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| United States Patent Application |
20020019022
|
| Kind Code
|
A1
|
|
Dunn, Timothy C.
;   et al.
|
February 14, 2002
|
Method and device for predicting physiological values
Abstract
The invention relates generally to methods, systems, and devices for
measuring the concentration of target analytes present in a biological
system using a series of measurements obtained from a monitoring system
and a Mixtures of Experts (MOE) algorithm. In one embodiment, the present
invention describes a method for measuring blood glucose in a subject.
| Inventors: |
Dunn, Timothy C.; (San Francisco, CA)
; Jayalakshmi, Yalia; (Sunnyvale, CA)
; Kurnik, Ronald T.; (Foster City, CA)
; Lesho, Matthew J.; (San Mateo, CA)
; Oliver, Jonathan James; (Oakland, CA)
; Potts, Russell O.; (San Francisco, CA)
; Tamada, Janet A.; (Mountain View, CA)
; Waterhouse, Steven Richard; (San Francisco, CA)
; Wei, Charles W.; (Fremont, CA)
|
| Correspondence Address:
|
Barbara G. McClung
Cygnus Inc.
Intellectual Property Dept.
400 Penobscot Drive
Redwood City
CA
94063
US
|
| Assignee: |
Cygnus, Inc.
|
| Serial No.:
|
911341 |
| Series Code:
|
09
|
| Filed:
|
July 23, 2001 |
| Current U.S. Class: |
435/14; 702/19 |
| Class at Publication: |
435/14; 702/19 |
| International Class: |
C12Q 001/54; G06F 019/00; G01N 033/48; G01N 033/50 |
Claims
What is claimed is:
1. A method for continually or continuously measuring an analyte present
in a biological system, said method comprising: (a) transdermally
extracting the analyte from the biological system using a sampling system
that is in operative contact with a skin or mucosal surface of said
biological system; (b) obtaining a raw signal from the extracted analyte,
wherein said raw signal is specifically related to the analyte; (c)
performing a calibration step which correlates the raw signal obtained in
step (b) with a measurement value indicative of the concentration of
analyte present in the biological system at the time of extraction; (d)
repeating steps (a)-(b) to obtain a series of measurement values at
selected time intervals, wherein the sampling system is maintained in
operative contact with the skin or mucosal surface of said biological
system to provide for a continual or continuous analyte measurement; and
(e) predicting a measurement value based on the series of measurement
values using the Mixtures of Experts algorithm, where the individual
experts have a linear form 23 An = i = 1 n An i w i
( 1 ) wherein (An) is an analyte of interest, n is the number of
experts, An.sub.i is the analyte predicted by Expert i; and w.sub.i is a
parameter, and the individual experts An.sub.i are further defined by the
expression shown as Equation (2) 24 An i = j = 1 m a ij
P j + z i ( 2 ) wherein, An.sub.i is the analyte predicted
by Expert i; P.sub.j is one of m parameters, m is typically less than
100; a.sub.ij are coefficients; and z.sub.i is a constant; and further
where the weighting value, w.sub.i, is defined by the formula shown as
Equation (3) 25 w i = d i [ k = 1 n d k ]
( 3 ) where e refers to the exponential function and the d.sub.k (note
that the d.sub.i in the numerator of Equation 3 is one of the d.sub.k)
are a parameter set analogous to Equation 2 that is used to determine the
weights w.sub.i, The d.sub.k are given by Equation 4 26 d k =
j = 1 m jk P j + k ( 4 ) where .alpha..sub.jk is a
coefficient, P.sub.j is one of m parameters, and where .omega..sub.k is a
constant.
2. The method of claim 1, wherein the analyte is extracted from the
biological system in step (a) into a collection reservoir to obtain a
concentration of the analyte in said reservoir.
3. The method of claim 2, wherein the collection reservoir is in contact
with the skin or mucosal surface of the biological system and the analyte
is extracted using an iontophoretic current applied to said skin or
mucosal surface.
4. The method of claim 3, wherein the collection reservoir contains an
enzyme that reacts with the extracted analyte to produce an
electrochemically detectable signal.
5. The method of claim 4, wherein the analyte is glucose.
6. The method of claim 5, wherein the enzyme is glucose oxidase.
7. The method of claim 1, wherein the prediction of step (e) is carried
out using said series of two or more measurement values in an algorithm
represented by the Mixtures of Experts algorithm, where the individual
experts have a linear form BG=w.sub.1BG+w.sub.2BG.sub.2+w.sub.3BG.sub.3
(5) wherein (BG) is blood glucose, there are three experts (n=3) and
BG.sub.i is the analyte predicted by Expert i; w.sub.i is a parameter,
and the individual Experts BG.sub.i are further defined by the expression
shown as Equations 6, 7, and 8 BG.sub.1=p.sub.1(time)+q.sub.1(active)+r.s-
ub.1(signal)+s.sub.1(BG.vertline.cp)+t.sub.1 (6) BG.sub.2=p.sub.2(time)+q-
.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.vertline.cp)+t.sub.2 (7)
BG.sub.3=p.sub.3(time)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.vertlin-
e.cp)+t.sub.3 (8) wherein, BG.sub.i is the analyte predicted by Expert i;
parameters include, time (elapsed time since the sampling system was
placed in operative contact with said biological system), active (active
signal), signal (calibrated signal), and BG/cp (blood glucose value at a
calibration point); P.sub.i, q.sub.i, r.sub.i, and s.sub.i are
coefficients; and t.sub.i is a constant; and further where the weighting
value, w.sub.i, is defined by the formulas shown as Equations 9, 10, and
11 27 w 1 = d 1 d 1 + d 2 + d 3 ( 9 )
w 2 = d 2 d 1 + d 2 + d 3 ( 10 )
w 3 = d 3 d 1 + d 2 + d 3 ( 11 ) where e
refers to the exponential function and d.sub.i is a parameter set
(analogous to Equations 6, 7, and 8) that are used to determine the
weights w.sub.i, given by Equations 9, 10, and 11, and
d.sub.1=.tau..sub.1(time)+.beta..sub.1(active)+.gamma..sub.1(signal)+.del-
ta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (12) d.sub.2=.tau..sub.2(time)+-
.beta..sub.2(active)+.gamma..sub.2(signal)+.delta..sub.2(BG.vertline.cp)+.-
epsilon..sub.2 (13) d.sub.3=.tau..sub.3(time)+.beta..sub.3(active)+.gamma-
..sub.3(signal)+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3 (14) where
.tau..sub.i, .beta..sub.i, .gamma..sub.i and .delta..sub.i are
coefficients, and where .epsilon..sub.i is a constant.
8. The method of claim 1, wherein the prediction of step (e) is carried
out using said series of two or more measurement values in an algorithm
represented by the Mixtures of Experts algorithm, where the individual
experts have a linear form BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.s-
ub.3 (15) wherein (BG) is blood glucose, there are three experts (n=3)
and BG.sub.i is the analyte predicted by Expert i; w.sub.i is a
parameter, and the individual Experts BG.sub.i are further defined by the
expression shown as Equations 16, 17, and 18 BG.sub.1=p.sub.1(time.sub.c)-
+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.vertline.cp)+t.sub.1 (16)
BG.sub.2=p.sub.2(time.sub.c)+q.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.v-
ertline.cp)+t.sub.2 (17) BG.sub.3=p.sub.3(time.sub.c)+q.sub.3(active)+r.s-
ub.3(signal)+s.sub.3(BG.vertline.cp)+t.sub.3 (18) wherein, BG.sub.i is
the analyte predicted by Expert i; parameters include, time, (elapsed
time from a calibration of said sampling system), active (active signal),
signal (calibrated signal), and BG/cp (blood glucose value at a
calibration point); p.sub.i, q.sub.i, r.sub.i, and s.sub.i are
coefficients; and t.sub.i is a constant; and further where the weighting
value, w.sub.i, is defined by the formulas shown as Equations 19, 20, and
21 28 w 1 = d 1 d 1 + d 2 + d 3 ( 19 )
w 2 = d 2 d 1 + d 2 + d 3 ( 20 )
w 3 = d 3 d 1 + d 2 + d 3 ( 21 ) where e
refers to the exponential function and d.sub.i is a parameter set
(analogous to Equations 6, 7, and 8) that are used to determine the
weights w.sub.i, given by Equations 19, 20, and 21, and
d.sub.1=.tau..sub.1(time.sub.c)+.beta..sub.1(active)+.gamma..sub.1(signal-
)+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (22)
d.sub.2=.tau..sub.2(time.sub.c)+.beta..sub.2(active)+.gamma..sub.2(signal-
)+.delta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (23)
d.sub.3=.tau..sub.3(time.sub.c)+.beta..sub.3(active)+.gamma..sub.3(signal-
)+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3 (24) where .tau..sub.i,
.beta..sub.i, .gamma..sub.i and .delta..sub.i are coefficients, and where
.epsilon..sub.i is a constant.
9. The method of either of claim 7 or claim 8, which includes further
parameters for measurement values selected from the group consisting of
temperature, ionophoretic voltage, and skin conductivity.
10. A method for measuring blood glucose in a subject, said method
comprising: (a) obtaining a raw signal from a sensing apparatus, wherein
said raw signal is specifically related to the glucose detected by the
sensing apparatus; (b) performing a calibration step which correlates the
raw signal obtained in step (a) with a measurement value indicative of
the subject's blood glucose concentration; (c) repeating step (a) to
obtain a series of measurement values at selected time intervals; and (d)
predicting a measurement value using the Mixtures of Experts algorithm,
where the individual experts have a linear form: 29 An = i = 1 n
An i w i ( 1 ) wherein (An) is blood glucose value, n is
the number of experts, An.sub.i is the blood glucose value predicted by
Expert i; and w.sub.i is a parameter, and the individual experts An.sub.i
are further defined by the expression shown as Equation (2) 30 An i
= j = 1 m a ij P j + z i ( 2 ) wherein, An.sub.i
is the blood glucose value predicted by Expert i; P.sub.j is one of m
parameters, m is typically less than 100; a.sub.ij are coefficients; and
z.sub.i is a constant; and further where the weighting value, w.sub.i, is
defined by the formula shown as Equation (3), 31 w i = d i [
k = 1 n d k ] ( 3 ) where e refers to the
exponential function and the d.sub.k (note that the d.sub.i in the
numerator of Equation 3 is one of the d.sub.k) are a parameter set
analogous to Equation 2 that is used to determine the weights w.sub.i,
The d.sub.k are given by Equation 4 32 d k = j = 1 m jk
P j + k ( 4 ) where .alpha..sub.jk is a coefficient,
P.sub.j is one of m parameters, and where .omega..sub.k is a constant.
11. The method of claim 10, where in said Mixtures of Experts algorithm,
the individual experts have a linear form BG.sub.1=w.sub.1BG.sub.1+w.sub.-
2BG.sub.2+w.sub.3BG.sub.3 (5) wherein (BG) is blood glucose, there are
three experts (n=3) and BG.sub.i is the analyte predicted by Expert i;
w.sub.i is a parameter, and the individual Experts BG.sub.i are further
defined by the expression shown as Equations 6, 7, and 8
BG.sub.1=p.sub.1(time)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.vertlin-
e.cp)+t.sub.1 (6) BG.sub.2=p.sub.2(time)+q.sub.2(active)+r.sub.2(signal)+-
s.sub.2(BG.vertline.cp)+t.sub.2 (7) BG.sub.3=p.sub.3(time)+q.sub.3(active-
)+r.sub.3(signal)+s.sub.3(BG.vertline.cp)+t.sub.3 (8) wherein, BG.sub.i
is the analyte predicted by Expert i; parameters include, time (elapsed
time since the sampling system was placed in operative contact with said
biological system), active (active signal), signal (calibrated signal),
and BG/cp (blood glucose value at a calibration point); p.sub.i, q.sub.i,
r.sub.i, and s.sub.i are coefficients; and t.sub.i is a constant; and
further where the weighting value, w.sub.i, is defined by the formulas
shown as Equations 9, 10, and 11 33 w 1 = d 1 d 1 +
d 2 + d 3 ( 9 ) w 2 = d 2 d 1 + d 2
+ d 3 ( 10 ) w 3 = d 3 d 1 + d 2 +
d 3 ( 11 ) where e refers to the exponential function and
d.sub.i is a parameter set (analogous to Equations 6, 7, and 8) that are
used to determine the weights w.sub.i, given by Equations 9, 10, and 11,
and d.sub.1=.tau..sub.1(time)+.beta..sub.1(active)+.gamma..sub.1(signal)+-
.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (12)
d.sub.2=.tau..sub.2(time)+.beta..sub.2(active)+.gamma..sub.2(signal)+.del-
ta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (13) d.sub.3=.tau..sub.3(time)+-
.beta..sub.3(active)+.gamma..sub.3(signal)+.delta..sub.3(BG.vertline.cp)+.-
epsilon..sub.3 (14) where .tau..sub.i, .beta..sub.i, .gamma..sub.i and
.delta..sub.i are coefficients, and where .epsilon..sub.i is a constant.
12. The method of claim 10, where in said Mixtures of Experts algorithm,
the individual experts have a linear form BG=w.sub.1BG.sub.1+w.sub.2BG.su-
b.2+w.sub.3BG.sub.3 (15) wherein (BG) is blood glucose, there are three
experts (n=3) and BG.sub.i is the analyte predicted by Expert i; w.sub.i
is a parameter, and the individual Experts BG.sub.i are further defined
by the expression shown as Equations 16, 17, and 18
BG.sub.i=p.sub.1(time.sub.c)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.v-
ertline.cp)+t.sub.1 (16) BG.sub.2=p.sub.2(time.sub.c)+q.sub.2(active)+r.s-
ub.2(signal)+s.sub.2(BG.vertline.cp)+t.sub.2 (17) BG.sub.3=p.sub.3(time.s-
ub.c)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.vertline.cp)+t.sub.3
(18) wherein, BG.sub.i is the analyte predicted by Expert i; parameters
include, time.sub.c (elapsed time from a calibration of said sampling
system), active (active signal), signal (calibrated signal), and BG/cp
(blood glucose value at a calibration point); p.sub.i, q.sub.i, r.sub.i,
and s.sub.i are coefficients; and t.sub.i is a constant; and further
where the weighting value, w.sub.i, is defined by the formulas shown as
Equations 19, 20, and 21 34 w 1 = d 1 d 1 + d 2 +
d 3 ( 19 ) w 2 = d 2 d 1 + d 2 + d
3 ( 20 ) w 3 = d 3 d 1 + d 2 + d 3
( 21 ) where e refers to the exponential function and d.sub.i is a
parameter set (analogous to Equations 6, 7, and 8) that are used to
determine the weights w.sub.i, given by Equations 19, 20, and 21, and
d.sub.1=.tau..sub.1(time.sub.c)+.beta..sub.1(active)+.gamma..sub.1(signal-
)+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1(22)
d.sub.2=.tau..sub.2(time.sub.c)+.beta..sub.2(active)+.gamma..sub.2(signal-
)+.delta..sub.2(BG.vertline.cp)+.epsilon..sub.2(23)
d.sub.3=.tau..sub.3(time.sub.c)+.beta..sub.2(active)+.gamma..sub.3(signal-
)+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3(24) where .tau..sub.i,
.beta..sub.i, .gamma..sub.i and .delta..sub.i are coefficients, and where
.epsilon..sub.i is a constant.
13. The method of either claim 11 or claim 12, wherein the sensing
apparatus is a near-IR spectrometer.
14. The method of either claim 11 or claim 12, wherein the sensing means
comprises a biosensor having an electrochemical sensing element.
15. A monitoring system for continually or continuously measuring an
analyte present in a biological system, said system comprising, in
operative combination: (a) sampling means for continually or continuously
extracting the analyte from the biological system, wherein said sampling
means is adapted for extracting the analyte across a skin or mucosal
surface of said biological system; (b) sensing means in operative contact
with the analyte extracted by the sampling means, wherein said sensing
means obtains a raw signal from the extracted analyte and said raw signal
is specifically related to the analyte; and (c) microprocessor means in
operative communication with the sampling means and the sensing means,
wherein said microprocessor means (i) is used to control the sampling
means and the sensing means to obtain a series of raw signals at selected
time intervals during a continual or continuous measurement period, (ii)
correlate the raw signals with measurement values indicative of the
concentration of analyte present in the biological system, and (iii)
predict a measurement value using the Mixtures of Experts algorithm,
where the individual experts have a linear form 35 An = i = 1 n
An i w i ( 1 ) wherein (An) is an analyte of interest, n
is the number of experts, An.sub.i is the analyte predicted by Expert i;
and w.sub.i is a parameter, and the individual experts An.sub.i are
further defined by the expression shown as Equation (2) 36 An i =
j = 1 m a ij P j + z i ( 2 ) wherein, An.sub.i is
the analyte predicted by Expert i; P.sub.j is one of m parameters, m is
typically less than 100; a.sub.ij are coefficients; and z.sub.i is a
constant; and further where the weighting value, w.sub.i, is defined by
the formula shown as Equation (3) 37 w i = d i [ k = 1
n d k ] ( 3 ) where e refers to the exponential function
and the d.sub.k (note that the d.sub.i in the numerator of Equation 3 is
one of the d.sub.k) are a parameter set analogous to Equation 2 that is
used to determine the weights w.sub.i. The d.sub.k are given by Equation
4 38 d k = j = 1 m jk P j + k ( 4 )
where .alpha..sub.k is a coefficient, P.sub.j is one of m parameters, and
where .omega..sub.k is a constant.
16. The monitoring system of claim 15, wherein the sampling means includes
one or more collection reservoirs for containing the extracted analyte.
17. The monitoring system of claim 16, wherein the sampling means uses an
iontophoretic current to extract the analyte from the biological system.
