Subcutaneous Glucose Concentration in Humans: Real estimation and continuous monitoring

Sternberg, F; Meyerhoff, C; Mennel, Franz J; Bischof, F; Pfeiffer, E. F.

doi:10.2337/diacare.18.9.1266

Cited by 65 publications

(31 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is no consensus in the literature on the absolute tissue glucose concentration compared to blood, however most data point to a ratio of 70% to 100% during steady state conditions. 7,8 There are also limited data on the variability between sites and subjects, or possible differences between subjects with diabetes and healthy subjects. Since we have shown previously 3 that the intersubject sensor response is not significantly different in healthy subjects, we specified the inclusion criteria for this study to only enroll subjects with diabetes ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Factory Calibration for Subcutaneous Glucose Sensors in Subjects With Diabetes

Hoss

Budiman

Liu

et al. 2014

J Diabetes Sci Technol

View full text Add to dashboard Cite

Background: Continuous glucose monitoring using subcutaneously inserted sensors currently requires blood glucose tests for sensor calibration. Alternatively, sensors precalibrated during the manufacturing process may eliminate the need for fingerstick calibrations. In this study we evaluated the feasibility of sensor factory calibration in subjects with diabetes. Methods: A total of 33 subjects with diabetes were asked to wear 4 sensors in parallel, 2 on the arm and 2 on the abdomen. Sensors from a lot with low in vitro sensitivity coefficient of variation were used in the study. Based on frequent capillary blood glucose measurements, the average glucose sensitivity of each sensor was determined over a 5-day wear time. The in vivo sensitivities were analyzed for inter-and intrasubject variation. Mean absolute relative difference (MARD) calculation and consensus error grid analysis (EGA) were performed using a single calibration factor for all sensors, to simulate factory calibration and compared against conventional finger-stick calibration. Results: The sensitivity coefficient of variation between sensors increased from 2.9% in vitro to 6.0% in vivo. No difference in sensor response between subjects (P = .069) as well as between insertion sites (arm and abdomen) was detected (P = .104). Applying one calibration factor to all sensors in the study resulted in an MARD of 13.4%, and 83.5% of the values fell in consensus EGA zone A. Multiple fingerstick calibration resulted in an MARD of 12.7% and 84.1% in zone A. Conclusions: Feasibility of factory calibration was demonstrated in subjects with diabetes using sensors based on "wired enzyme" technology, resulting in accuracy metrics similar to sensors calibrated with capillary blood glucose.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility of Factory Calibration for Subcutaneous Glucose Sensors in Subjects With Diabetes

Hoss

Budiman

Liu

et al. 2014

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…Automated delivery of insulin is projected to reduce the mean BG by responding promptly to hyperglycemic excursions. [3][4][5][6][7][8] However, as mean BG levels are lowered, the risk of overadministration of insulin by automated delivery systems increases, in part owing to the delayed absorption of insulin delivered subcutaneously. Earlier studies testing automated subcutaneous insulin delivery systems in experiments lasting 24 hours or more reported multiple episodes of hypoglycemia in several subjects.…”

Section: Introductionmentioning

confidence: 99%

Efficacy Determinants of Subcutaneous Microdose Glucagon during Closed-Loop Control

Russell

El-Khatib

Nathan

et al. 2010

J Diabetes Sci Technol

View full text Add to dashboard Cite

“…For the plasma sodium concentration, a constant concentration was applied for all patients (see CONCLU-SIONS). SATg, as calculated using the ionic reference technique, is lower compared with the actual arterial blood glucose concentration (19,20). Therefore, as a second calibration step, SATg was calibrated to blood glucose using a one-point calibration procedure.…”

Section: Calculations and Calibrationmentioning

confidence: 99%

Clinical Evaluation of Alternative-Site Glucose Measurements in Patients After Major Cardiac Surgery

et al. 2006

View full text Add to dashboard Cite

OBJECTIVE -Tight glycemic control improves outcome in critically ill patients but requires frequent glucose measurements. Subcutaneous adipose tissue (SAT) has been characterized as promising for glucose monitoring in diabetes, but it remains unknown whether it can also be used as an alternative site in critically ill patients. The present study was performed to clinically evaluate the relation of glucose in SAT compared with arterial blood in patients after major cardiac surgery.RESEARCH DESIGN AND METHODS -Forty critically ill patients were investigated at two clinical centers after major cardiac surgery. Arterial blood and SAT microdialysis samples were taken in hourly intervals for a period of up to 48 h. The glucose concentration in dialysate was calibrated using a two-step approach, first using the ionic reference technique to calculate the SAT glucose concentration (SATg) and second using a one-point calibration procedure to obtain a glucose profile comparable to SAT-derived blood glucose (BgSAT). Clinical validation of the data was performed by introducing data analysis based on an insulin titration algorithm. CONCLUSIONS -The results indicate good correlation between SATg and blood glucose in patients after major cardiac surgery. Clinical evaluation of the data suggests that with minor limitations, glucose from SAT can be used to establish tight glycemic control in this patient group. RESULTS Diabetes Care 29:1275-1281, 2006M aintaining critically ill patients within strict glycemic limits can dramatically reduce mortality, risk of infection, and other complications and also has substantial socioeconomic impact (1-3). Due to administration of varying doses of parenteral and enteral nutrition, intravenous infusion of medications that affect glucose metabolism, and development of acute insulin resistance during sepsis, tight glycemic control can only be granted by frequent blood glucose monitoring. Although most critically ill and hospitalized patients have routinely placed venous or arterial access lines, glycemic control is still inadequate.The unmanageable workload for the nursing staff and the prevalent fear of hypoglycemia among critical care physicians hinders the implementation of glycemic control in the intensive care unit (ICU) (4).For diabetic patients, alternative-site glucose testing to achieve better, continuous, or automated feedback control of glycemia has been sought for a long time (5-7). Thanks to minimal invasiveness and good correlation with blood glucose, subcutaneous adipose tissue (SAT) is probably the most investigated alternative sampling site (8 -13). Glucose monitoring in SAT would provide more frequent information about glycemia (trend information) and would therefore also be of benefit for critically ill patients.Microdialysis of SAT has been well established for the investigation of the interstitial fluid glucose profile in relation to blood glucose in healthy individuals and diabetic patients (9). Due to critical illness of patients in the ICU, the perfusion status of variou...

show abstract

Subcutaneous Glucose Concentration in Humans: Real estimation and continuous monitoring

Abstract: The recirculation method estimated the real subcutaneous glucose concentration, opening the way to develop new calibration procedures for subcutaneous glucosensors. However, a suitable calibration procedure is still lacking.

Cited by 65 publications

References 6 publications

Feasibility of Factory Calibration for Subcutaneous Glucose Sensors in Subjects With Diabetes

Feasibility of Factory Calibration for Subcutaneous Glucose Sensors in Subjects With Diabetes

Efficacy Determinants of Subcutaneous Microdose Glucagon during Closed-Loop Control

Clinical Evaluation of Alternative-Site Glucose Measurements in Patients After Major Cardiac Surgery

Contact Info

Product

Resources

About