US 20070293744 A1
A noninvasive glucose concentration analyzer having an optical probe with incident and collection optics and a channel for coupling fluid delivery is disclosed. Fluid is delivered through the channel to a skin tissue site that is subsequently optically sampled using the analyzer.
1. An apparatus for noninvasive glucose concentration analysis of tissue/blood of a sample site of skin, comprising:
an optical based analyzer comprising an optical probe, wherein said optical probe comprises a tip, wherein said optical probe comprises at least one optical incident member for delivering incident photons, wherein said optical probe comprises at least one optical collection member for collecting photons,
wherein said optical probe comprises at least one channel for delivery of a coupling fluid.
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16. A method for noninvasive glucose concentration analysis of tissue/blood of a sample site of skin, comprising:
using an analyzer comprising an optical probe, wherein said optical probe comprises a tip, wherein said optical probe comprises at least one optical incident member for delivering incident photons, wherein said optical probe comprises at least one optical collection member for collecting photons; and
delivering optical fluid through a channel in said optical probe during use.
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This application is a continuation of U.S. patent application Ser. No. 10/824,459, filed Apr. 13, 2004, which claims benefits to the U.S. provisional patent application Ser. No. 60/463,616 filed on 16 Apr. 2003 the contents of each of which are incorporated herein in their entirety by this reference thereto.
1. Field of the Invention
The invention relates generally to the technology of noninvasive analyte determination in the human body. More particularly, the invention relates to the use of a placement guide in conjunction with a diffuse reflectance based near-IR glucose analyzer. The placement guide couples to a glucose analyzer and has at least one of a hydration inducer and a reservoir for a coupling agent used for automatic or manual delivery of the coupling agent to the sampling site.
2. Description of Related Art
Spectroscopy based noninvasive analyzers deliver external energy in the form of light or rays to a specific sampling site or region of the human body where the photons interact with the chemistry and physiology of the sampled tissue. A portion of the incident photons are scattered or transmitted out of the body where they are detected. Based upon knowledge of the incident photons and detected photons, the chemical and/or structural basis of the sampled site may be deduced. Several distinct advantages to a noninvasive system are the analyses of chemical and structural constituents in the body without the generation of a biohazard in a pain free manner with limited consumables. The technique may also allow for multiple analytes or structural features to be determined at one time. Some common examples of noninvasive analyzers are magnetic resonance imaging (MRI), X-rays, pulse oximeters, and noninvasive glucose analyzers. With the exception of X-rays, these determinations are performed with relatively harmless wavelengths of radiation. Examples herein focus on noninvasive glucose determination, but the principles apply to other modes of noninvasive analyses.
Diabetes is a chronic disease that results in improper production and utilization of insulin, a hormone that facilitates glucose uptake into cells. While a precise cause of diabetes is unknown, genetic factors, environmental factors, and obesity appear to play roles. Diabetics have increased risk in three broad categories: cardiovascular heart disease, retinopathy, and neuropathy. Diabetics may have one or more of the following complications: heart disease and stroke, high blood pressure, kidney disease, neuropathy (nerve disease and amputations), retinopathy, diabetic ketoacidosis, skin conditions, gum disease, impotence, and fetal complications. Diabetes is a leading cause of death and disability worldwide. Moreover, diabetes is merely one among a group of disorders of glucose metabolism that also includes impaired glucose tolerance, and hyperinsulinemia, or hypoglycemia.
Diabetes Prevalence and Trends
Diabetes is an ever more common disease. The World Health Organization (WHO) estimates that diabetes currently afflicts 154 million people worldwide. There are 54 million people with diabetes living in developed countries. The WHO estimates that the number of people with diabetes will grow to 300 million by the year 2025. In the United States, 15.7 million people or 5.9 percent of the population are estimated to have diabetes. Within the United States, the prevalence of adults diagnosed with diabetes increased by 6% in 1999 and rose by 33% between 1990 and 1998. This corresponds to approximately eight hundred thousand new cases every year in America. The estimated total cost to the United States economy alone exceeds $90 billion per year. Diabetes Statistics, National Institutes of Health, Publication No. 98-3926, Bethesda, Md. (November 1997).
Long-term clinical studies show that the onset of complications can be significantly reduced through proper control of blood glucose levels. The Diabetes Control and Complications Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, N Eng J of Med, 329:977-86 (1993); U.K. Prospective Diabetes Study (UKPDS) Group, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes, Lancet, 352:837-853 (1998); and Y. Ohkubo, H. Kishikawa, E. Araki, T. Miyata, S. Isami, S. Motoyoshi, Y. Kojima, N. Furuyoshi, M. Shichizi, Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study, Diabetes Res Clin Pract, 28:103-117 (1995).
A vital element of diabetes management is the self-monitoring of blood glucose levels by diabetics in the home environment. However, current monitoring techniques discourage regular use due to the inconvenient and painful nature of drawing blood through the skin prior to analysis. The Diabetes Control and Complication Trial Research Group, supra. As a result, noninvasive measurement of glucose has been identified as a beneficial development for the management of diabetes. Implantable glucose analyzers eventually coupled to an insulin delivery system providing an artificial pancreas are also being pursued.
A wide range of technologies serve to analyze the chemical make-up of the body. These techniques may be broadly categorized into two groups, invasive and noninvasive. For the purposes of this document, a technology that acquires any biosample from the body for analysis or if any part of the measuring apparatus penetrates into the body, the technology is referred to as invasive.
There exist a number of noninvasive approaches for glucose determination. These approaches vary widely, but have at least two common steps. First, an apparatus is utilized to acquire a signal from the body without obtaining a biological sample. Second, an algorithm is utilized to convert this signal into a glucose determination.