18. The monitoring system of claim 17, wherein the collection reservoir
contains an enzyme that reacts with the extracted analyte to produce an
electrochemically detectable signal.
19. The monitoring system of claim 18, wherein the analyte is glucose and
the enzyme is glucose oxidase.
20. A monitoring system for measuring blood glucose in a subject, said
system comprising, in operative combination: (a) sensing means in
operative contact with the subject or with a glucose-containing sample
extracted from the subject, wherein said sensing means obtains a raw
signal specifically related to blood glucose in the subject; and (b)
microprocessor means in operative communication with the sensing means,
wherein said microprocessor means (i) is used to control the sensing
means to obtain a series of raw signals at selected time-intervals, (ii)
correlates the raw signals with measurement values indicative of the
concentration of blood glucose present in the subject, and (iii) predicts
a measurement value at a further time interval using the Mixtures of
Experts algorithm, where the individual experts have a linear form
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (5) wherein (BG) is
blood glucose, there are three experts (n=3) and BG.sub.i is the analyte
predicted by Expert i; w.sub.i is a parameter, and the individual Experts
BG.sub.i are further defined by the expression shown as Equations 6, 7,
and 8 BG.sub.1=p.sub.1(time)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.v-
ertline.cp)+t.sub.i (6) BG.sub.2=p.sub.2(time)+q.sub.2(active)+r.sub.2(si-
gnal)+s.sub.2(BG.vertline.cp)+t.sub.2 (7) BG.sub.3=p.sub.3(time)+q.sub.3(-
active)+r.sub.3(signal)+s.sub.3(BG.vertline.cp)+t.sub.3 (8) wherein,
BG.sub.i is the analyte predicted by Expert i; parameters include, time
(elapsed time since the sampling system was placed in operative contact
with said biological system), active (active signal), signal (calibrated
signal), and BG/cp (blood glucose value at a calibration point); p.sub.i,
q.sub.i, r.sub.i, and s.sub.i are coefficients; and t.sub.i is a
constant; and further where the weighting value, w.sub.i, is defined by
the formulas shown as Equations 9, 10, and 11 39 w 1 = d 1
d 1 + d 2 + d 3 ( 9 ) w 2 = d 2 d 1
+ d 2 + d 3 ( 10 ) w 3 = d 3 d 1 +
d 2 + d 3 ( 11 ) where e refers to the exponential
function and d.sub.i is a parameter set (analogous to Equations 6, 7, and
8) that are used to determine the weights w.sub.i, given by Equations 9,
10, and 11, and d.sub.1=.tau..sub.1(time)+.beta..sub.1(active)+.gamma..su-
b.1(signal)+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (12)
d.sub.2=.tau..sub.2(time)+.beta..sub.2(active)+.gamma..sub.2(signal)+.del-
ta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (13) d.sub.3=.tau..sub.3(time)+-
.beta..sub.3(active)+.gamma..sub.3(signal)+.delta..sub.3(BG.vertline.cp)+.-
epsilon..sub.3 (14) where .tau..sub.i, .beta..sub.i, .gamma..sub.i and
.delta..sub.i are coefficients, and where .epsilon..sub.i is a constant.
21. A monitoring system for measuring blood glucose in a subject, said
system comprising, in operative combination: (a) sensing means in
operative contact with the subject or with a glucose-containing sample
extracted from the subject, wherein said sensing means obtains a raw
signal specifically related to blood glucose in the subject; and (b)
microprocessor means in operative communication with the sensing means,
wherein said microprocessor means (i) is used to control the sensing
means to obtain a series of raw signals at selected time intervals, (ii)
correlates the raw signals with measurement values indicative of the
concentration of blood glucose present in the subject, and (iii) predicts
a measurement value at a further time interval using the Mixtures of
Experts algorithm, where the individual experts have a linear form
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (15) wherein (BG) is
blood glucose, there are three experts (n=3) and BG.sub.i is the analyte
predicted by Expert i; w.sub.i is a parameter, and the individual Experts
BG.sub.i are further defined by the expression shown as Equations 16, 17,
and 18 BG.sub.1=p.sub.1(time.sub.c)+q.sub.1(active)+r.sub.1(signal)+s.sub-
.1(BG.vertline.cp)+t.sub.1 (16) BG.sub.2=p.sub.2(time.sub.c)+q.sub.2(acti-
ve)+r.sub.2(signal)+s.sub.2(BG.vertline.cp)+t.sub.2 (17)
BG.sub.3=p.sub.3(time.sub.c)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.v-
ertline.cp)+t.sub.3 (18) wherein, BG.sub.i is the analyte predicted by
Expert i; parameters include, time, (elapsed time from a calibration of
said sampling system), active (active signal), signal (calibrated
signal), and BG/cp (blood glucose value at a calibration point) ;
p.sub.i, q.sub.i, r.sub.i, and s.sub.i are coefficients; and t.sub.i is a
constant; and further where the weighting value, w.sub.i, is defined by
the formulas shown as Equations 19, 20, and 21 40 w 1 = d 1
d 1 + d 2 + d 3 ( 19 ) w 2 = d 2 d
1 + d 2 + d 3 ( 20 ) w 3 = d 3 d 1
+ d 2 + d 3 ( 21 ) where e refers to the exponential
function and d.sub.i is a parameter set (analogous to Equations 6, 7, and
8) that are used to determine the weights w.sub.i, given by Equations 19,
20, and 21, and d.sub.1=.tau..sub.1(time.sub.c)+.beta..sub.1(active)+.gam-
ma..sub.1(signal)+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (22)
d.sub.2=.tau..sub.2(time.sub.c)+.beta..sub.2(active)+.gamma..sub.2(signal-
)+.delta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (23)
d.sub.3=.tau..sub.3(time.sub.c)+.beta..sub.3(active)+.gamma..sub.3(signal-
)+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3 (24) where .tau..sub.i,
.beta..sub.i, .gamma..sub.i and .delta..sub.i are coefficients, and where
.epsilon..sub.i is a constant.
22. The monitoring system of either claim 20 or claim 21, which includes
further parameters for raw signals selected from the group consisting of
temperature, ionophoretic voltage, and skin conductivity.
23. The monitoring system of either claim 20 or claim 21, wherein the
sensing means comprises a biosensor having an electrochemical sensing
element.
24. The monitoring system of either claim 20 or claim 21, wherein the
sensing means comprises a near-IR spectrometer.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S. patent
application Ser. No. 09/241,929, filed Feb. 1, 1999, which is a
continuation-in-part of U.S. patent application Ser. No. 09/198,039,
filed Nov. 23, 1998, which is a continuation-in-part of U.S. patent
application Ser. No. 09/163,856, filed Sep. 30, 1998, all applications
are herein incorporated by reference in their entireties.
FIELD OF THE INVENTION
[0002] The invention relates generally to a method and device for
measuring the concentration of target chemical analytes present in a
biological system. More particularly, the invention relates to a method
and monitoring systems for predicting a concentration of an analyte using
a series of measurements obtained from a monitoring system and a Mixtures
of Experts (MOE) algorithm.
BACKGROUND OF THE INVENTION
[0003] The Mixtures of Experts model is a statistical method for
classification and regression (Waterhouse, S., "Classification and
Regression Using Mixtures of Experts, October 1997, Ph.D. Thesis,
Cambridge University). Waterhouse discusses Mixtures of Experts models
from a theoretical perspective and compares them with other models, such
as, trees, switching regression models, modular networks. The first
extension described in Waterhouse's thesis is a constructive algorithm
for learning model architecture and parameters, which is inspired by
recursive partitioning. The second extension described in Waterhouse's
thesis uses Bayesian methods for learning the parameters of the model.
These extensions are compared empirically with the standard Mixtures of
Experts model and with other statistical models on small to medium sized
data sets. Waterhouse also describes the application of the Mixtures of
Experts framework to acoustic modeling within a large vocabulary speech
recognition system.
[0004] The Mixtures of Experts model has been employed in protein
secondary structure prediction (Barlow, T. W., Journal Of Molecular
Graphics, 13(3), p. 175-183, 1995). In this method input data were
clustered and used to train a series different networks. Application of a
Hierarchical Mixtures of Experts to the prediction of protein secondary
structure was shown to provide no advantages over a single network.
[0005] Mixtures of Experts algorithms have also been applied to the
analysis of a variety of different kinds of data sets including the
following: human motor systems (Ghahramani, Z. and Wolpert, D. M.,
Nature, 386(6623):392-395, 1997); and economic analysis (Hamilton, J. D.
and Susmel, R., Journal of Econometrics, 64(1-2):307-333, 1994).
SUMMARY OF THE INVENTION
[0006] The present invention provides a method and device (for example, a
monitoring or sampling system) for continually or continuously measuring
the concentration of an analyte present in a biological system. The
method entails continually or continuously detecting a raw signal from
the biological system, wherein the raw signal is specifically related to
the analyte. A calibration step is performed to correlate the raw signal
with a measurement value indicative of the concentration of analyte
present in the biological system. These steps of detection and
calibration are used to obtain a series of measurement values at selected
time intervals. Once the series of measurement values is obtained, the
method of the invention provides for the prediction of a measurement
value using a Mixtures of Experts (MOE) algorithm.
[0007] The raw signal can be obtained using any suitable sensing
methodology including, for example, methods which rely on direct contact
of a sensing apparatus with the biological system; methods which extract
samples from the biological system by invasive, minimally invasive, and
non-invasive sampling techniques, wherein the sensing apparatus is
contacted with the extracted sample; methods which rely on indirect
contact of a sensing apparatus with the biological system; and the like.
In preferred embodiments of the invention, methods are used to extract
samples from the biological sample using minimally invasive or
non-invasive sampling techniques. The sensing apparatus used with any of
the above-noted methods can employ any suitable sensing element to
provide the raw signal including, but not limited to, physical, chemical,
electrochemical, p
hotochemical, spectrop
hotometric, polarimetric,
calorimetric, radiometric, or like elements. In preferred embodiments of
the invention, a biosensor is used which comprises an electrochemical
sensing element.
[0008] In one particular embodiment of the invention, the raw signal is
obtained using a transdermal sampling system that is placed in operative
contact with a skin or mucosal surface of the biological system. The
sampling system transdermally extracts the analyte from the biological
system using any appropriate sampling technique, for example,
iontophoresis. The transdermal sampling system is maintained in operative
contact with the skin or mucosal surface of the biological system to
provide for continual or continuous analyte measurement.
[0009] In a preferred embodiment of the invention, a Mixtures of Experts
algorithm is used to predict measurement values. The general Mixtures of
Experts algorithm is represented by the following series of equations:
where the individual experts have a linear form: 1 An = i = 1 n
An i w i ( 1 )
[0010] wherein (An) is an analyte of interest, n is the number of experts,
An.sub.i is the analyte predicted by Expert i; and w.sub.i is a
parameter, and the individual experts An.sub.i are further defined by the
expression shown as Equation (2) 2 An i = j = 1 m a
ij P j + z i (2)
[0011] wherein, An.sub.i is the analyte predicted by Expert i; p.sub.j is
one of m parameters, m is typically less than 100; a.sub.ij are
coefficients; and z.sub.i is a constant; and further where the weighting
value, w.sub.i, is defined by the formula shown as Equation (3). 3 w
i = d i [ k = 1 n d k ] ( 3 )
[0012] where e refers to the exponential function and the d.sub.k (note
that the d.sub.i in the numerator of Equation 3 is one of the d.sub.k)
are a parameter set analogous to Equation 2 that is used to determine the
weights w.sub.i. The d.sub.k are given by Equation 4. 4 d k =
j = 1 m jk P j + k ( 4 )
[0013] where .alpha..sub.jk is a coefficient, P.sub.j is one of m
parameters, and where .omega..sub.k is a constant.
[0014] Another object of the invention to use the Mixtures of Experts
algorithm of the invention to predict blood glucose values. In one
aspect, the method of the invention is used in conjunction with an
iontophoretic sampling device that provides continual or continuous blood
glucose measurements. In one embodiment the Mixtures of Experts algorithm
is essentially as follows: where the individual experts have a linear
form
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (5)
[0015] wherein (BG) is blood glucose, there are three experts (n=3) and
BG.sub.i is the analyte predicted by Expert i; w.sub.i is a parameter,
and the individual Experts BG.sub.i are further defined by the expression
shown as Equations 6, 7, and 8
BG.sub.1=p.sub.1(time)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.vertline-
.cp)+t.sub.1 (6)
BG.sub.2=p.sub.2(time)+q.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.vertline-
.cp)+t.sub.2 (7)
BG.sub.3=p.sub.3(time)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.vertline-
.cp)+t.sub.3 (8)
[0016] wherein, BG is the analyte predicted by Expert i; parameters
include, time (elapsed time since the sampling system was placed in
operative contact with said biological system), active (active signal),
signal (calibrated signal), and BG/cp (blood glucose value at a
calibration point); p.sub.i, q.sub.i, r.sub.i, and s.sub.i are
coefficients; and t.sub.i is a constant; and further where the weighting
value, w.sub.i, is defined by the formulas shown as Equations 9, 10, and
11 5 w 1 = d 1 d 1 + d 2 + d 3 ( 9 )
w 2 = d 2 d 1 + d 2 + d 3 ( 10 )
w 3 = d 3 d 1 + d 2 + d 3 ( 11 )
[0017] where e refers to the exponential function and d.sub.i is a
parameter set (analogous to Equations 6, 7, and 8) that are used to
determine the weights w.sub.i, given by Equations 9, 10, and 11, and
d.sub.1=.tau..sub.1(time)+.beta..sub.1(active)+.gamma..sub.1(signal)+.delt-
a..sub.1(BG.vertline.cp)+.epsilon..sub.1 (12)
d.sub.2=.tau..sub.2(time)+.beta..sub.2(active)+.gamma..sub.2(signal)+.delt-
a..sub.2(BG.vertline.cp)+.epsilon..sub.2 (13)
d.sub.3=.tau..sub.3(time)+.beta..sub.3(active)+.gamma..sub.3(signal)+.delt-
a..sub.3(BG.vertline.cp)+.epsilon..sub.3 (14)
[0018] where .tau..sub.i, .beta..sub.i, .gamma..sub.i and .delta..sub.i
are coefficients, and where .epsilon..sub.i is a constant.
[0019] In another embodiment for the prediction of blood glucose values,
the Mixtures of Experts algorithm is essentially as follows: where the
individual experts have a linear form
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (15)
[0020] wherein (BG) is blood glucose, there are three experts (n=3) and
BG.sub.i is the analyte predicted by Expert i; w.sub.i is a parameter,
and the individual Experts BG.sub.i are further defined by the expression
shown as Equations 16, 17, and 18
BG.sub.1=p.sub.1(time.sub.c)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.ve-
rtline.cp)+t.sub.1 (16)
BG.sub.2=p.sub.2(time.sub.c)+q.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.ve-
rtline.cp)+t.sub.2 (17)
BG.sub.3=p.sub.3(time.sub.c)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.ve-
rtline.cp)+t.sub.3 (18)
[0021] wherein, BG.sub.i is the analyte predicted by Expert i; parameters
include, time.sub.c (elapsed time since calibration of said sampling
system), active (active signal), signal (calibrated signal), and BG/cp
(blood glucose value at a calibration point) ; p.sub.i, q.sub.i, r.sub.i,
and s.sub.i are coefficients; and t.sub.i is a constant; and further
where the weighting value, w.sub.i, is defined by the formulas shown as
Equations 19, 20, and 21 6 w 1 = d 1 d 1 + d 2 +
d 3 ( 19 ) w 2 = d 2 d 1 + d 2 + d 3
( 20 ) w 3 = d 3 d 1 + d 2 + d 3
( 21 )
[0022] where e refers to the exponential function and d.sub.i is a
parameter set (analogous to Equations 6, 7, and 8) that are used to
determine the weights w.sub.i, given by Equations 19, 20, and 21, and
d.sub.1=.tau..sub.1(time.sub.c)+.beta..sub.1(active)+.gamma..sub.1(signal)-
+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (22)
d.sub.2=.tau..sub.2(time.sub.c)+.beta..sub.2(active)+.gamma..sub.2(signal)-
+.delta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (23)
d.sub.3=.tau..sub.3(time.sub.c)+.beta..sub.3(active)+.gamma..sub.3(signal)-
+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3 (24)
[0023] where .tau..sub.i, .beta..sub.i, .gamma..sub.i and .delta..sub.i
are coefficients, and where .epsilon..sub.i is a constant.
[0024] Parameters can be substituted, and/or other parameters can be
included in these calculations, for example, time parameters can be
varied (e.g., as described above, elapsed time since the sampling system
was placed in contact with a biological system, or elapsed time since the
sampling system was calibrated) or multiple time parameters can be used
in the same equation where these parameters are appropriately weighted.
Further parameters include, but are not limited to, temperature,
ionophoretic voltage, and skin conductivity. In addition, a calibration
check can be used to insure an efficacious calibration.
[0025] A further object of the invention to provide a method for measuring
an analyte, for example, blood glucose, in a subject. In one embodiment,
the method entails operatively contacting a glucose sensing apparatus
with the subject to detect blood glucose and thus obtain a raw signal
from the sensing apparatus. The raw signal is specifically related to the
glucose, and is converted into a measurement value indicative of the
subject's blood glucose concentration using a calibration step. In one
aspect of the invention, the sensing apparatus is a near-IR spectrometer.
In another aspect of the invention, the sensing means comprises a
biosensor having an electrochemical sensing element.
