test data of the second study visit to evaluate the predictive power of the model (R(2)=0.68, MARD=27.3%). It appears as if the Multisensor together with the global linear regression model applied, allows for tracking glucose changes non-invasively in patients with diabetes without requiring new model coefficients for each visit. Confirmation of these findings in a larger study group and under less experimentally controlled conditions is required for understanding whether a global parameterisation routine is feasible.

The electromagnetic response of human skin in the millimetre and submillimetre wave range

Recent studies of the minute morphology of the skin by optical coherence tomography revealed that the sweat ducts in human skin are helically shaped tubes, filled with a conductive aqueous solution. This, together with the fact that the dielectric permittivity of the dermis is higher than that of the epidermis, brings forward the supposition that as electromagnetic entities, the sweat ducts could be regarded as low Q helical antennas. The implications of this statement were further investigated by electromagnetic simulation and experiment of the in vivo reflectivity of the skin of subjects under varying physiological conditions (Feldman et al 2008 Phys. Rev. Lett. 100 128102). The simulation and experimental results are in a good agreement and both demonstrate that sweat ducts in the skin could indeed behave as low Q antennas. Thus, the skin spectral response in the sub-Terahertz region is governed by the level of activity of the perspiration system and shows the minimum of reflectivity at some frequencies in the frequency band of 75-110 GHz. It is also correlated to physiological stress as manifested by the pulse rate and the systolic blood pressure. As such, it has the potential to become the underlying principle for remote sensing of the physiological parameters and the mental state of the examined subject.

Cutaneous Blood Perfusion as a Perturbing Factor for Noninvasive Glucose Monitoring

It is widely accepted that noninvasive glucose monitoring (NIGM) has the potential to revolutionize diabetes therapy. However, current approaches to NIGM studied to date have not yet demonstrated a level of acceptable functionality to allow real-time use, beyond restricted fields of application. A number of reviews have been devoted to the subject of NIGM with different focuses related to challenges and a description of the respective underlying problems. This review is aimed at addressing a fundamental topic in the application of NIGM that seems to have received less attention, by describing the perturbations that result in a reduced functionality of NIGM in daily use. Here we provide a short general introduction to glucose monitoring and a basic illustration of the electromagnetic spectrum with a description of the respective physical mechanisms underlying the measurement techniques. This allows for a better understanding of how these perturbing factors affect the measured properties. Cutaneous blood perfusion is one of the major perturbing factors to NIGM, along with variations in temperature, migration of water, and the effect of attachment of the sensor to the skin. An understanding of the mechanisms underlying perfusion variation over time and within the measured human skin tissue matrix is required to enable a discrimination between glucose-induced effects within the tissue and various biophysical impacts to be made. It is suggested that a plurality of probing frequencies is required to discriminate glucose-related changes from the perturbations. A system designed to perform the measurements in different regions of the electromagnetic spectrum with dedicated sensors (multisensor approach) has the potential to more efficiently and reliably discriminate glucose-related information from perturbations. This can be achieved by combining signals related to measurements with different physical underlying mechanisms of the interaction between the probing field propagation and the tissue to help account for the different sources of perturbations.

Characteristics of a multisensor system for non invasive glucose monitoring with external validation and prospective evaluation

The Multisensor Glucose Monitoring System (MGMS) features non invasive sensors for dielectric characterisation of the skin and underlying tissue in a wide frequency range (1 kHz-100 MHz, 1 and 2 GHz) as well as optical characterisation. In this paper we describe the results of using an MGMS in a miniaturised housing with fully integrated sensors and battery. Six patients with Type I Diabetes Mellitus (age 44±16 y; BMI 24.1±1.3 kg/m(2), duration of diabetes 27±12 y; HbA1c 7.3±1.0%) wore a single Multisensor at the upper arm position and performed a total of 45 in-clinic study days with 7 study days per patient on average (min. 5 and max. 10). Glucose changes were induced either orally or by i.v. glucose administration and the blood glucose was measured routinely. Several prospective data evaluation routines were applied to evaluate the data. The results are shown using one of the restrictive data evaluation routines, where measurements from the first 22 study days were used to train a linear regression model. The global model was then prospectively applied to the data of the remaining 23 study days to allow for an external validation of glucose prediction. The model application yielded a Mean Absolute Relative Difference of 40.8%, a Mean Absolute Difference of 51.9 mg dL(-1), and a correlation of 0.84 on average per study day. The Clarke error grid analyses showed 89.0% in A+B, 4.5% in C, 4.6% in D and 1.9% in the E region. Prospective application of a global, purely statistical model, demonstrates that glucose variations can be tracked non invasively by the MGMS in most cases under these conditions.

