Diabetes: Glucose Monitoring Topics in Bioengineering

Diabetes background: Trivia What are the three main types? Type I (children, no insulin) Type II (adults, insulin resistance) Gestational (resolves after pregnancy What cells make insulin? Beta cells Where are they found? Pancreas, Islets of Langerhans How many people in the US? 20 million How many people worldwide? 346 million (type II only!) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/ http://en.wikipedia.org/wiki/Diabetes_mellitus

Diabetes – huge healthcare problem! Type I is autoimmune, causes unknown (requires insulin) Life-long, no cure Type II linked with obesity (sometimes managed/ reversed with drugs, lifestyle changes) Gestational: if not carefully managed, serious risks for mother and baby Complications: Cardiovascular diseases (risk doubled) Diabetic retinopathy (impaired vision, blindness) Diabetic nephropathy (chronic kidney disease, dialysis) Diabetic neuropathy (numbness, tingling  foot ulcers  amputation) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/ http://en.wikipedia.org/wiki/Diabetes_mellitus

How is it managed? Insulin first available in 1921 Blood glucose must be tightly monitored and controlled  glucose biosensors Types: Finger prick (still most common?) Continuous (insert sensor SubQ) Microdialysis (still requires SubQ implant) Reverse iontophoresis (noninvasive) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/ http://en.wikipedia.org/wiki/Diabetes_mellitus TMH Lee (2008) Sensors. 8:5535-5559.

Commercially Available Finger-Prick Glucose Meters TMH Lee (2008) Sensors. 8:5535-5559. Table 1.

Inseong

i.v. insulin glucose i.v. oral Inseong Tamada et al. (1995) Nature Medicine. Figure 1

Maura Tamada et al. (1995) Nature Medicine. Figure 2

Maura Tamada et al. (1995) Nature Medicine. Table 1

Michael Tamada et al. (1995) Nature Medicine. Figure 3

What does it look like? Paige Tamada’s version was probably something like this… Modern version? Commercially/clinically available? https://www.google.com/search?q=transdermal%20extraction%20of%20glucose&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&ei=XB6hUMTrOIa50QHl9IAQ&biw=1366&bih=644&sei=dh6hUMj8AfDh0wGvqoGoDQ

Shrinidhi

GlucoDay (A. Menarini) Microdialysis CGMS Gold (Medtronic) Needle-type http://www.medtronic.co.jp/about-medtronic/news-release/2009/2009-13/index.htm http://www.diabetesdaily.com/voices/2012/07/my-lovehate-relationship-with-the-cgm-continuous-glucose-monitor/ http://216.71.46.171/diabetesforum/articles/2003/2003_A2/04%20weitgasser%202003%20A2.htm

Shrinidhi Wentholt et al. (2005) Diabetes Care. Figure 1

Anna Wentholt et al. (2005) Diabetes Care. Figure 2

Felix Wentholt et al. (2005) Diabetes Care. Figure 3

Wrap-up Kevin