[0026] It is also an object of the invention to provide a monitoring
system for continually or continuously measuring an analyte present in a
biological system. The monitoring system is formed from the operative
combination of a sampling means, a sensing means, and a microprocessor
means which controls the sampling means and the sensing means. The
sampling means is used to continually or continuously extract the analyte
from the biological system across a skin or mucosal surface of said
biological system. The sensing means is arranged in operative contact
with the analyte extracted by the sampling means, such that the sensing
means can obtain a raw signal from the extracted analyte which signal is
specifically related to the analyte. The microprocessor means
communicates with the sampling means and the sensing means, and is used
to: (a) control the sampling means and the sensing means to obtain a
series of raw signals at selected time intervals during a continual or
continuous measurement period; (b) correlate the raw signals with
measurement values indicative of the concentration of analyte present in
the biological system; and (c) predict a measurement value using the
Mixtures of Experts algorithm. In one aspect, the monitoring system uses
an iontophoretic current to extract the analyte from the biological
system.
[0027] It is a further object of the invention to provide a monitoring
system for measuring blood glucose in a subject. The monitoring system is
formed from an operative combination of a sensing means and a
microprocessor means. The sensing means is adapted for operative contact
with the subject or with a glucose-containing sample extracted from the
subject, and is used to obtain a raw signal specifically related to blood
glucose in the subject. The microprocessor means communicates with the
sensing means, and is used to: (a) control the sensing means to obtain a
series of raw signals (specifically related to blood glucose) at selected
time intervals; (b) correlate the raw signals with measurement values
indicative of the concentration of blood glucose present in the subject;
and (c) predict a measurement value using the Mixtures of Experts
algorithm.
[0028] In a further aspect, the monitoring system comprises a biosensor
having an electrochemical sensing element. In another aspect, the
monitoring system comprises a near-IR spectrometer.
[0029] Additional objects, advantages and novel features of the invention
will be set forth in part in the description which follows, and in part
will become apparent to those skilled in the art upon examination of the
following, or may be learned by practice of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0030] FIG. 1A depicts a top plan view of an iontophoretic collection
reservoir and electrode assembly for use in a transdermal sampling device
constructed according to the present invention.
[0031] FIG. 1B depicts the side view of the iontophoretic collection
reservoir and electrode assembly shown in FIG. 1A.
[0032] FIG. 2 is a pictorial representation of an iontophoretic sampling
device which includes the iontophoretic collection reservoir and
electrode assembly of FIGS. 1A and 1B.
[0033] FIG. 3 is an exploded pictorial representation of components from a
preferred embodiment of the automatic sampling system of the present
invention.
[0034] FIG. 4 is a representation of one embodiment of a bimodal electrode
design. The figure presents an overhead and schematic view of the
electrode assembly 433. In the figure, the bimodal electrode is shown at
430 and can be, for example, a Ag/AgCl iontophoretic/counter electrode.
The sensing or working electrode (made from, for example, platinum) is
shown at 431. The reference electrode is shown at 432 and can be, for
example, a Ag/AgCl electrode. The components are mounted on a suitable
nonconductive substrate 434, for example, plastic or ceramic. The
conductive leads 437 (represented by dotted lines) leading to the
connection pad 435 are covered by a second nonconductive piece 436 (the
area represented by vertical striping) of similar or different material
(e.g., plastic or ceramic). In this example of such an electrode the
working electrode area is approximately 1.35 cm.sup.2. The dashed line in
FIG. 4 represents the plane of the cross-sectional schematic view
presented in FIG. 5.
[0035] FIG. 5 is a representation of a cross-sectional schematic view of
the bimodal electrodes as they may be used in conjunction with a
reference electrode and a hydrogel pad. In the figure, the components are
as follows: bimodal electrodes 540 and 541; sensing electrodes 542 and
543; reference electrodes 544 and 545; a substrate 546; and hydrogel pads
547 and 548.
[0036] FIG. 6 depicts predicted blood glucose data (using the Mixtures of
Experts algorithm) versus measured blood glucose data, as described in
Example 2.
[0037] FIG. 7 depicts predicted blood glucose data (using the Mixtures of
Experts algorithm) versus measured blood glucose data, as described in
Example 4.
[0038] FIG. 8 presents a graph of the measured and predicted blood glucose
levels vs. time, as described in Example 4.
[0039] FIG. 9 depicts an exploded view of an embodiment of an autosensor.
[0040] FIGS. 10A and 10B graphically illustrate the method of the present
invention used for decreasing the bias of a data set.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0041] Before describing the present invention in detail, it is to be
understood that this invention is not limited to particular compositions
or biological systems, as such may vary. It is also to be understood that
the terminology used herein is for the purpose of describing particular
embodiments only, and is not intended to be limiting.
[0042] It must be noted that, as used in this specification and the
appended claims, the singular forms "a", "an" and "the" include plural
referents unless the content clearly dictates otherwise. Thus, for
example, reference to "an analyte" includes mixtures of analytes, and the
like.
[0043] All publications, patents and patent applications cited herein,
whether supra or infra, are hereby incorporated by reference in their
entirety.
[0044] Unless defined otherwise, all technical and scientific terms used
herein have the same meaning as commonly understood by one of ordinary
skill in the art to which the invention pertains. Although any methods
and materials similar or equivalent to those described herein can be used
in the practice for testing of the present invention, the preferred
materials and methods are described herein.
[0045] In describing and claiming the present invention, the following
terminology will be used in accordance with the definitions set out
below.
1.0.0 DEFINITIONS
[0046] The terms "analyte" and "target analyte" are used herein to denote
any physiological analyte of interest that is a specific substance or
component that is being detected and/or measured in a chemical, physical,
enzymatic, or optical analysis. A detectable signal (e.g., a chemical
signal or electrochemical signal) can be obtained, either directly or
indirectly, from such an analyte or derivatives thereof. Furthermore, the
terms "analyte" and "substance" are used interchangeably herein, and are
intended to have the same meaning, and thus encompass any substance of
interest. In preferred embodiments, the analyte is a physiological
analyte of interest, for example, glucose, or a chemical that has a
physiological action, for example, a drug or pharmacological agent.
[0047] A "sampling device" or "sampling system" refers to any device for
obtaining a sample from a biological system for the purpose of
determining the concentration of an analyte of interest. As used herein,
the term "sampling" means invasive, minimally invasive or non-invasive
extraction of a substance from the biological system, generally across a
membrane such as skin or mucosa. The membrane can be natural or
artificial, and can be of plant or animal nature, such as natural or
artificial skin, blood vessel tissue, intestinal tissue, and the like.
Typically, the sampling means are in operative contact with a
"reservoir," or "collection reservoir," wherein the sampling means is
used for extracting the analyte from the biological system into the
reservoir to obtain the analyte in the reservoir. A "biological system"
includes both living and artificially maintained systems. Examples of
minimally invasive and noninvasive sampling techniques include
iontophoresis, sonophoresis, suction, electroporation, thermal poration,
passive diffusion, microfine (miniature) lances or cannulas, subcutaneous
implants or insertions, and laser devices. Sonophoresis uses ultrasound
to increase the permeability of the skin (see, e.g., Menon et al. (1994)
Skin Pharmacology 7:130-139). Suitable sonophoresis sampling systems are
described in International Publication No. WO 91/12772, published Sep. 5,
1991. Passive diffusion sampling devices are described, for example, in
International Publication Nos.: WO 97/38126 (published Oct. 16, 1997); WO
97/42888, WO 97/42886, WO 97/42885, and WO 97/42882 (all published Nov.
20, 1997); and WO 97/43962 (published Nov. 27, 1997). Laser devices use a
small laser beam to burn a hole through the upper layer of the patient's
skin (see, e.g., Jacques et al. (1978) J. Invest. Dermatology 88:88-93).
Examples of invasive sampling techniques include traditional needle and
syringe or vacuum sample tube devices.
[0048] The term "collection reservoir" is used to describe any suitable
containment means for containing a sample extracted from a biological
system. For example, the collection reservoir can be a receptacle
containing a material which is ionically conductive (e.g., water with
ions therein), or alternatively, it can be a material, such as, a
sponge-like material or hydrophilic polymer, used to keep the water in
place. Such collection reservoirs can be in the form of a hydrogel (for
example, in the form of a disk or pad). Hydrogels are typically referred
to as "collection inserts." Other suitable collection reservoirs include,
but are not limited to, tubes, vials, capillary collection devices,
cannulas, and miniaturized etched, ablated or molded flow paths.
[0049] A "housing" for the sampling system can further include suitable
electronics (e.g., microprocessor, memory, display and other circuit
components) and power sources for operating the sampling system in an
automatic fashion.
[0050] A "monitoring system," as used herein, refers to a system useful
for continually or continuously measuring a physiological analyte present
in a biological system. Such a system typically includes, but is not
limited to, sampling means, sensing means, and a microprocessor means in
operative communication with the sampling means and the sensing means.
[0051] The term "artificial," as used herein, refers to an aggregation of
cells of monolayer thickness or greater which are grown or cultured in
vivo or in vitro, and which function as a tissue of an organism but are
not actually derived, or excised, from a pre-existing source or host.
[0052] The term "subject" encompasses any warm-blooded animal,
particularly including a member of the class Mammalia such as, without
limitation, humans and nonhuman primates such as chimpanzees and other
apes and monkey species; farm animals such as cattle, sheep, pigs, goats
and horses; domestic mammals such as dogs and cats; laboratory animals
including rodents such as mice, rats and guinea pigs, and the like. The
term does not denote a particular age or sex. Thus, adult and newborn
subjects, as well as fetuses, whether male or female, are intended to be
covered.
[0053] As used herein, the term "continual measurement" intends a series
of two or more measurements obtained from a particular biological system,
which measurements are obtained using a single device maintained in
operative contact with the biological system over the time period in
which the series of measurements is obtained. The term thus includes
continuous measurements.
[0054] The term "transdermal," as used herein, includes both transdermal
and transmucosal techniques, i.e., extraction of a target analyte across
skin or mucosal tissue. Aspects of the invention which are described
herein in the context of "transdermal," unless otherwise specified, are
meant to apply to both transdermal and transmucosal techniques.
[0055] The term "transdermal extraction," or "transdermally extracted"
intends any noninvasive, or at least minimally invasive sampling method,
which entails extracting and/or transporting an analyte from beneath a
tissue surface across skin or mucosal tissue. The term thus includes
extraction of an analyte using iontophoresis (reverse iontophoresis),
electroosmosis, sonophoresis, microdialysis, suction, and passive
diffusion. These methods can, of course, be coupled with application of
skin penetration enhancers or skin permeability enhancing technique such
as tape stripping or pricking with micro-needles. The term "transdermally
extracted" also encompasses extraction techniques which employ thermal
poration, electroporation, microfine lances, microfine canulas,
subcutaneous implants or insertions, and the like.
[0056] The term "iontophoresis" intends a method for transporting
substances across tissue by way of an application of electrical energy to
the tissue. In conventional iontophoresis, a reservoir is provided at the
tissue surface to serve as a container of material to be transported.
Iontophoresis can be carried out using standard methods known to those of
skill in the art, for example, by establishing an electrical potential
using a direct current (DC) between fixed anode and cathode
"iontophoretic electrodes," alternating a direct current between anode
and cathode iontophoretic electrodes, or using a more complex waveform
such as applying a current with alternating polarity (AP) between
iontophoretic electrodes (so that each electrode is alternately an anode
or a cathode).
[0057] The term "reverse iontophoresis" refers to the movement of a
substance from a biological fluid across a membrane by way of an applied
electric potential or current. In reverse iontophoresis, a reservoir is
provided at the tissue surface to receive the extracted material.
[0058] "Electroosmosis" refers to the movement of a substance through a
membrane by way of an electric field-induced convective flow. The terms
iontophoresis, reverse iontophoresis, and electroosmosis, will be used
interchangeably herein to refer to movement of any ionically charged or
uncharged substance across a membrane (e.g., an epithelial membrane) upon
application of an electric potential to the membrane through an ionically
conductive medium.
[0059] The term "sensing device," "sensing means," or "biosensor device"
encompasses any device that can be used to measure the concentration of
an analyte, or derivative thereof, of interest. Preferred sensing devices
for detecting blood analytes generally include electrochemical devices
and chemical devices. Examples of electrochemical devices include the
Clark electrode system (see, e.g., Updike, et al., (1967) Nature
214:986-988), and other amperometric, coulometric, or potentiometric
electrochemical devices. Examples of chemical devices include
conventional enzyme-based reactions as used in the Lifescan.RTM. glucose
monitor (Johnson and Johnson, New Brunswick, N.J.) (see, e.g., U.S. Pat.
No. 4,935,346 to Phillips, et al.).
[0060] A "biosensor" or "biosensor device" includes, but is not limited
to, a "sensor element" which includes, but is not limited to, a
"biosensor electrode" or "sensing electrode" or "working electrode" which
refers to the electrode that is monitored to determine the amount of
electrical signal at a point in time or over a given time period, which
signal is then correlated with the concentration of a chemical compound.
The sensing electrode comprises a reactive surface which converts the
analyte, or a derivative thereof, to electrical signal. The reactive
surface can be comprised of any electrically conductive material such as,
but not limited to, platinum-group metals (including, platinum,
palladium, rhodium, ruthenium, osmium, and iridium), nickel, copper,
silver, and carbon, as well as, oxides, dioxides, combinations or alloys
thereof. Some catalytic materials, membranes, and fabrication
technologies suitable for the construction of amperometric biosensors
were described by Newman, J. D., et al. (Analytical Chemistry 67 (24),
4594-4599, 1995).
[0061] The "sensor element" can include components in addition to a
biosensor electrode, for example, it can include a "reference electrode,"
and a "counter electrode." The term "reference electrode" is used herein
to mean an electrode that provides a reference potential, e.g., a
potential can be established between a reference electrode and a working
electrode. The term "counter electrode" is used herein to mean an
electrode in an electrochemical circuit which acts as a current source or
sink to complete the electrochemical circuit. Although it is not
essential that a counter electrode be employed where a reference
electrode is included in the circuit and the electrode is capable of
performing the function of a counter electrode, it is preferred to have
separate counter and reference electrodes because the reference potential
provided by the reference electrode is most stable when it is at
equilibrium. If the reference electrode is required to act further as a
counter electrode, the current flowing through the reference electrode
may disturb this equilibrium. Consequently, separate electrodes
functioning as counter and reference electrodes are most preferred.
[0062] In one embodiment, the "counter electrode" of the "sensor element"
comprises a "bimodal electrode." The term "bimodal electrode" as used
herein typically refers to an electrode which is capable of functioning
non-simultaneously as, for example, both the counter electrode (of the
"sensor element") and the iontophoretic electrode (of the "sampling
means").
[0063] The terms "reactive surface," and "reactive face" are used
interchangeably herein to mean the surface of the sensing electrode that:
(1) is in contact with the surface of an electrolyte containing material
(e.g. gel) which contains an analyte or through which an analyte, or a
derivative thereof, flows from a source thereof; (2) is comprised of a
catalytic material (e.g., carbon, platinum, palladium, rhodium,
ruthenium, or nickel and/or oxides, dioxides and combinations or alloys
thereof) or a material that provides sites for electrochemical reaction;
(3) converts a chemical signal (e.g. hydrogen peroxide) into an
electrical signal (e.g., an electrical current); and (4) defines the
electrode surface area that, when composed of a reactive material, is
sufficient to drive the electrochemical reaction at a rate sufficient to
generate a detectable, reproducibly measurable, electrical signal that is
correlatable with the amount of analyte present in the electrolyte.
[0064] An "ionically conductive material" refers to any material that
provides ionic conductivity, and through which electrochemically active
species can diffuse. The lonically conductive material can be, for
example, a solid, liquid, or semi-solid (e.g., in the form of a gel)
material that contains an electrolyte, which can be composed primarily of
water and ions (e.g., sodium chloride), and generally comprises 50% or
more water by weight. The material can be in the form of a gel, a sponge
or pad (e.g., soaked with an electrolytic solution), or any other
material that can contain an electrolyte and allow passage therethrough
of electrochemically active species, especially the analyte of interest.
[0065] The term "physiological effect" encompasses effects produced in the
subject that achieve the intended purpose of a therapy. In preferred
embodiments, a physiological effect means that the symptoms of the
subject being treated are prevented or alleviated. For example, a
physiological effect would be one that results in the prolongation of
survival in a patient.
[0066] A "laminate", as used herein, refers to structures comprised of at
least two bonded layers. The layers may be bonded by welding or through
the use of adhesives. Examples of welding include, but are not limited
to, the following: ultrasonic welding, heat bonding, and inductively
coupled localized heating followed by localized flow. Examples of common
adhesives include, but are not limited to, pressure sensitive adhesives,
thermoset adhesives, cyanocrylate adhesives, epoxies, contact adhesives,
and heat sensitive adhesives.
[0067] A "collection assembly", as used herein, refers to structures
comprised of several layers, where the assembly includes at least one
collection insert, for example a hydrogel. An example of a collection
assembly of the present invention is a mask layer, collection inserts,
and a retaining layer where the layers are held in appropriate,
functional relationship to each other but are not necessarily a laminate,
i.e., the layers may not be bonded together. The layers may, for example,
be held together by interlocking geometry or friction.
[0068] An "autosensor assembly", as used herein, refers to structures
generally comprising a mask layer, collection inserts, a retaining layer,
an electrode assembly, and a support tray. The autosensor assembly may
also include liners. The layers of the assembly are held in appropriate,
functional relationship to each other.
[0069] The mask and retaining layers are preferably composed of materials
that are substantially impermeable to the analyte (chemical signal) to be
detected (e.g., glucose); however, the material can be permeable to other
substances. By "substantially impermeable" is meant that the material
reduces or eliminates chemical signal transport (e.g., by diffusion). The
material can allow for a low level of chemical signal transport, with the
proviso that chemical signal that passes through the material does not
cause significant edge effects at the sensing electrode.