Dielectric response of biconcave erythrocyte membranes to D- and L-Glucose

In this paper, we report on the influence of D- and L-glucose on the dielectric properties of native shaped (biconcave) human erythrocytes using time domain dielectric spectroscopy. The dielectric spectra of biconcave cells were analysed using a modified form of the model originally reported for spheroid particle suspensions (Asami and Yonezawa 1995 Biochim. Biophys. Acta. 1245 317–24) The observed increase in the specific membrane capacitance of the biconcave erythrocytes was correlated with an increase in the concentration of D-glucose. In contrast, no associated correlation was found to changes in the membrane capacitance with increasing concentrations of L-glucose. A similar analysis of the dielectric response of osmotically swollen erythrocytes to changes in D-glucose concentration revealed a significantly different calculated specific cell membrane capacitance at elevated (>12 mM) D-glucose concentrations. The paper outlines and discusses the possible biochemical mechanisms that could be responsible for the measured dielectric properties of the erythrocyte membrane capacitances.

Non-Invasive Continuous Glucose Monitoring with Multi-Sensor Systems: A Monte Carlo-Based Methodology for Assessing Calibration Robustness

In diabetes research, non-invasive continuous glucose monitoring (NI-CGM) devices represent a new and appealing frontier. In the last years, some multi-sensor devices for NI-CGM have been proposed, which exploit several sensors measuring phenomena of different nature, not only for measuring glucose related signals, but also signals reflecting some possible perturbing processes (temperature, blood perfusion). Estimation of glucose levels is then obtained combining these signals through a mathematical model which requires an initial calibration step exploiting one reference blood glucose (RBG) sample. Even if promising results have been obtained, especially in hospitalized volunteers, at present the temporal accuracy of NI-CGM sensors may suffer because of environmental and physiological interferences. The aim of this work is to develop a general methodology, based on Monte Carlo (MC) simulation, to assess the robustness of the calibration step used by NI-CGM devices against these disturbances. The proposed methodology is illustrated considering two examples: the first concerns the possible detrimental influence of sweat events, while the second deals with calibration scheduling. For implementing both examples, 45 datasets collected by the Solianis Multisensor system are considered. In the first example, the MC methodology suggests that no further calibration adjustments are needed after the occurrence of sweat events, because the “Multisensor+model” system is able to deal with the disturbance. The second case study shows how to identify the best time interval to update the models calibration for improving the accuracy of the estimated glucose. The methodology proposed in this work is of general applicability and can be helpful in making those incremental steps in NI-CGM devices development needed to further improve their performance.

Data Processing for Noninvasive Continuous Glucose Monitoring with a Multisensor Device

Background: Impedance spectroscopy has been shown to be a candidate for noninvasive continuous glucose monitoring in humans. However, in addition to glucose, other factors also have effects on impedance characteristics of the skin and underlying tissue. Method: Impedance spectra were summarized through a principal component analysis and relevant variables were identified with Akaikes information criterion. In order to model blood glucose, a linear least-squares model was used. A Monte Carlo simulation was applied to examine the effects of personalizing models. Results: The principal component analysis was able to identify two major effects in the impedance spectra: A blood glucose-related process and an equilibration process related to moisturization of the skin and underlying tissue. With a global linear least-squares model, a coefficient of determination (R 2) of 0.60 was achieved, whereas the personalized model reached an R 2 of 0.71. The Monte Carlo simulation proved a significant advantage of personalized models over global models. Conclusion: A principal component analysis is useful for extracting glucose-related effects in the impedance spectra of human skin. A linear global model based on Solianis Multisensor data yields a good predictive power for blood glucose estimation. However, a personalized linear model still has greater predictive power.