[0070] "Substantially planar" as used herein, includes a planar surface
that contacts a slightly curved surface, for example, a forearm or upper
arm of a subject. A "substantially planar" surface is, for example, a
surface having a shape to which skin can conform, i.e., contacting
contact between the skin and the surface.
[0071] A "Mixtures of Experts (MOE)" algorithm is used in the practice of
the present invention. An example of a
[0072] Mixtures of Experts algorithm useful in connection with the present
invention is represented by the following equations, where the individual
experts have a linear form: 7 An = i = 1 n An i w i
( 1 )
[0073] wherein (An) is an analyte of interest, n is the number of experts,
An.sub.i is the analyte predicted by Expert i; and w.sub.i is a
parameter, and the individual experts An.sub.i are further defined by the
expression shown as Equation (2) 8 An i = j = 1 m a
ij P j + z i (2)
[0074] wherein, An.sub.i is the analyte predicted by Expert i; P.sub.j is
one of m parameters, m is typically less than 100; a.sub.ij are
coefficients; and z.sub.i is a constant; and further where the weighting
value, w.sub.i, is defined by the formula shown as Equation (3). 9 w
i = d i [ k = 1 n d k ] ( 3 )
[0075] where e refers to the exponential function the d.sub.k (note that
the d.sub.i in the numerator of Equation 3 is one of the d.sub.k) are a
parameter set analogous to Equation 2 that is used to determine the
weights w.sub.i. The d.sub.k are given by Equation 4. 10 d k =
j = 1 m jk P j + k ( 4 )
[0076] where .alpha..sub.jk is a coefficient, P.sub.j is one of m
parameters, and where .omega..sub.k is a constant.
[0077] The Mixtures of Experts algorithm is a generalized predictive
technology for data analysis. This method uses a superposition of
multiple linear regressions, along with a switching algorithm, to predict
outcomes. Any number of input/output variables are possible. The unknown
coefficients in this method are determined by a maximum posterior
probability technique.
[0078] The method is typically implemented as follows. An experimental
data set of input/output pairs is assembled that spans the expected
ranges of all variables. These variables are then used to train the
Mixtures of Experts (that is, used to determine the unknown
coefficients). These coefficients are determined using, for example, the
Expectation Maximization method (Dempster, A. P., N. M. Laird, and D. B.
Rubin, J. Royal Statistical Society (Series B-Methodological) 39:(1),
1977). Once these coefficients are known, the Mixtures of Experts is
easily applied to a new data set.
[0079] "Parameter" as used herein refers to an arbitrary constant or
variable so appearing in a mathematical expression that changing it give
various cases of the phenomenon represented (McGraw-Hill Dictionary of
Scientific and Technical Terms, S. P. Parker, ed., Fifth Edition,
McGraw-Hill Inc., 1994). In the context of the GlucoWatch.RTM. monitor
(Cygnus, Inc., Redwood City, Calif.), a parameter is a variable that
influences the value of the blood glucose level as calculated by an
algorithm. For the Mixtures of Experts algorithm, these parameters
include, but are not limited to, the following: time (e.g., elapsed time
since the monitor was applied to a subject; and/or elapsed time since
calibration); the active signal; the calibrated signal; the blood glucose
value at the calibration point; the skin temperature; the skin
conductivity; and the iontophoretic voltage. Changes in the values of any
of these parameters can be expected to change the value of the calculated
blood glucose value. Parameters can be substituted, and/or other
parameters can be included in these calculations, for example, time
parameters can be varied (e.g., elapsed time since the sampling system
was placed in contact with a biological system, or elapsed time since the
sampling system was calibrated) or multiple time parameters can be used
in the same equation where these parameters are appropriately weighted.
[0080] By the term "printed" as used herein is meant a substantially
uniform deposition of an electrode formulation onto one surface of a
substrate (i.e., the base support). It will be appreciated by those
skilled in the art that a variety of techniques may be used to effect
substantially uniform deposition of a material onto a substrate, e.g.,
Gravure-type printing, extrusion coating, screen coating, spraying,
painting, or the like.
[0081] "Bias" as used herein refers to the difference between the expected
value of an estimator and the true value of a parameter. "Bias" is used
in a statistical context, in particular, in estimating the value of a
parameter of a probability distribution. For example, in the case of a
linear regression wherein
y=mx+b, for x=a,
[0082] the bias at "a" equals (ma+b)-a.
[0083] "Decay" as used herein refers to a gradual reduction in the
magnitude of a quantity, for example, a current detected using a sensor
electrode where the current is correlated to the concentration of a
particular analyte and where the detected current gradually reduces but
the concentration of the analyte does not.
2.0.0 GENERAL METHODS
[0084] The present invention relates to the analysis of data obtained by
use of a sensing device for measuring the concentration of a target
analyte present in a biological system. In preferred embodiments, the
sensing device comprises a biosensor. In other preferred embodiments, a
sampling device is used to extract small amounts of a target analyte from
the biological system, and then sense and/or quantify the concentration
of the target analyte. Measurement with the biosensor and/or sampling
with the sampling device can be carried out in a continual manner.
Continual measurement allows for closer monitoring of target analyte
concentration fluctuations.
[0085] In the general method of the invention, a raw signal is obtained
from a sensing device, which signal is related to a target analyte
present in the biological system. The raw signal can be obtained using
any suitable sensing methodology including, for example, methods which
rely on direct contact of a sensing apparatus with the biological system;
methods which extract samples from the biological system by invasive,
minimally invasive, and non-invasive sampling techniques, wherein the
sensing apparatus is contacted with the extracted sample; methods which
rely on indirect contact of a sensing apparatus with the biological
system; and the like. In preferred embodiments of the invention, methods
are used to extract samples from the biological sample using minimally
invasive or non-invasive sampling techniques. The sensing apparatus used
with any of the above-noted methods can employ any suitable sensing
element to provide the signal including, but not limited to, physical,
chemical, electrochemical, p
hotochemical, spectrop
hotometric,
polarimetric, calorimetric, radiometric, or like elements. In preferred
embodiments of the invention, a biosensor is used which comprises an
electrochemical sensing element.
[0086] In another embodiment of the invention, a near-IR glucose sensing
apparatus is used to detect blood glucose in a subject, and thus generate
the raw signal. A number of near-IR glucose sensing devices suitable for
use in the present method are known in the art and are readily available.
For example, a near-IR radiation diffuse-reflection laser spectroscopy
device is described in U.S. Pat. No. 5,267,152 to Yang et al. Similar
near-IR spectrometric devices are also described in U.S. Pat. No.
5,086,229 to Rosenthal et al. and U.S. Pat. No. 4,975,581 to Robinson et
al. These near-IR devices use traditional methods of reflective or
transmissive near infrared (near-IR) analysis to measure absorbance at
one or more glucose-specific wavelengths, and can be contacted with the
subject at an appropriate location, such as a finger-tip, skin fold,
eyelid, or forearm surface to obtain the raw signal.
[0087] The raw signal obtained using any of the above-described
methodologies is then converted into an analyte-specific value of known
units to provide an interpretation of the signal obtained from the
sensing device. The interpretation uses a mathematical transformation to
model the relationship between a measured response in the sensing device
and a corresponding analyte-specific value (in the present invention, a
Mixtures of Experts algorithm). Thus, a calibration step is used herein
to relate, for example, an electrochemical signal (detected by a
biosensor), or near-IR absorbance spectra (detected with a near-IR
detector) with the concentration of a target analyte in a biological
system.
[0088] The predicted analyte values can optionally be used in a subsequent
step to control an aspect of the biological system. In one embodiment,
predicted analyte values are used to determine when, and at what level, a
constituent should be added to the biological system in order to control
an aspect of the biological system. In a preferred embodiment, the
analyte value can be used in a feedback control loop to control a
physiological effect in the biological system.
[0089] The above general methods can, of course, be used with a wide
variety of biological systems, target analytes, and/or sensing
techniques. The determination of particularly suitable combinations is
within the skill of the ordinarily skilled artisan when directed by the
instant disclosure. Although these methods are broadly applicable to
measuring any chemical analyte and/or substance in a biological system,
the invention is expressly exemplified for use in a non-invasive,
transdermal sampling system which uses an electrochemical biosensor to
quantify or qualify glucose or a glucose metabolite.
2.1.0 OBTAINING THE RAW SIGNAL.
[0090] The raw signal can be obtained using any sensing device that is
operatively contacted with the biological system. Such sensing devices
can employ physical, chemical, electrochemical, spectrop
hotometric,
polarimetric, colorimetric, radiometric, or like measurement techniques.
In addition, the sensing device can be in direct or indirect contact with
the biological system, or used with a sampling device which extracts
samples from the biological system using invasive, minimally invasive or
non-invasive sampling techniques. In preferred embodiments, a minimally
invasive or non-invasive sampling device is used to obtain samples from
the biological system, and the sensing device comprises a biosensor with
an electrochemical sensing element.
[0091] The analyte can be any specific substance or component in a
biological system that one is desirous of detecting and/or measuring in a
chemical, physical, enzymatic, or optical analysis. Such analytes
include, but are not limited to, amino acids, enzyme substrates or
products indicating a disease state or condition, other markers of
disease states or conditions, drugs of abuse, therapeutic and/or
pharmacologic agents (e.g., theophylline, anti-HIV drugs, lithium,
anti-epileptic drugs, cyclosporin, chemotherapeutics), electrolytes,
physiological analytes of interest (e.g., urate/uric acid, carbonate,
calcium, potassium, sodium, chloride, bicarbonate (CO.sub.2), glucose,
urea (blood urea nitrogen) lactate/lactic acid, hydroxybutyrate,
cholesterol, triglycerides, creatine, creatinine, insulin, hematocrit,
and hemoglobin), blood gases (carbon dioxide, oxygen, pH), lipids, heavy
metals (e.g., lead, copper), and the like. In preferred embodiments, the
analyte is a physiological analyte of interest, for example glucose, or a
chemical that has a physiological action, for example a drug or
pharmacological agent.
[0092] In order to facilitate detection of the analyte, an enzyme can be
disposed in the collection reservoir, or, if several collection
reservoirs are used, the enzyme can be disposed in several or all of the
reservoirs. The selected enzyme is capable of catalyzing a reaction with
the extracted analyte (e.g., glucose) to the extent that a product of
this reaction can be sensed, e.g., can be detected electrochemically from
the generation of a current which current is detectable and proportional
to the concentration or amount of the analyte which is reacted. A
suitable enzyme is glucose oxidase which oxidizes glucose to gluconic
acid and hydrogen peroxide. The subsequent detection of hydrogen peroxide
on an appropriate biosensor electrode generates two electrons per
hydrogen peroxide molecule which create a current which can be detected
and related to the amount of glucose entering the device. Glucose oxidase
(GOx) is readily available commercially and has well known catalytic
characteristics. However, other enzymes can also be used, so long as they
specifically catalyze a reaction with an analyte or substance of interest
to generate a detectable product in proportion to the amount of analyte
so reacted.
[0093] In like manner, a number of other analyte-specific enzyme systems
can be used in the invention, which enzyme systems operate on much the
same general techniques. For example, a biosensor electrode that detects
hydrogen peroxide can be used to detect ethanol using an alcohol oxidase
enzyme system, or similarly uric acid with urate oxidase system, urea
with a urease system, cholesterol with a cholesterol oxidase system, and
theophylline with a xanthine oxidase system.
[0094] In addition, the oxidase enzyme (used for hydrogen peroxidase-based
detection) can be replaced with another redox system, for example, the
dehydrogenase-enzyme NAD-NADH, which offers a separate route to detecting
additional analytes. Dehydrogenase-based sensors can use working
electrodes made of gold or carbon (via mediated chemistry). Examples of
analytes suitable for this type of monitoring include, but are not
limited to, cholesterol, ethanol, hydroxybutyrate, phenylalanine,
triglycerides, and urea. Further, the enzyme can be eliminated and
detection can rely on direct electrochemical or potentiometric detection
of an analyte. Such analytes include, without limitation, heavy metals
(e.g., cobalt, iron, lead, nickel, zinc), oxygen, carbonate/carbon
dioxide, chloride, fluoride, lithium, pH, potassium, sodium, and urea.
Also, the sampling system described herein can be used for therapeutic
drug monitoring, for example, monitoring anti-epileptic drugs (e.g.,
phenytion), chemotherapy (e.g., adriamycin), hyperactivity (e.g.,
ritalin), and anti-organ-rejection (e.g., cyclosporin).
[0095] In particularly preferred embodiments, a sampling device is used to
obtain continual transdermal or transmucosal samples from a biological
system, and the analyte of interest is glucose. More specifically, a
non-invasive glucose monitoring device is used to measure changes in
glucose levels in an animal subject over a wide range of glucose
concentrations. The sampling method is based on transdermal glucose
extraction and the sensing method is based on electrochemical detection
technology. The device can be contacted with the biological system
continuously, and automatically obtains glucose samples in order to
measure glucose concentration at preprogrammed intervals.
[0096] Sampling is carried out continually by non-invasively extracting
glucose through the skin of the patient using an iontophoretic current.
More particularly, an iontophoretic current is applied to a surface of
the skin of a subject. When the current is applied, ions or charged
molecules pull along other uncharged molecules or particles such as
glucose which are drawn into a collection reservoir placed on the surface
of the skin. The collection reservoir may comprise any ionically
conductive material and is preferably in the form of a hydrogel which is
comprised of a hydrophilic material, water and an electrolyte. The
collection reservoir may further contain an enzyme which catalyzes a
reaction between glucose and oxygen. The enzyme is preferably glucose
oxidase (GOx) which catalyzes the reaction between glucose and oxygen and
results in the production of hydrogen peroxide. The hydrogen peroxide
reacts at a catalytic surface of a biosensor electrode, resulting in the
generation of electrons which create a detectable biosensor current (raw
signal). Based on the amount of biosensor current created over a given
period of time, a measurement is taken, which measurement is related to
the amount of glucose drawn into the collection reservoir over a given
period of time. In a preferred embodiment the reaction is allowed to
continue until substantially all of the glucose in the collection
reservoir has been subjected to a reaction and is therefore no longer
detectable, and the total biosensor current generated is related to the
concentration of glucose in the subject.
[0097] When the reaction is complete, the process is repeated and a
subsequent measurement is obtained. More specifically, the iontophoretic
current is again applied, glucose is drawn through the skin surface into
the collection reservoir, and the reaction is catalyzed in order to
create a biosensor current. These sampling (extraction) and sensing
operations are integrated such that glucose from interstitial fluid
directly beneath the skin surface is extracted into the hydrogel
collection pad where it contacts the GOx enzyme. The GOx enzyme converts
glucose and oxygen in the hydrogel to hydrogen peroxide which diffuses to
a Pt-based sensor and reacts with the sensor to regenerate oxygen and
form electrons. The electrons generate an electrical signal that can be
measured, analyzed, and correlated to blood glucose.
[0098] A generalized method for continual monitoring of a physiological
analyte is disclosed in International Publication No. WO 97/24059,
published Jul. 10, 1997, which publication is incorporated herein by
reference. As noted in that publication, the analyte is extracted into a
reservoir containing a hydrogel which is preferably comprised of a
hydrophilic material of the type described in International Publication
No. WO 97/02811, published Jan. 30, 1997, which publication is
incorporated herein by reference. Suitable hydrogel materials include
polyethylene oxide, polyacrylic acid, polyvinylalcohol and related
hydrophilic polymeric materials combined with water to form an aqueous
gel.
[0099] In the above non-invasive glucose monitoring device, a biosensor
electrode is positioned on a surface of the hydrogel opposite the surface
contacting the skin. The sensor electrode acts as a detector which
detects current generated by hydrogen peroxide in the redox reaction, or
more specifically detects current which is generated by the electrons
generated by the redox reaction catalyzed by the platinum surface of the
electrode. The details of such electrode assemblies and devices for
iontophoretic extraction of glucose are disclosed in International
Publication No. WO 96/00110, published Jan. 4, 1996, and International
Publication No. WO 97/10499, published Mar. 2, 1997, which publications
are also incorporated herein by reference.
[0100] Referring now to FIGS. 1A and 1B, one example of an iontophoretic
collection reservoir and electrode assembly for use in a transdermal
sensing device is generally indicated at 2. The assembly comprises two
iontophoretic collection reservoirs, 4 and 6, each having a conductive
medium 8, and 10 (preferably hydrogel pads), respectively disposed
therein. First (12) and second (14) ring-shaped iontophoretic electrodes
are respectively contacted with conductive medium 8 and 10. The first
iontophoretic electrode 12 surrounds three biosensor electrodes which are
also contacted with the conductive medium 8, a working electrode 16, a
reference electrode 18, and a counter electrode 20. A guard ring 22
separates the biosensor electrodes from the iontophoretic electrode 12 to
minimize noise from the iontophoretic circuit. Conductive contacts
provide communication between the electrodes and an associated power
source and control means as described in detail below. A similar
biosensor electrode arrangement can be contacted with the conductive
medium 10, or the medium can not have a sensor means contacted therewith.
[0101] Referring now to FIG. 2, the iontophoretic collection reservoir and
electrode assembly 2 of FIGS. 1A and 1B is shown in exploded view in
combination with a suitable iontophoretic sampling device housing 32. The
housing can be a plastic case or other suitable structure which
preferably is configured to be worn on a subjects arm in a manner similar
to a wrist watch. As can be seen, conductive media 8 and 10 (hydrogel
pads) are separable from the assembly 2; however, when the assembly 2 and
the housing 32 are assembled to provide an operational iontophoretic
sampling device 30, the media are in contact with the electrodes to
provide a electrical contact therewith.
[0102] A power source (e.g., one or more rechargeable or nonrechargeable
batteries) can be disposed within the housing 32 or within the straps 34
which hold the device in contact with a skin or mucosal surface of a
subject. In use, an electric potential (either direct current or a more
complex waveform) is applied between the two iontophoretic electrodes 12
and 14 such that current flows from the first iontophoretic electrode 12,
through the first conductive medium 8 into the skin or mucosal surface,
and then back out through the second conductive medium 10 to the second
iontophoretic electrode 14. The current flow is sufficient to extract
substances including an analyte of interest through the skin into one or
both of collection reservoirs 4 and 6. The electric potential may be
applied using any suitable technique, for example, the applied current
density may be in the range of about 0.01 to 0.5 mA/cm.sup.2. In a
preferred embodiment, the device is used for continual or continuous
monitoring, and the polarity of iontophoretic electrodes 12 and 14 is
alternated at a rate of about one switch every 10 seconds to about one
switch every hour so that each electrode is alternately a cathode or an
anode. The housing 32 can further include an optional temperature sensing
element (e.g., a thermistor, thermometer, or thermocouple device) which
monitors the temperature at the collection reservoirs to enable
temperature correction of sensor signals. The housing can also include an
optional conductance sensing element (e.g., an integrated pair of
electrodes) which monitors conductance at the skin or mucosal surface to
enable data screening correction or invalidation of sensor signals.
[0103] After a suitable iontophoretic extraction period, one or both of
the sensor electrode sets can be activated in order to detect extracted
substances including the analyte of interest. Operation of the
iontophoretic sampling device 30 can be controlled by a controller 36
(e.g., a microprocessor), which interfaces with the iontophoretic
electrodes, the sensor electrodes, the power supply, the optional
temperature and/or conductance sensing elements, a display and other
electronics. For example, the controller 36 can include a programmable a
controlled circuit source/sink drive for driving the iontophoretic
electrodes. Power and reference voltage are provided to the sensor
electrodes, and signal amplifiers can be used to process the signal from
the working electrode or electrodes. In general, the controller
discontinues the iontophoretic current drive during sensing periods. A
sensor confidence loop can be provided for continually monitoring the
sampling system to insure proper operations.
[0104] User control can be carried out using push buttons located on the
housing 32, and an optional liquid crystal display (LCD) can provide
visual prompts, readouts and visual alarm indications. The microprocessor
generally uses a series of program sequences to control the operations of
the sampling device, which program sequences can be stored in the
microprocessor's read only memory (ROM). Embedded software (firmware)
controls activation of measurement and display operations, calibration of
analyte readings, setting and display of high and low analyte value
alarms, display and setting of time and date functions, alarm time, and
display of stored readings. Sensor signals obtained from the sensor
electrodes can be processed before storage and display by one or more
signal processing functions or algorithms which are stored in the
embedded software. The microprocessor can also include an electronically
erasable, programmable, read only memory (EEPROM) for storing calibration
parameters, user settings and all downloadable sequences. A serial
communications port allows the device to communicate with associated
electronics, for example, wherein the device is used in a feedback
control application to control a pump for delivery of a medicament.
[0105] Further, the sampling system can be pre-programmed to begin
execution of its signal measurements (or other functions) at a designated
time. One application of this feature is to have the sampling system in
contact with a subject and to program the sampling system to begin
sequence execution during the night so that it is available for
calibration immediately upon waking. One advantage of this feature is
that it removes any need to wait for the sampling system to warm-up
before calibrating it.
2.1.1 EXEMPLARY EMBODIMENTS OF THE SAMPLING SYSTEM
[0106] An exemplary method and apparatus for sampling small amounts of an
analyte via transdermal methods is described below in further detail. The
method and apparatus are used to detect and/or quantify the concentration
of a target analyte present in a biological system. This sampling is
carried out in a continual manner, and quantification is possible even
when the target analyte is extracted in sub-millimolar concentrations.
Although the method and apparatus are broadly applicable to sampling any
chemical analyte and/or substance, the sampling system is expressly
exemplified for use in transdermal sampling and quantifying or qualifying
glucose or a glucose metabolite.
[0107] Accordingly, in one aspect, an automatic sampling system is used to
monitor levels of glucose in a biological system. The method can be
practiced using a sampling system (device) which transdermally extracts
glucose from the system, in this case, an animal subject. Transdermal
extraction is carried out by applying an electrical current or ultrasonic
radiation to a tissue surface at a collection site. The electrical
current or ultrasonic radiation is used to extract small amounts of
glucose from the subject into a collection reservoir. The collection
reservoir is in contact with a biosensor which provides for measurement
of glucose concentration in the subject.
[0108] In the practice, a collection reservoir is contacted with a tissue
surface, for example, on the stratum corneum of a patient's skin. An
electrical or ultrasonic force is then applied to the tissue surface in
order to extract glucose from the tissue into the collection reservoir.
Extraction is carried out continually over a period of about 1-24 hours,
or longer. The collection reservoir is analyzed, at least periodically,
to measure glucose concentration therein. The measured value correlates
with the subject's blood glucose level.
[0109] More particularly, one or more collection reservoirs are placed in
contact with a tissue surface on a subject. The collection reservoirs are
also contacted with an electrode which generates a current (for reverse
iontophoretic extraction) or with a source of ultrasonic radiation such
as a transducer (for sonophoretic extraction) sufficient to extract
glucose from the tissue into the collection reservoir.
[0110] The collection reservoir contains an ionically conductive liquid or
liquid-containing medium. The conductive medium is preferably a hydrogel
which can contain ionic substances in an amount sufficient to produce
high ionic conductivity. The hydrogel is formed from a solid material
(solute) which, when combined with water, forms a gel by the formation of
a structure which holds water including interconnected cells and/or
network structure formed by the solute. The solute may be a naturally
occurring material such as the solute of natural gelatin which includes a
mixture of proteins obtained by the hydrolysis of collagen by boiling
skin, ligaments, tendons and the like. However, the solute or gel forming
material is more preferably a polymer material (including, but not
limited to, polyethylene oxide, polyvinyl alcohol, polyacrylic acid,
polyacrylamidomethylpropanesulfonate and copolymers thereof, and
polyvinyl pyrrolidone) present in an amount in the range of more than
0.5% and less than 40% by weight, preferably 8 to 12% by weight when a
humectant is also added, and preferably about 15 to 20% by weight when no
humectant is added. Additional materials may be added to the hydrogel,
including, without limitation, electrolyte (e.g., a salt), buffer,
tackifier, humectant, biocides, preservatives and enzyme stabilizers.
Suitable hydrogel formulations are described in International Publication
Nos. WO 97/02811, published Jan. 30, 1997, and WO 96/00110, published
Jan. 4, 1996, each of which publications are incorporated herein by
reference in their entireties.
[0111] Since the sampling system must be operated at very low
(electrochemical) background noise levels, the collection reservoir must
contain an ionically conductive medium that does not include significant
electrochemically sensitive components and/or contaminants. Thus, the
preferred hydrogel composition described hereinabove is formulated using
a judicious selection of materials and reagents which do not add
significant amounts of electrochemical contaminants to the final
composition.
[0112] In order to facilitate detection of the analyte, an enzyme is
disposed within the one or more collection reservoirs. The enzyme is
capable of catalyzing a reaction with the extracted analyte (in this case
glucose) to the extent that a product of this reaction can be sensed,
e.g., can be detected electrochemically from the generation of a current
which current is detectable and proportional to the amount of the analyte
which is reacted. A suitable enzyme is glucose oxidase which oxidizes
glucose to gluconic acid and hydrogen peroxide. The subsequent detection
of hydrogen peroxide on an appropriate biosensor electrode generates two
electrons per hydrogen peroxide molecule which create a current which can
be detected and related to the amount of glucose entering the device (see
FIG. 1). Glucose oxidase (GOx) is readily available commercially and has
well known catalytic characteristics. However, other enzymes can also be
used, so long as they specifically catalyze a reaction with an analyte,
or derivative thereof (or substance of interest), to generate a
detectable product in proportion to the amount of analyte so reacted.
[0113] In like manner, a number of other analyte-specific enzyme systems
can be used in the sampling system, which enzyme systems operate on much
the same general techniques. For example, a biosensor electrode that
detects hydrogen peroxide can be used to detect ethanol using an alcohol
oxidase enzyme system, or similarly uric acid with urate oxidase system,
cholesterol with a cholesterol oxidase system, and theophylline with a
xanthine oxidase system.
[0114] The biosensor electrode must be able to detect the glucose analyte
extracted into the one or more collection reservoirs even when present at
nominal concentration levels. In this regard, conventional
electrochemical detection systems which utilize glucose oxidase (GOx) to
specifically convert glucose to hydrogen peroxide, and then detect with
an appropriate electrode, are only capable of detecting the analyte when
present in a sample in at least mM concentrations. In contrast, the
sampling system allows sampling and detection of small amounts of analyte
from the subject, wherein the analyte is detected at concentrations on
the order of 2 to 4 orders of magnitude lower (e.g., .mu.M concentration
in the reservoir) than presently detectable with conventional systems.
[0115] Accordingly, the biosensor electrode must exhibit substantially
reduced background current relative to prior such electrodes. In one
particularly preferred embodiment, an electrode is provided which
contains platinum (Pt) and graphite dispersed within a polymer matrix.
The electrode exhibits the following features, each of which are
essential to the effective operation of the biosensor: background current
in the electrode due to changes in the Pt oxidation state and
electrochemically sensitive contaminants in the electrode formulation is
substantially reduced; and catalytic activity (e.g., non-electrochemical
hydrogen peroxide decomposition) by the Pt in the electrode is reduced.
[0116] The Pt-containing electrode is configured to provide a geometric
surface area of about 0.1 to 3 cm.sup.2, preferably about 0.5 to 2
cm.sup.2, and more preferably about 1 cm.sup.2. This particular
configuration is scaled in proportion to the collection area of the
collection reservoir used in the sampling system, throughout which the
extracted analyte and/or its reaction products will be present. The
electrode is specially formulated to provide a high signal-to-noise ratio
(S/N ratio) for this geometric surface area not heretofore available with
prior Pt-containing electrodes. For example, a Pt-containing electrode
constructed for use in the sampling system and having a geometric area of
about 1 cm.sup.2 preferably has a background current on the order of
about 20 nA or less (when measured with buffer solution at 0.6V), and has
high sensitivity (e.g., at least about 60 nA/.mu.M of H.sub.2O.sub.2 in
buffer at 0.6V). In like manner, an electrode having a geometric area of
about 0.1 cm.sup.2 preferably has a background current of about 2 nA or
less and sensitivity of at least about 6 nA/.mu.M of H.sub.2O.sub.2; and
an electrode having a geometric area of about 3 cm.sup.2 preferably has a
background current of about 60 nA or less and sensitivity of at least
about 180 nA/.mu.M of H.sub.2O.sub.2, both as measured in buffer at 0.6V.
These features provide for a high S/N ratio, for example a S/N ratio of
about 3 or greater. The electrode composition is formulated using
analytical- or electronic-grade reagents and solvents which ensure that
electrochemical and/or other residual contaminants are avoided in the
final composition, significantly reducing the background noise inherent
in the resultant electrode. In particular, the reagents and solvents used
in the formulation of the electrode are selected so as to be
substantially free of electrochemically active contaminants (e.g.,
anti-oxidants), and the solvents in particular are selected for high
volatility in order to reduce washing and cure times.
[0117] The Pt powder used to formulate the electrode composition is also
substantially free from impurities, and the Pt/graphite powders are
evenly distributed within the polymer matrix using, for example,
co-milling or sequential milling of the Pt and graphite. Alternatively,
prior to incorporation into the polymer matrix, the Pt can be sputtered
onto the graphite powder, colloidal Pt can be precipitated onto the
graphite powder (see, e.g., U.K. patent application number GB 2,221,300,
published Jan. 31, 1990, and references cited therein), or the Pt can be
adsorbed onto the graphite powder to provide an even distribution of Pt
in contact with the conductive graphite. In order to improve the S/N
ratio of the electrode, the Pt content in the electrode is lower relative
to prior Pt or Pt-based electrodes. In a preferred embodiment, the
overall Pt content is about 3-7% by weight. Although decreasing the
overall amount of Pt may reduce the sensitivity of the electrode, the
inventors have found that an even greater reduction in background noise
is also achieved, resulting in a net improvement in signal-to-noise
quality.
[0118] The Pt/graphite matrix is supported by a suitable binder, such as
an electrochemically inert polymer or resin binder, which is selected for
good adhesion and suitable coating integrity. The binder is also selected
for high purity, and for absence of components with gelectrochemical
background. In this manner, no electrochemically sensitive contaminants
are introduced into the electrode composition by way of the binder. A
large number of suitable such binders are known in the art and are
commercially available, including, without limitation, vinyl, acrylic,
epoxy, phenoxy and polyester polymers, provided that the binder or
binders selected for the formulation are adequately free of electroactive
impurities.
[0119] The Pt/graphite biosensor electrodes formulated above exhibit
reduced catalytic activity (e.g., passive or non-electrochemical hydrogen
peroxide degradation) relative to prior Pt-based electrode systems, and
thus have substantially improved signal-to-noise quality. In preferred
Pt/graphite electrode compositions, the biosensor exhibits about 10-25%
passive hydrogen peroxide degradation.
[0120] Once formulated, the electrode composition is affixed to a suitable
nonconductive surface which may be any rigid or flexible material having
appropriate insulating and/or dielectric properties. The electrode
composition can be affixed to the surface in any suitable pattern or
geometry, and can be applied using various thin film techniques, such as
sputtering, evaporation, vapor phase deposition, or the like; or using
various thick film techniques, such as film laminating, electroplating,
or the like. Alternatively, the composition can be applied using screen
printing, pad printing, inkjet methods, transfer roll printing, or
similar techniques. Preferably, the electrode is applied using a low
temperature screen print onto a polymeric substrate. The screening can be
carried out using a suitable mesh, ranging from about 100-400 mesh.
[0121] As glucose is transdermally extracted into the collection
reservoir, the analyte reacts with the glucose oxidase within the
reservoir to produce hydrogen peroxide. The presence of hydrogen peroxide
generates a current at the biosensor electrode that is directly
proportional to the amount of hydrogen peroxide in the reservoir. This
current provides a signal which can be detected and interpreted by an
associated system controller to provide a glucose concentration value for
display. In particular embodiments, the detected current can be
correlated with the subject's blood glucose concentration so that the
system controller may display the subject's actual blood glucose
concentration as measured by the sampling system. For example, the system
can be calibrated to the subject's actual blood glucose concentration by
sampling the subject's blood during a standard glucose tolerance test,
and analyzing the blood glucose using both a standard blood glucose
monitor and the sampling system. In this manner, measurements obtained by
the sampling system can be correlated to actual values using known
statistical techniques.
[0122] In one preferred embodiment, the automatic sampling system
transdermally extracts the sample in a continual manner over the course
of a 1-24 hour period, or longer, using reverse iontophoresis. More
particularly, the collection reservoir contains an ionically conductive
medium, preferably the hydrogel medium described hereinabove. A first
iontophoresis electrode is contacted with the collection reservoir (which
is in contact with a target tissue surface), and a second iontophoresis
electrode is contacted with either a second collection reservoir in
contact with the tissue surface, or some other ionically conductive
medium in contact with the tissue. A power source provides an electric
potential between the two electrodes to perform reverse iontophoresis in
a manner known in the art. As discussed above, the biosensor selected to
detect the presence, and possibly the level, of the target analyte
(glucose) within a reservoir is also in contact with the reservoir.
[0123] In practice, an electric potential (either direct current or a more
complex waveform) is applied between the two lontophoresis electrodes
such that current flows from the first electrode through the first
conductive medium into the skin, and back out from the skin through the
second conductive medium to the second electrode. This current flow
extracts substances through the skin into the one or more collection
reservoirs through the process of reverse iontophoresis or
electroosmosis. The electric potential may be applied as described in
International Publication No. WO 96/00110, published Jan. 4, 1996.
[0124] As an example, to extract glucose, the applied electrical current
density on the skin or tissue is preferably in the range of about 0.01 to
about 2 mA/cm.sup.2. In a preferred embodiment, in order to facilitate
the extraction of glucose, electrical energy is applied to the
electrodes, and the polarity of the electrodes is alternated at a rate of
about one switch every 7.5 minutes (for a 15 minute extraction period),
so that each electrode is alternately a cathode or an anode. The polarity
switching can be manual or automatic.
[0125] Any suitable iontophoretic electrode system can be employed,
however it is preferred that a silver/silver chloride (Ag/AgCl) electrode
system is used. The iontophoretic electrodes are formulated using two
critical performance parameters: (1) the electrodes are capable of
continual operation for extended periods, preferably periods of up to 24
hours or longer; and (2) the electrodes are formulated to have high
electrochemical purity in order to operate within the present system
which requires extremely low background noise levels. The electrodes must
also be capable of passing a large amount of charge over the life of the
electrodes.
[0126] In an alternative embodiment, the sampling device can operate in an
alternating polarity mode necessitating the presence of a first and
second bimodal electrodes (FIG. 5, 540 and 541) and two collection
reservoirs (FIG. 5, 547 and 548). Each bi-modal electrode (FIG. 4, 430;
FIG. 5, 540 and 541) serves two functions depending on the phase of the
operation: (1) an electro-osmotic electrode (or iontophoretic electrode)
used to electrically draw analyte from a source into a collection
reservoir comprising water and an electrolyte, and to the area of the
electrode subassembly; and (2) as a counter electrode to the first
sensing electrode at which the chemical compound is catalytically
converted at the face of the sensing electrode to produce an electrical
signal.
[0127] The reference (FIG. 5, 544 and 545; FIG. 4, 432) and sensing
electrodes (FIG. 5, 542 and 543; FIG. 4, 431), as well as, the bimodal
electrode (FIG. 5, 540 and 541; FIG. 4, 430) are connected to a standard
potentiostat circuit during sensing. In general, practical limitations of
the system require that the bimodal electrode will not act as both a
counter and iontophoretic electrode simultaneously.
[0128] The general operation of an iontophoretic sampling system is the
cyclical repetition of two phases: (1) a reverse-iontophoretic phase,
followed by a (2) sensing phase. During the reverse iontophoretic phase,
the first bimodal electrode (FIG. 5, 540) acts as an iontophoretic
cathode and the second bimodal electrode (FIG. 5, 541) acts as an
iontophoretic anode to complete the circuit. Analyte is collected in the
reservoirs, for example, a hydrogel (FIG. 5, 547 and 548). At the end of
the reverse iontophoretic phase, the iontophoretic current is turned off.
During the sensing phase, in the case of glucose, a potential is applied
between the reference electrode (FIG. 5, 544) and the sensing electrode
(FIG. 5, 542). The chemical signal reacts catalytically on the catalytic
face of the first sensing electrode (FIG. 5, 542) producing an electrical
current, while the first bi-modal electrode (FIG. 5, 540) acts as a
counter electrode to complete the electrical circuit.
[0129] At the end of the sensing phase, the next iontophoresis phase
begins. The polarity of the iontophoresis current is reversed in this
cycle relative to the previous cycle, so that the first bi-modal
electrode (FIG. 5, 540) acts as an iontophoretic anode and the second
bi-modal electrode (FIG. 5, 541) acts as an iontophoretic cathode to
complete the circuit. At the end of the iontophoretic phase, the sensor
is activated. The chemical signal reacts catalytically on the catalytic
face of the second sensing electrode (FIG. 5, 543) producing an
electrical current, while the second bi-modal electrode (FIG. 5, 541)
acts as a counter electrode to complete the electrical circuit.
[0130] The iontophoretic and sensing phases repeat cyclically with the
polarity of the iontophoretic current alternating between each cycle.
This results in pairs of readings for the signal, that is, one signal
obtained from a first iontophoretic and sensing phase and a second signal
obtained from the second phase. These two values can be used (i)
independently as two signals, (ii) as a cumulative (additive) signal, or
(iii) the signal values can be added and averaged.
[0131] If two active reservoirs are used for analyte detection (for
example, where both hydrogels contain the GOx enzyme), a sensor
consistency check can be employed that detects whether the signals from
the reservoirs are changing in concert with one another. This check
compares the percentage change from the calibration signal for each
reservoir, then calculates the difference in percentage change of the
signal between the two reservoirs. If this difference is greater than a
predetermined threshold value (which is commonly empirically determined),
then the signals are said not to be tracking one another and the data
point related to the two signals can be, for example, ignored.
[0132] The electrode described is particularly adapted for use in
conjunction with a hydrogel collection reservoir system for monitoring
glucose levels in a subject through the reaction of collected glucose
with the enzyme glucose oxidase present in the hydrogel matrix.
[0133] The bi-modal electrode is preferably comprised of Ag/AgCl. The
electrochemical reaction which occurs at the surface of this electrode
serves as a facile source or sink for electrical current. This property
is especially important for the iontophoresis function of the electrode.
Lacking this reaction, the iontophoresis current could cause the
hydrolysis of water to occur at the iontophoresis electrodes causing pH
changes and possible gas bubble formation. The pH changes to acidic or
basic pH could cause skin irritation or burns. The ability of an Ag/AgCl
electrode to easily act as a source of sink current is also an advantage
for its counter electrode function. For a three electrode electrochemical
cell to function properly, the current generation capacity of the counter
electrode must not limit the speed of the reaction at the sensing
electrode. In the case of a large sensing electrode, the ability of the
counter electrode to source proportionately larger currents is required.
[0134] The design of the sampling system provides for a larger sensing
electrode (see for example, FIG. 4) than previously designed.
Consequently, the size of the bimodal electrode must be sufficient so
that when acting as a counter electrode with respect to the sensing
electrode the counter electrode does not become limiting the rate of
catalytic reaction at the sensing electrode catalytic surface.
[0135] Two methods exist to ensure that the counter electrode does not
limit the current at the sensing electrode: (1) the bi-modal electrode is
made much larger than the sensing electrode, or (2) a facile counter
reaction is provided.
[0136] During the reverse iontophoretic phase, the power source provides a
current flow to the first bi-modal electrode to facilitate the extraction
of the chemical signal into the reservoir. During the sensing phase, the
power source is used to provide voltage to the first sensing electrode to
drive the conversion of chemical signal retained in reservoir to
electrical signal at the catalytic face of the sensing electrode. The
power source also maintains a fixed potential at the electrode where, for
example hydrogen peroxide is converted to molecular oxygen, hydrogen
ions, and electrons, which is compared with the potential of the
reference electrode during the sensing phase. While one sensing electrode
is operating in the sensing mode it is electrically connected to the
adjacent bimodal electrode which acts as a counter electrode at which
electrons generated at the sensing electrode are consumed.
[0137] The electrode sub-assembly can be operated by electrically
connecting the bimodal electrodes such that each electrode is capable of
functioning as both an iontophoretic electrode and counter electrode
along with appropriate sensing electrode(s) and reference electrode(s),
to create standard potentiostat circuitry.
[0138] A potentiostat is an electrical circuit used in electrochemical
measurements in three electrode electrochemical cells. A potential is
applied between the reference electrode and the sensing electrode. The
current generated at the sensing electrode flows through circuitry to the
counter electrode (i.e., no current flows through the reference electrode
to alter its equilibrium potential). Two independent potentiostat
circuits can be used to operate the two biosensors. For the purpose of
the present sampling system, the electrical current measured at the
sensing electrode subassembly is the current that is correlated with an
amount of chemical signal.
[0139] With regard to continual operation for extended periods of time,
Ag/AgCl electrodes are provided herein which are capable of repeatedly
forming a reversible couple which operates without unwanted
electrochemical side reactions (which could give rise to changes in pH,
and liberation of hydrogen and oxygen due to water hydrolysis). The
Ag/AgCl electrodes of the present sampling system are thus formulated to
withstand repeated cycles of current passage in the range of about 0.01
to 1.0 mA per cm.sup.2 of electrode area. With regard to high
electrochemical purity, the Ag/AgCl components are dispersed within a
suitable polymer binder to provide an electrode composition which is not
susceptible to attack (e.g., plasticization) by components in the
collection reservoir, e.g., the hydrogel composition. The electrode
compositions are also formulated using analytical- or electronic-grade
reagents and solvents, and the polymer binder composition is selected to
be free of electrochemically active contaminants which could diffuse to
the biosensor to produce a background current.
[0140] Since the Ag/AgCl iontophoretic electrodes must be capable of
continual cycling over extended periods of time, the absolute amounts of
Ag and AgCl available in the electrodes, and the overall Ag/AgCl
availability ratio, can be adjusted to provide for the passage of high
amounts of charge. Although not limiting in the sampling system described
herein, the Ag/AgCl ratio can approach unity. In order to operate within
the preferred system which uses a biosensor having a geometric area of
0.1 to 3 cm.sup.2, the iontophoretic electrodes are configured to provide
an approximate electrode area of 0.3 to 1.0 cm.sup.2, preferably about
0.85 cm.sup.2. These electrodes provide for reproducible, repeated cycles
of charge passage at current densities ranging from about 0.01 to 1.0
mA/cm.sup.2 of electrode area. More particularly, electrodes constructed
according to the above formulation parameters, and having an approximate
electrode area of 0.85 cm.sup.2, are capable of a reproducible total
charge passage (in both anodic and cathodic directions) of 270 mC, at a
current of about 0.3 mA (current density of 0.35 mA/cm.sup.2) for 48
cycles in a 24 hour period.
[0141] Once formulated, the Ag/AgCl electrode composition is affixed to a
suitable rigid or flexible nonconductive surface as described above with
respect to the biosensor electrode composition. A silver (Ag) underlayer
is first applied to the surface in order to provide uniform conduction.
The Ag/AgCl electrode composition is then applied over the Ag underlayer
in any suitable pattern or geometry using various thin film techniques,
such as sputtering, evaporation, vapor phase deposition, or the like, or
using various thick film techniques, such as film laminating,
electroplating, or the like. Alternatively, the Ag/AgCl composition can
be applied using screen printing, pad printing, inkjet methods, transfer
roll printing, or similar techniques. Preferably, both the Ag underlayer
and the Ag/AgCl electrode are applied using a low temperature screen
print onto a polymeric substrate. This low temperature screen print can
be carried out at about 125 to 160.degree. C., and the screening can be
carried out using a suitable mesh, ranging from about 100-400 mesh.
[0142] In another preferred embodiment, the automatic sampling system
transdermally extracts the sample in a continual manner over the course
of a 1-24 hour period, or longer, using sonophoresis. More particularly,
a source of ultrasonic radiation is coupled to the collection reservoir
and used to provide sufficient perturbation of the target tissue surface
to allow passage of the analyte (glucose) across the tissue a surface.
The source of ultrasonic radiation provides ultrasound frequencies of
greater than about 10 MHz, preferably in the range of about 10 to 50 MHz,
most preferably in the range of about 15 to 25 MHz. It should be
emphasized that these ranges are intended to be merely illustrative of
the preferred embodiment; in some cases higher or lower frequencies may
be used.
[0143] The ultrasound may be pulsed or continuous, but is preferably
continuous when lower frequencies are used. At very high frequencies,
pulsed application will generally be preferred so as to enable
dissipation of generated heat. The preferred intensity of the applied
ultrasound is less than about 5.0 W/cm.sup.2, more preferably is in the
range of about 0.01 to 5.0 W/cm.sup.2, and most preferably is in the
range of 0.05 to 3.0 W/cm.sup.2.
[0144] Virtually any type of device may be used to administer the
ultrasound, providing that the device is capable of producing the
suitable frequency ultrasonic waves required by the sampling system. An
ultrasound device will typically have a power source such as a small
battery, a transducer, and a means to attach the system to the sampling
system collection reservoir. Suitable sonophoresis sampling systems are
described in International Publication No. WO 91/12772, published Sep. 5,
1991, the disclosure of which is incorporated herein by reference.
[0145] As ultrasound does not transmit well in air, a liquid medium is
generally needed in the collection reservoir to efficiently and rapidly
transmit ultrasound between the ultrasound applicator and the tissue
surface.
[0146] Referring now to FIG. 3, an exploded view of the key components
from a preferred embodiment of an autosensor is presented. The sampling
system components include two biosensor/iontophoretic electrode
assemblies, 304 and 306, each of which have an annular iontophoretic
electrode, respectively indicated at 308 and 310, which encircles a
biosensor 312 and 314. The electrode assemblies 304 and 306 are printed
onto a polymeric substrate 316 which is maintained within a sensor tray
318. A collection reservoir assembly 320 is arranged over the electrode
assemblies, wherein the collection reservoir assembly comprises two
hydrogel inserts 322 and 324 retained by a gel retaining layer 326.
[0147] Referring now to FIG. 9, an exploded view of the key components
from another embodiment of an autosensor for use in an iontophoretic
sampling device is presented. The sampling system components include, but
are not limited to, the following: a sensor-to-tray assembly comprising
two bimodal electrode assemblies and a support tray 904; two holes 906 to
insure proper alignment of the support tray in the sampling device; a
plowfold liner 908 used to separate the sensors from the hydrogels 912
(for example, during storage); a gel retaining layer 910; a mask layer
914 (where the gel retaining layer, hydrogels, and mask layer form a
collection assembly, which can, for example, be a laminate); and a
patient liner 916.
[0148] The components shown in exploded view in FIGS. 3 and 9 are intended
for use in, for example, an automatic sampling device which is configured
to be worn like an ordinary wristwatch. As described in International
Publication No. WO 96/00110, published Jan. 4, 1996, the wristwatch
housing (not shown) contains conductive leads which communicate with the
iontophoretic electrodes and the biosensor electrodes to control cycling
and provide power to the iontophoretic electrodes, and to detect
electrochemical signals produced at the biosensor electrode surfaces. The
wristwatch housing can further include suitable electronics (e.g.,
microprocessor, memory, display and other circuit components) and power
sources for operating the automatic sampling system.
[0149] Modifications and additions to the embodiments of FIGS. 3 and 9
will be apparent to those skilled in the art in light of the teachings of
the present specification. The laminates and collection assemblies
described herein are suitable for use as consumable components in an
iontophoretic sampling device.
[0150] In one aspect, the electrode assemblies can include bimodal
electrodes as shown in FIG. 4 and described above.
[0151] Modifications and additions to the embodiments shown in FIGS. 3 and
9 will be apparent to those skilled in the art.
2.2.0 CONVERTING TO AN ANALYTE-SPECIFIC VALUE
[0152] The raw signal is then converted into an analyte-specific value
using a calibration step which correlates the signal obtained from the
sensing device with the concentration of the analyte present in the
biological system. A wide variety of calibration techniques can be used
to interpret such signals. These calibration techniques apply
mathematical, statistical and/or pattern recognition techniques to the
problem of signal processing in chemical analyses, for example, using
neural networks, genetic algorithm signal processing, linear regression,
multiple-linear regression, or principal components analysis of
statistical (test) measurements.
[0153] One method of calibration involves estimation techniques. To
calibrate an instrument using estimation techniques, it is necessary to
have a set of exemplary measurements with known concentrations referred
to as the calibration set (e.g., reference set). This set consists of S
samples, each with m instrument variables contained in an S by m matrix
(X), and an S by 1 vector (y), containing the concentrations. If a priori
information indicates the relationship between the measurement and
concentration is linear, the calibration will attempt to determine an S
by 1 transformation or mapping (b), such that y=Xb, is an optimal
estimate of y according to a predefined criteria. Numerous suitable
estimation techniques useful in the practice of the invention are known
in the art. These techniques can be used to provide correlation factors
(e.g., constants), which correlation factors are then used in a
mathematical transformation to obtain a measurement value indicative of
the concentration of analyte present in the biological system at the
times of measurement.
[0154] In one particular embodiment, the calibration step can be carried
out using artificial neural networks or genetic algorithms. The structure
of a particular neural network algorithm used in the practice of the
invention can vary widely; however, the network should contain an input
layer, one or more hidden layers, and one output layer. Such networks can
be trained on a test data set, and then applied to a population. There
are an infinite number of suitable network types, transfer functions,
training criteria, testing and application methods which will occur to
the ordinarily skilled artisan upon reading the instant specification.
[0155] The iontophoretic glucose sampling device described hereinabove
typically uses one or more "active" collection reservoirs (e.g., each
containing the GOx enzyme) to obtain measurements. In one embodiment, two
active collection reservoirs are used. An input value can be obtained
from these reserviors by, for example, taking an average between signals
from the reservoirs for each measurement time point or using a summed
value. Such inputs are discussed in greater detail below. In another
embodiment, a second collection reservoir can be provided which does not
contain, for example, the GO.sub.x enzyme. This second reservoir can
serve as an internal reference (blank) for the sensing device, where a
biosensor is used to measure the "blank" signal from the reference
reservoir which signal can then be used in, for example, a blank
subtraction step.
[0156] In the context of such a sampling device an algorithm, in a
preferred embodiment a Mixtures of Experts algorithm, could use the
following inputs to provide a blood glucose measurement: time (for
example, time since monitor was applied to a subject, and/or time since
calibration); signal from an active reservoir; signal from a blank
reservoir; averaged (or a cumulative) signal from two active reservoirs;
calibration time; skin temperature; voltage; normalized background; raw
data current; peak or minimum value of a selected input, e.g., current,
averged signal, calibrated signal; discrete value points of a selected
input, e.g., current, averged signal, calibrated signal; integral average
temperature, initial temperature, or any discrete time temperature; skin
conductivity, including, but not limited to, sweat value, iontophoretic
voltage, baseline value, normalized baseline value, other background
values; relative change in biosensor current or iontophoretic voltage
(relative to calibration) as an indicator of decay; alternate integration
ranges for calculating nanocoulomb (nC) values, e.g., using an entire
biosensor time interval, or alternative ranges of integration (for
example, using discrete time points instead of ranges, break out
intervals from the total sampling time interval, or full integration of
the interval plus partial integration of selected portions of the
interval); and, when operating in the training mode, measured glucose
(use of exemplary inputs are presented in Examples 1 and 2). Further, a
calibration ratio check is described in Example 4 that is useful to
insure that the calibration has been efficacious, and that the
calibration demonstrates a desired level of sensitivity of the sampling
system.
2.3.0 PREDICTING MEASUREMENTS
[0157] The analyte-specific values obtained using the above techniques are
used herein to predict target analyte concentrations in a biological
system using a Mixtures of Experts (MOE) analysis.
[0158] The Mixtures of Experts algorithm breaks up a non-linear prediction
equation into several linear prediction equations ("Experts"). An
"Expert" routine is then used to switch between the different linear
equations. In the equations presented below, the w (weighting) factor
determines the switch by weighting the different Experts with a number
between 0 and 1, with the restriction that: 11 i = 1 n w i
= 1
[0159] The Mixtures of Experts algorithm of the present invention is based
on the ideal case presented in Equation 1, where the individual experts
have a linear form: 12 An = i = 1 n An i w i
( 1 )
[0160] wherein (An) is an analyte of interest, n is the number of experts,
An.sub.i is the analyte predicted by Expert i; and w.sub.i is a
parameter. The number of experts is chosen based on the quality of the
fit of the model, subject to the requirement that it is desirable to use
the least number of experts possible. The number of experts is preferably
less than 100, and more preferably less than 30. In most cases, selection
of the fewest possible experts is desirable.
[0161] The individual Experts An.sub.i are further defined by the
expression shown as Equation (2). 13 An i = j = 1 m
a ij P j + z i ( 2 )
[0162] wherein, An.sub.i is the analyte predicted by Expert i; P.sub.j is
one of m parameters, m is typically less than 100; a.sub.ij are
coefficients; and z.sub.i is a constant.
[0163] The weighting value, w.sub.i, is defined by the formula shown as
Equation (3). 14 w i = d i [ k = 1 n d k ]
( 3 )
[0164] where e refers to the exponential function and the d.sub.k (note
that the d.sub.i in the numerator of Equation 3 is one of the d.sub.k)
are a parameter set analogous to Equation 2 that is used to determine the
weights w.sub.i. The d.sub.k are given by Equation 4. 15 d k =
j = 1 m jk P j + k ( 4 )
[0165] where .alpha..sub.jk is a coefficient, P.sub.j is one of m
parameters, and where .omega..sub.k is a constant.
[0166] The Mixtures of Experts method described by the above equations is
supplied with a large data base of empirically obtained information about
the parameters defined by the equations. By employing a linear regression
function, the equations are simultaneously solved for the values of all
coefficients and constants. In other words, the algorithm is trained to
be predictive for the value of An (the analyte) given a particular set of
data. A preferred optimization method to determine the coefficients and
constants is the Expectation Maximization method (Dempster, A. P., N. M.
Laird, and D. B. Rubin, J. Royal Statistical Society (Series
B-Methodological) 39: (1), 1977). Other optimization methods include the
Levenburg-Marquardt algorithm (Marquardt, D. W., J. Soc. Ind. Appl. Math.
11:p431-441, 1963) and the Simplex algorithm (Nelder, J. A., and Mead,
R., Computer Journal 7:p308, 1965).
[0167] In the context of blood glucose monitoring with an iontophoretic
sampling device, the MOE algorithm allows for the accurate prediction of
glucose concentration. In this regard, during a typical iontophoretic
measuring cycle, iontophoretic extraction of the analyte is carried out
for a suitable amount of time, for example about 1 to 30 minutes, after
which time the extracted analyte is detected for a suitable amount of
time, for example about 1-30 minutes. An application of the Mixtures of
Experts algorithm to a specific set of parameters for glucose monitoring
is presented in Example 1.
[0168] In the context of blood glucose monitoring with an iontophoretic
sampling device, the Mixtures of Experts algorithm allows for the
accurate prediction of blood glucose concentrations.
2.4.0 ALGORITHM MODIFICATIONS
[0169] A further aspect of the present invention is the modification of
the Mixtures of Experts (MOE) algorithm. The MOE can be modified in a
number of ways including, but not limited to, the following
modifications: using different groups of selected inputs (see above);
adapting the algorithm by modifying the training set; using different
algorithms or modifications of the MOE for different ranges of analyte
detection; using different statistical distributions in the Mixtures of
Experts; rejection of selected expert(s); and, switching algorithms.
2.4.1 ADAPTING THE ALGORITHM
[0170] The Mixtures of Experts (MOE) is trained using sets of data that
contain patterns. Those patterns, represented in a training data set,
typically give good performance. Accordingly, training MOE with a wide
variety of patterns improves the predictive performance of MOE, for
example, using a variety of blood glucose patterns that occur in
diabetics patients to obtain parameters that represent the patterns. In
this case the selected patterns are used to develop an appropriate
training set for MOE and then the parameters generated from that training
set are used to test data representing a variety of patterns. In one
embodiment, a "global" training set may be augmented by providing a
training data set developed from an individual subject's blood glucose
data taken over several (or many) days. Such an individual pattern is
potentially useful to customize the algorithm to that subject. The
parameters generated from using a training set including such an
individual patterns is then tested in the same individual to determine
whether the expanded training data set provides better predicted values.
In an alternative embodiment, a selected percentage of the global
training set can be used with the individual's training set (rather than
using the entire global training set).
[0171] Further, the data comprising a training data set can be
specifically chosen to optimize performance of the MOE under specific
conditions. Such optimization may include, for example, using diverse
data sets or selecting the best data to represent a specific condition.
For example, different training data sets based on data obtained from a
variety of races can be used to train the MOE to optimize predictive
performance for individual members of the different races represented by
different data sets.
[0172] Finally, MOE is typically trained with values chosen in a selected
range (e.g., blood glucose values in the range of 40-400 mg/dl). However,
the MOE can be trained with data sets that fall outside of the selected
range.
2.4.2 ALGORITHM OPTIMIZED FOR DIFFERENT RANGES
[0173] The MOE can be optimized for predictive performance in selected
ranges of data. Depending on the range different MOEs may be invoked for
prediction of analyte values (see "Switching Algorithms" below).
Alternatively, different algorithms can be used for prediction of values
in selected ranges of analyte detection. For example, MOE may be used for
prediction of glucose values in a range of 40-400 mg/dl; however, at low
and high ends of glucose values a specifically defined function can be
applied to the data in order to get preferred values. Such preferred
values may, for example, be useful in the situation where
under-prediction is more desirable than over-prediction (e.g., at low
blood glucose values). In this case a modification of MOE may be used or
an specific algorithm may be optimized for prediction in the selected
range using, for example, a non-linear distribution function that
emphasizes predicting low blood glucose (BG) in the range BG.ltoreq.100.
2.4.3 EMPLOYING DIFFERENT DISTRIBUTION FUNCTIONS
[0174] When calculating the weights used in the MOE algorithm a selected
distribution is used. One exemplary distribution is a Gaussian
distribution (Example 3) that weighs deviations relative to the square of
difference from the mean. However, other distributions can be used to
improve predictive function of the algorithm. For example, a Laplacian
distribution function was used in the calculations presented in Example
4. The Laplacian distribution has longer tails than a Gaussian
distribution, and weighs deviations relative to the absolute difference
from the mean. Other distribution functions can be used as well
including, but not limited to, Cauchy distribution or a specific
distribution function devised (or calculated) based on specific data sets
obtained, for example, from different individuals or different groups of
individuals (e.g., different races).
2.4.4 REJECTING EXPERTS
[0175] When multiple experts are used in the MOE each expert can be
inspected to determine if, for example, one or more of the experts is
providing incongruous values. When such an expert is identified (e.g., in
the calculation of a particular data point) the expert may be eliminated
for that calculation and the weights of the remaining experts readjusted
appropriately. Inspection of the experts can be carried out by a separate
algorithm and can, for example, be based on whether the value predicted
by the expert falls outside of a designated range. If the value falls
outside of a designated range, the expert may be eliminated in that
calculation. For example, Example 3 describes the use of three experts
(BG.sub.1, BG.sub.2, and BG.sub.3) in an MOE for prediction of blood
glucose values, wherein a weighted average is used to calculate the final
blood glucose value. However, each of these three experts can be
inspected to determine if one (or more) of them does not make sense
(e.g., is providing a stochastic or out-lying value significantly
different from the other two experts). The expert providing the
incongruous value is disregarded and the weights of the other two experts
are readjusted accordingly.
2.4.5 SWITCHING ALGORITHMS
[0176] In yet another aspect of the present invention, prediction of the
concentration of an analyte can be accomplished using specialized
algorithms, where the specialized algorithms are useful for predictions
in particular situations (e.g., particular data sets or ranges of
predicted values) and where the algorithm used for performing the
calculations is determined based on the situation. In this case a
"switch" can be used to employ one (or more) algorithm rather than
another (or more) algorithm. For example, a global MOE algorithm can be
the switch used to selected one of three different MOE algorithms. In one
embodiment such a global MOE algorithm may be used to determine a blood
glucose value. The blood glucose value is determined, by the algorithm,
to fall into one of three ranges (for example, low, normal, and high).
For each range there is an separate MOE algorithm that optimizes the
prediction for values in the particular range. The global MOE algorithm
then selects the appropriate MOE algorithm based on the value and the
selected MOE performs a new prediction of blood glucose values based on
the original input values but optimized for the range into which the
value was predicted (by the global MOE) to fall. As a further
illustration, inputs to determine a blood glucose value are provided to a
global MOE which determines that the value is a low-value. The inputs are
then directed to a Low-Value Optimized MOE to generate a more accurate
predicted blood glucose value.
[0177] Specialized algorithms may be developed to be used in different
parts of a range of analyte signal spectrum or other input values (e.g.,
high signal/low signal; high BGCal/low BGCal; high/low calratio; high/low
temp; etc., for all variables used in the prediction). A global algorithm
can be used to decide which region of the spectrum the analyte signal is
in, and then the global algorithm switches the data to the appropriate
specialized algorithm.
[0178] In another embodiment, an algorithm other than the MOE can be used
as the switch to choose among a set of MOE algorithms, or an MOE can be
used as the switch to choose among a set of other algorithms. Further,
there can be multiple levels of specialized switching (which can be
graphically represented for instance by branched tree-diagrams).
[0179] Following here are several specific, non-limiting examples, of the
uses of switching in the practice of the present invention when blood
glucose values are being determined.
[0180] In one embodiment, variables are identified that explicitly
represent signal decay, for example, a switch based on elapsed time since
calibration (early or late) or the value of Calratio at CAL (high or
low). An exemplary switch of this type is represented by elapsed time
since calibration where, for example, the algorithm described in Example
3 may be trained independently with inputs from an early phase of sensor
use and inputs from a late phase sensor use (e.g., the total useful life
of a sensor element may be split into two halves--early and late). Then,
depending on the time since calibration that selected input values are
being obtained (an exemplary switch), the input values are directed to an
MOE algorithm that was trained on data from the appropriate phase (i.e.,
either early or late). Such a switch is useful to help correct for error
based in sensor decay.
[0181] Another exemplary switch of this type is represented by the value
of Calratio at the calibration point. Calratio is described in Example 4.
The Calratio is a measure of sensor sensitivity.
[0182] Accordingly, if desired the Calratio range can be divided into two
halves (high and low ranges). The algorithm described in Example 3 may be
trained independently with inputs from the high and low ranges of the
Calratio. A switch is then based on the Calratio values to direct the
inputs to the MOE algorithm that is trained with the appropriate data set
(i.e., data sets corresponding to inputs from high and low Calratio
ranges).
2.5.0 DECREASING THE BIAS OF A DATA SET
[0183] In addition to the MOE algorithm described in the present
specification, following here is a description of a method to alter data
used to generate a training data set so as to correct slope, intercept
(and resultant bias) introduced by the limited range of data input. This
invention provides a useful correction for any asymmetric data input that
gives a bias to resultant predictions. In this method, the values of a
data set are used to create a second data set that mirrors the first,
i.e., positive values become negative values (opposite signs). The two
data sets are then used as the training data set. This transformation of
the asymmetrical data set results in a forced symmetry of the data
comprising the training set.
[0184] The following is a non-limiting example of this method for the
correction of bias using blood glucose level determination. In the blood
glucose value determinations described herein there is an inherent bias
(manifested by a slope of <1 and a positive intercept, e.g., FIG. 10A;
in the figure, pBG is predicted blood glucose and mBG is directly
measured blood glucose--measured, for example, using a HemoCue.RTM.
meter) introduced into the prediction function. This is in part due to
the fact that there are no blood glucose levels of <40 mg/dl used in
the data input training set. The data input for training the MOE
algorithm, used to predict blood glucose levels, uses, for example, the
following variables: elapsed time since calibration, average signal,
calibrated signal, and the blood glucose at the calibration point (see,
e.g., Examples 3 and 4). The value that these inputs predict and try to
match is directly measured blood glucose. The allowed range for blood
glucose is 40-400 mg/dl. Due to this limited range of blood glucose, the
resultant function predictions (i.e., via the MOE) result in an inherent
bias, slope <1 and positive intercept when plotting predicted blood
glucose (y-axis variable, pBG, FIG. 10A) versus directly measured blood
glucose (x-axis variable, mBG, FIG. 10A).
[0185] The method of the present invention circumvents this problem by
augmenting the original input data set with a data set comprising the
same elapsed time since calibration, but with values of the average
signal (in nanocoulombs) and directly measured blood glucose both of the
opposite sign relative to the original, real data set. The calibrated
signal is then calculated using the opposite sign data. In this way the
input data is doubled and is now symmetric around the origin (FIG. 10B;
in the figure, pBG is predicted blood glucose and mBG is directly
measured blood glucose--measured, for example, using a HemoCue.RTM.
meter). In FIG. 10B the dotted lines represent the slopes predicted from
the single data set with which they are associated. The solid line
between the two dashed lines represents the corrected slope based on use
of the original data set and the opposite sign data set to train the
algorithm.
[0186] The value of this approach when plotting predicted blood
glucose(using MOE) versus measured blood glucose can be seen by examining
the results presented in the following table.
1
Original Data Set
& Opposite Sign
Original Data Set Data Set
Deming Slope* 0.932
1.042
Deming Intercept* 12.04 -5.63
Bias 50 mg/dl 8.64
-3.53
Bias 80 mg/dl 6.6 -2.27
Bias 100 mg/dl 5.24 -1.43
Bias 150 mg/dl 1.84 0.67
Bias 200 mg/dl -1.56 2.77
*Based on orthogonal regression with a variance ratio equal to
two.
[0187] As the results in this table demonstrate, the bias reducing method
of the present invention has a slope closer to 1, an intercept closer to
zero, and the bias values are, in general, closer to zero.
[0188] Accordingly, one aspect of the present invention is a method for
decreasing the bias of a data set. The method involves generating a
second data set that has values opposite in sign of the original data set
and using this first and second data set as a combined data set to train
the algorithm (e.g., MOE).
EXAMPLES
[0189] The following examples are put forth so as to provide those of
ordinary skill in the art with a complete disclosure and description of
how to make and use the devices, methods, and formulae of the present
invention, and are not intended to limit the scope of what the inventor
regards as the invention. Efforts have been made to ensure accuracy with
respect to numbers used (e.g., amounts, temperature, etc.) but some
experimental errors and deviations should be accounted for. Unless
indicated otherwise, parts are parts by weight, molecular weight is
weight average molecular weight, temperature is in degrees Centigrade,
and pressure is at or near atmospheric.
EXAMPLE 1
Application of the "Mixtures of Experts" to Glucose Monitoring
[0190] This example describes the use of a Mixtures of Experts (MOE)
algorithm to predict blood glucose data from a series of signals.
[0191] In the present example, a GlucoWatch.RTM. monitor was used to
collect data and the following variables were chosen to generate data
sets for the MOE algorithm:
[0192] 1) elapsed time (time), elapsed time since the GlucoWatch.RTM.
monitor was applied to the subject, i.e., elapsed time since the sampling
system was placed in operative contact with the biological system;
[0193] 2) active signal (active), in this example, the value of the active
parameter corresponded to the nanoamp signal that was integrated over the
sensing time-interval to give the active parameter in nanocoulombs (nC);
[0194] 3) calibrated signal (signal), in this example was obtained by
multiplying an active by a constant, where the constant was defined as
the blood glucose level at the calibration point divided by the active
value at the calibration point. For example, as follows: 16 signal =
BG / cp active / cp ( active )
[0195] where the slope of the line active versus blood glucose had a
non-zero intercept and the offset took into account that the intercept
was not zero. In the alternative, the constant could be as follows: 17
signal = BG / cp ( active / cp + offset ) ( active + offset
)
[0196] where the offset takes into account the intercept value.
[0197] 4) blood glucose value at the calibration point (BG/cp) was
determined by direct blood testing.
[0198] Other possible variables include, but are not limited to,
temperature, iontophoretic voltage (which is inversely proportional to
skin resistance), and skin conductivity.
[0199] Large data sets were generated by collecting signals using a
transdermal sampling system that was placed in operative contact with the
skin. The sampling system transdermally extracted the analyte from the
biological system using an appropriate sampling technique (in this case,
iontophoresis). The transdermal sampling system was maintained in
operative contact with the skin to provide a near continual or continuous
stream of signals.
[0200] The basis of the Mixtures of Experts was to break up a non-linear
prediction equation (Equation 5, below) into several Expert prediction
equations, and then to have a routine to switch between the different
linear equations. For predicting blood glucose levels, three separate
linear equations (Equations 6, 7, and 8) were used to represent blood
glucose, with the independent variables discussed above of time, active,
signal, blood glucose at a calibration point (BG/cp), and a constant
(t.sub.i).
[0201] The switching between equations 6, 7, and 8 was determined by the
parameters w.sub.1, w.sub.2, and w.sub.3 in equation 5, which was further
determined by the parameters d.sub.1, d.sub.2, and d.sub.3 as given by
equations 9-14, where the individual experts had a linear form:
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (5)
[0202] wherein (BG) was blood glucose, there are three experts (n=3);
BG.sub.i was the analyte predicted by Expert i; and w.sub.i was a
parameter, and the individual Experts BG.sub.i were further defined by
the expression shown as Equations 6, 5 7, and 8
BG.sub.1=p.sub.1(time)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.vertline-
.cp)+t.sub.1 (6)
BG.sub.2=p.sub.2(time)+q.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.vertline-
.cp)+t.sub.2 (7)
BC.sub.3=p.sub.3(time)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.vertline-
.cp)+t.sub.3 (8)
[0203] wherein, BC.sub.i was the analyte predicted by Expert i; parameters
include, time (elapsed time), active (active signal), signal (calibrated
signal), and BG/cp (blood glucose value at a calibration point); p.sub.i,
q.sub.i, r.sub.i, and s.sub.i were coefficients; and t.sub.i was a
constant; and further where the weighting value, w.sub.i was defined by
the formulas shown as Equations 9, 10, and 11 18 w 1 = d 1
d 1 + d 2 + d 3 ( 9 ) w 2 = d 2 d 1
+ d 2 + d 3 ( 10 ) w 3 = d 3 d 1 +
d 2 + d 3 ( 11 )
[0204] where e referred to the exponential function and d.sub.i was a
parameter set (analogous to Equations 6, 7, and 8) that were used to
determine the weights w.sub.i, given by Equations 9, 10, and 11, and
d.sub.2=.tau..sub.1(time)+.beta..sub.1(active)+.gamma..sub.1(signal)+.delt-
a..sub.1(BG.vertline.cp)+.epsilon..sub.1 (12)
d.sub.2=.tau..sub.2(time)+.beta..sub.2(active)+.gamma..sub.2(signal)+.delt-
a..sub.2(BG.vertline.cp)+.epsilon..sub.2 (13)
d.sub.3=.tau..sub.3(time)+.beta..sub.3(active)+.gamma..sub.3(signal)+.delt-
a..sub.3(BG.vertline.cp)+.epsilon..sub.3 (14)
[0205] where .tau..sub.i, .beta..sub.i, .gamma..sub.i and .delta..sub.i
were coefficients, and where .epsilon..sub.i is a constant.
[0206] To calculate the above parameters-an optimization method was
applied to the algorithm (Equations 5-14) and the large data set. The
optimization method used was the Expectation Maximization method
(Dempster, A. P., N. M. Laird, and D. B. Rubin, J. Royal Statistical
Society (Series B-Methodological) 39:(1), 1977), but other methods may be
used as well.
[0207] The parameters in these equations were determined such that the
posterior probability of the actual glucose was maximized.
EXAMPLE 2
Prediction of Measurement Values I
[0208] Iontophoretic extraction of glucose was carried out using a
GlucoWatch.RTM. monitor which employs (i) a low-level iontophoretic
current to extract glucose through patient's skin, and (ii) an
electrochemical biosensor to detect the extracted glucose. Iontophoresis
was carried out for 3 minute intervals and electrochemical detection was
carried out for 7 minute intervals to result in 10 minute measurement
cycles--thus generating collections of data (data sets) as described in
Example 1.
[0209] The data that were used for this analysis were obtained by diabetic
subjects each wearing a GlucoWatch.RTM. monitor over a 14 hour period.
The MOE inputs consisted of the following parameters (described in
Example 1): time, active, signal, blood glucose at a calibration point
(BG/cp). These training data were used to determine the unknown
parameters in the MOE using the Expectation Maximization Method. The
output of the MOE algorithm was the measured value of blood glucose.
Using a three hour time point for calibrating the GlucoWatch.RTM.
monitor, the mean percentage error (MPE) between the actual blood glucose
and the calculated (MOE predicted) blood glucose was 13%.
[0210] In a diabetic study consisting of 61 patients, the diabetic
subjects' blood glucose ranged from 23-389 mg/dl. A protocol was followed
whereby a subject (who had fasted since the previous midnight) came to a
test site where the GlucoWatch.RTM. monitor was applied to the subject,
started, and calibrated. Over the next 14 hours, the subject had normal
meals and a finger prick blood sample was taken every 20 minutes for
glucose determination ("actual glucose"). Blood glucose levels were
measured using the HemoCue.RTM. meter (HemoCue AB, Sweden), which has an
accuracy of .+-.10%.
[0211] A plot of the glucose levels predicted by the Mixtures of Experts
algorithm (based on the data described above) versus the actual blood
glucose levels is presented in FIG. 6 (a Correlation Plot). Analysis of
the data shown in FIG. 6 showed a slope of 0.88, an intercept of 14, and
a correlation coefficient of R=0.93. There were N=1,348 points comprising
the Correlation Plot.
[0212] These statistical results, along with the MPE=0.13 (discussed
above), show the excellent predictive capabilities of the GlucoWatch.RTM.
monitor and the Mixtures of Experts algorithm.
EXAMPLE 3
Another Application of the "Mixtures of Experts" to Glucose Monitoring
[0213] This example describes the use of a Mixtures of Experts (MOE)
algorithm to predict blood glucose data from a series of signals.
[0214] In the present example, a GlucoWatch.RTM. monitor was used to
collect data and the following variables were chosen to generate data
sets for the MOE algorithm:
[0215] 1) time since calibration (time.sub.c), the elapsed time since the
calibration step was carried out for the GlucoWatch.RTM. monitor (in
hours);
[0216] 2) active signal (active), in this example, the value of the active
parameter corresponded to the averaged signal from two active reservoirs,
where each reservoir provided a nanoamp signal that was integrated over
the sensing time-interval, the two values were then added and averaged to
give the active parameter in nanocoulombs (nC);
[0217] 3) calibrated signal (signal), in this example was obtained as
follows: 19 signal = BG / cp ( active / cp + offset ) (
active + offset )
[0218] where the offset takes into account the intercept value.
[0219] 4) blood glucose value at the calibration point (BG/cp), in mg/dl,
was determined by direct blood testing.
[0220] Other possible variables include, but are not limited to,
temperature, iontophoretic voltage (which is inversely proportional to
skin resistance), and skin conductivity.
[0221] Large data sets were generated by collecting signals using a
transdermal sampling system that was placed in operative contact with the
skin. The sampling system transdermally extracted the analyte from the
biological system using an appropriate sampling technique (in this case,
iontophoresis). The transdermal sampling system was maintained in
operative contact with the skin to provide a near continual or continuous
stream of signals.
[0222] The basis of the Mixtures of Experts was to break up a non-linear
prediction equation (Equation 15, below) into several Expert prediction
equations, and then to have a routine to switch between the different
linear equations. For predicting blood glucose levels, three separate
linear equations (Equations 16, 17, and 18) were used to represent blood
glucose, with the independent variables discussed above of time, active,
signal, blood glucose at a calibration point (BG/cp), and a constant
(t.sub.i).
[0223] The switching between Equations 16, 17, and 18 was determined by
the parameters w.sub.1, w.sub.2, and w.sub.3 in equation 5, which was
further determined by the parameters d.sub.1, d.sub.2, and d.sub.3 as
given by equations 9-14, where the individual experts had a linear form:
BG=w.sub.1BG.sub.1+w.sub.2BG.sub.2+w.sub.3BG.sub.3 (15)
[0224] wherein (BG) was blood glucose, there are three experts (n=3);
BG.sub.i was the analyte predicted by Expert i; and w.sub.i was a
parameter, and the individual Experts BG.sub.i were further defined by
the expression shown as Equations 16, 17, and 18
BG.sub.1=p.sub.1(time.sub.c)+q.sub.1(active)+r.sub.1(signal)+s.sub.1(BG.ve-
rtline.cp)+t.sub.1(16)
BG.sub.2=p.sub.2(time.sub.c)+q.sub.2(active)+r.sub.2(signal)+s.sub.2(BG.ve-
rtline.cp)+t.sub.2 (17)
BG.sub.3=p.sub.3(time.sub.c)+q.sub.3(active)+r.sub.3(signal)+s.sub.3(BG.ve-
rtline.cp)+t.sub.3 (18)
[0225] wherein, BG.sub.i was the analyte predicted by Expert i; parameters
include, time, (elapsed time since calibration), active (active signal),
signal (calibrated signal), and BG/cp (blood glucose value at a
calibration point); p.sub.i, q.sub.i, r.sub.i, and s.sub.i were
coefficients; and t.sub.i was a constant; and further where the weighting
value, w.sub.i, was defined by the formulas shown as Equations 19, 20,
and 21 20 w 1 = d 1 d 1 + d 2 + d 3 (
19 ) w 2 = d 2 d 1 + d 2 + d 3 ( 20 )
w 3 = d 3 d 1 + d 2 + d 3 ( 21 )
[0226] where e referred to the exponential function and d.sub.i was a
parameter set (analogous to Equations 16, 17, and 18) that were used to
determine the weights w.sub.i, given by Equations 19, 20, and 21, and
d.sub.1=.tau..sub.1(time.sub.c)+.beta..sub.1(active)+.gamma..sub.1(signal)-
+.delta..sub.1(BG.vertline.cp)+.epsilon..sub.1 (22)
d.sub.2=.tau..sub.2(time.sub.c)+.beta..sub.2(active)+.gamma..sub.2(signal)-
+.delta..sub.2(BG.vertline.cp)+.epsilon..sub.2 (23)
d.sub.3=.tau..sub.3(time.sub.c)+.beta..sub.3(active)+.gamma..sub.3(signal)-
+.delta..sub.3(BG.vertline.cp)+.epsilon..sub.3 (24)
[0227] where .tau..sub.i, .beta..sub.i, .gamma..sub.i and .delta..sub.i
were coefficients, and where .epsilon..sub.i is a constant.
[0228] To calculate the above parameters an optimization method was
applied to the algorithm (Equations 15-24) and the large data set. The
optimization method used was the Expectation Maximization method
(Dempster, A. P., N. M. Laird, and D. B. Rubin, J. Royal Statistical
Society (Series B-Methodological) 39:(1), 1977), but other methods may be
used as well.
[0229] The parameters in these equations were determined such that the
posterior probability of the actual glucose was maximized.
EXAMPLE 4
Prediction of Measurement Values II
[0230] A. Calibration Ratio Check
[0231] In order to insure an efficacious calibration of the sampling
system, the value of the following ratio was found to fall in a selected
range: 21 CalRatio = BG / cp ( active / cp + offset )
[0232] where the offset takes into account the intercept value. The range
is established using standard error minimization routines to evaluate a
large population of calibration points, and thereby determine the
CalRatio values which result in accurate blood glucose predictions. In
one embodiment, the preferred CalRatio range of values was between
0.00039 and 0.01. In the CalRatio, BG/cp was the blood glucose
concentration at the calibration point (or calibration time), active was
the input prediction at the calibration point, and offset was a constant
offset. The offset value was established empirically using standard error
minimization routines to evaluate a number of potential offset values for
a large data set, and thereby select the one that results in the most
accurate prediction of blood glucose.
[0233] The CalRatio check provides a screen for valid or efficacious
calibration readings. If the CalRatio falls outside of the range of
selected values, then the calibration was rejected and the calibration
was re-done. Low values of this ratio indicated low sensitivity of
glucose detection.
[0234] B. Prediction of Values
[0235] GlucoWatch.RTM. monitors (Cygnus, Inc., Redwood City, Calif., USA)
were applied to the lower forearm of human subjects with diabetes
(requiring insulin injection). Iontophoretic extraction of glucose was
carried out using the GlucoWatch.RTM. monitor which employs (i) a
low-level iontophoretic current to extract glucose through patient's
skin, and (ii) an electrochemical biosensor to detect the extracted
glucose.
[0236] The subjects were 18 years of age, or older, and consisted of both
males and females from a broad ethnic cross-section. Iontophoresis was
carried out for 3 minute intervals and electrochemical detection was
carried out for 7 minute intervals to result in 10 minute measurement
cycles--thus generating collections of data (data sets) as described in
Example 3. As described in Example 3, the active measurement was the
averaged signal from two active reservoirs, for example, a first
electrode acts as the cathode during the first 10 minute cycle (3 minutes
of iontophoresis, followed by 7 minutes of sensing) and a second
electrode acts as the cathode during the second 10 minute cycle. The
combined cycle requires 20 minutes, and the combined cathode sensor data
is used as a measure of the glucose extracted (an averaged "active
signal", see Example 3). This 20 minute cycle is repeated throughout
operation of the GlucoWatch.RTM. monitor.
[0237] In addition, subjects obtained two capillary blood samples per
hour, and the glucose concentration was determined using a HemoCue.RTM.
clinical analyzer (HemoCue AB, Sweden). The blood glucose measurement
obtained at three hours was used as a single point calibration, which was
used to calculate the extracted blood glucose for all subsequent
GlucoWatch.RTM. monitor measurements.
[0238] The data that were used for this analysis were obtained by diabetic
subjects each wearing two GlucoWatch.RTM. monitors over a 14 hour period.
The MOE inputs consisted of the following parameters (described in
Example 3): time.sub.c, active, signal, blood glucose at a calibration
point (BG/cp). For the calibrated signal: 22 signal = BG / cp (
active + offset ) ( active / cp + offset )
[0239] where (i) active/cp was the input prediction at the calibration
point, and (ii) the offset and takes into account the fact that when
predicted blood glucose is plotted vs. active, there is a non-zero
y-intercept. The optimized value of the offset that was used was a
constant value of 1000 nC. The signal that is used in the Mixtures of
Experts algorithm is temperature compensated by applying an Arrhenius
type correction to the raw signal data to account for skin temperature
fluctuations.
[0240] Finally, in order to eliminate potential outlier points, various
screens were applied to the raw and integrated sensor signals. The
purpose of these screens were to determine whether certain environmental,
physiological or technical conditions existed during a measurement cycle
that could result in an erroneous reading. The screens that were used
measured the averaged signal (active), iontophoretic voltage,
temperature, and skin surface conductance. If any of these measurements
deviated sufficiently from predefined behavior during a measurement, then
the entire measurement was excluded. For example, if the skin surface
conductance exceeded a set threshold, which indicated excessive sweating
(sweat contains glucose), then this potentially erroneous measurement was
excluded. These screens enable very noisy data to be removed, while
enabling the vast majority of points (>87%) to be accepted.
[0241] The Mixtures of Experts was further customized in the following
way. When the weights were updated using equations 19-24 (Example 3), a
Laplacian distribution function was used. The Laplacian distribution has
longer tails than a Gaussian distribution, and weighs deviations relative
to the absolute difference from the mean, whereas a Gaussian distribution
weighs deviations relative to the square of difference from the mean (P.
McCullagh and J. A. Nelder, Generalized Linear Models, Chapman and Hall,
1989; and W. H. Press, S. A. Teukolsky, W. T. Vetterling and B. P.
Flannery, Numerical Recipes in C. Cambridge University Press, Cambridge,
1992). In addition, the individual blood glucose values were weighted by
the inverse of the value of the blood glucose at the calibration point.
Both of these modifications result in increased accuracy of predictions,
especially at low blood glucose levels.
[0242] The training data were used to determine the unknown parameters in
the Mixtures of Experts using the Expectation Maximization Method. The
Mixtures of Experts algorithm was trained until convergence of the
weights was achieved. The output of the MOE algorithm was the measured
value of blood glucose. Using a three hour time point for calibrating the
GlucoWatch.RTM. monitor, the mean percentage error (MPE) between the
actual blood glucose and the calculated (MOE predicted) blood glucose was
14.4%.
[0243] In a diabetic study consisting of 91 GlucoWatch.RTM. monitors, the
diabetic subjects' blood glucose ranged from 40-360 mg/dl. A protocol was
followed whereby a subject (who had fasted since the previous midnight)
came to a test site where two GlucoWatch.RTM. monitors were applied to
the subject, started, and calibrated. Over the next 14 hours, the subject
had normal meals and a finger prick blood sample was taken every 20
minutes for glucose determination ("actual glucose"). Blood glucose
levels were measured using the HemoCue.RTM. meter (HemoCue AB, Sweden),
which has an accuracy of .+-.10%.
[0244] A plot of the glucose levels predicted by the Mixtures of Experts
algorithm (based on the data described above) versus the actual blood
glucose levels is presented in FIG. 7 (a Correlation Plot). Also shown in
FIG. 7 is the orthogonal least squares line (A. Madansky, The Fitting of
Straight Lines When both Variables are Subject to Error, J. American
Statistical Association 54:173-206, 1959; D. York, Least-Squares Fitting
of a Straight Line, Canadian Journal of Physics 44:1079-1986, 1966; W. A.
Fuller, Measurement Error Models, Wiley, New York, 1987; and W. H. Press,
S. A. Teukolsky, W. T. Vetterling and B. P. Flannery, Numerical Recipes
in C. Cambridge University Press, Cambridge, 1992) with an error variance
ratio (defined as the error in the dependent variable divided by the
error of the independent variable) of 2.05. This variance error ratio
corrects the linear regression line (which assumes zero error in the
independent variable) for the true error in both independent and
dependent variables.
[0245] The variance ratio was determined as follows. Each subject was
required to wear two GlucoWatch.RTM. monitors. Then, at each time point,
the difference between the two watches was determined, squared and
divided by 2. The resulting values were averaged over the total number of
time points used. Fifty pairs of watches, each with 42 time points, were
used for this calculation. The error variance for the HemoCue.RTM. was
obtained from clinical data published in the literature. The
GlucoWatch.RTM. monitor error variance was calculated to be 150 (standard
deviation 12 mg/dl) and the HemoCue.RTM. error variance was calculated to
be 73 (standard deviation =8.5 mg/dl), giving the error ratio of 2.05.
[0246] Analysis of the data shown in FIG. 7 showed a slope of 1.04, an
intercept of approximately -10.7 mg/dl, and a correlation coefficient of
R=0.89.
[0247] It is also instructive to examine graphs of the measured and
predicted blood glucose levels vs. time. One such graph is shown in FIG.
8 (in the legend of FIG. 8: solid diamonds-are measurements obtained
using the GlucoWatch.RTM. monitor; open circles are blood glucose
concentrations as determined using HemoCue.RTM.; and the "star" symbol
represents blood glucose concentration at the calibration point). FIG. 8
indicates the excellent capabilities of the GlucoWatch.RTM. monitor and
the Mixtures of Experts algorithm in calibrating the device.
[0248] These statistical results, along with the MPE=14.4% (discussed
above), show the excellent predictive capabilities of the GlucoWatche
monitor and the Mixtures of Experts algorithm.
[0249] Although preferred embodiments of the subject invention have been
described in some detail, it is understood that obvious variations can be
made without departing from the spirit and the scope of the invention as
defined by the appended claims.
* * * * *