One type of noninvasive glucose determination is based upon spectra. Typically, a noninvasive apparatus utilizes some form of spectroscopy to acquire the signal or spectrum from the body. Utilized spectroscopic techniques include, but are not limited to: Raman and fluorescence, as well as techniques using light from ultraviolet through the infrared [ultraviolet (200 to 400 nm), visible (400 to 700 nm), near-IR (700 to 2500 nm or 14,286 to 4000 cm−1), and infrared (2500 to 14,285 nm or 4000 to 700 cm−1)]. A particular range for noninvasive glucose determination in diffuse reflectance mode is about 1100 to 2500 nm or ranges therein. K. Hazen, Glucose Determination in Biological Matrices Using Near-Infrared Spectroscopy, doctoral dissertation, University of Iowa (1995). It is important to note that these techniques are distinct from the traditional invasive and alternative invasive techniques listed above in that the interrogated sample is a portion of the human body in-situ, not a biological sample acquired from the human body.
Typically, three modes are utilized to collect noninvasive scans: transmittance, transflectance, and/or diffuse reflectance. For example the signal collected, typically being light or a spectrum, may be transmitting through a region of the body such as a fingertip, diffusely reflected, or transflected. Transflected here refers to collection of the signal not at the incident point or area (diffuse reflectance), and not at the opposite side of the sample (transmittance), but rather at some point on the body between the transmitted and diffuse reflectance collection area. For example, transflected light enters the fingertip or forearm in one region and exits in another region typically 0.2 to 5 mm or more away depending on the wavelength utilized. Thus, light that is strongly absorbed by the body such as light near water absorbance maxima at 1450 or 1950 nm would need to be collected after a small radial divergence and light that is less absorbed such as light near water absorbance minima at 1300, 1600, or 2250 nm may be collected at greater radial or transflected distances from the incident photons.
Noninvasive techniques are not limited to using the fingertip as a measurement site. Alternative sites for taking noninvasive measurements include: a hand, finger, palmar region, base of thumb, wrist, dorsal aspect of the wrist, forearm, volar aspect of the forearm, dorsal aspect of the forearm, upper arm, head, earlobe, eye, tongue, chest, torso, abdominal region, thigh, calf, foot, plantar region, and toe. It is important to note that noninvasive techniques do not have to be based upon spectroscopy. For example, a bioimpedence meter would be considered a noninvasive device. Within the context of the invention, any device that reads a signal from the body without penetrating the skin and collecting a biological sample is referred to as a noninvasive glucose analyzer. For example, a bioimpedence meter is a noninvasive device.
Glucose analyzers require calibration. This is true for all types of glucose analyzers such as traditional invasive, alternative invasive, noninvasive, and implantable analyzers. One fact associated with noninvasive glucose analyzers is that they are secondary in nature, that is, they do not measure blood glucose levels directly. This means that a primary method is required to calibrate these devices to measure blood glucose levels properly. Many methods of calibration exist.
One noninvasive technology, near-infrared spectroscopy, requires that a mathematical relationship between an in vivo near-infrared measurement and the actual blood glucose value be developed. This is achieved through the collection of in-vivo NIR measurements with corresponding blood glucose values that have been obtained directly through the use of measurement tools like a HEMOCUE or a YSI (YSI INCORPORATED, Yellow Springs Ohio), or any appropriate and accurate traditional invasive reference device.
For spectrophotometric based analyzers, there are several univariate and multivariate methods that may be utilized to develop the mathematical relationship between the measured signal and the actual blood glucose value. However, the basic equation being solved is known as the Beer-Lambert Law. This law states that the strength of an absorbance/reflectance measurement is proportional to the concentration of the analyte which is being measured, as in equation 1,
Chemometric calibration techniques extract the glucose signal from the measured spectrum through various methods of signal processing and calibration including one or more mathematical models. The models are developed through the process of calibration on the basis of an exemplary set of spectral measurements known as the calibration set and associated set of reference blood glucose concentrations based upon an analysis of capillary blood or venous blood. Common multivariate approaches requiring an exemplary reference glucose concentration vector for each sample spectrum in a calibration include partial least squares (PLS) and principal component regression (PCR). Many additional forms of calibration are known, such as neural networks.
There are a number of reports on noninvasive glucose technologies. Some of these relate to general instrumentation configurations required for noninvasive glucose determination. Others refer to sampling technologies. Those most related to the present invention are briefly reviewed here:
As outlined above, there have been a number of studies documenting the need for an accurate and precise noninvasive glucose analyzer.
R. Barnes, J. Brasch, D. Purdy, W. Lougheed, Non-invasive determination of analyte concentration in body of mammals, U.S. Pat. No. 5,379,764 (Jan. 10, 1995) describe a noninvasive glucose analyzer that utilizes data pretreatment in conjunction with a multivariate analysis to determine blood glucose concentrations.
P. Rolfe, Investigating substances in a patient's bloodstream, UK Patent Application No. 2,033,575 (Aug. 24, 1979) describe an apparatus for directing light into the body, detecting attenuated backscattered light, and utilizing the collected signal to determine glucose concentrations in or near the bloodstream.
C. Dahne, D. Gross, Spectrophotometric method and apparatus for the non-invasive, U.S. Pat. No. 4,655,225 (Apr. 7, 1987) describe a method and apparatus for directing light into a patient's body, collecting transmitted or backscattered light, and determining glucose from selected near-IR wavelength bands. Wavelengths include 1560 to 1590, 1750 to 1780, 2085 to 2115, and 2255 to 2285 nm with at least one additional reference signal from 1000 to 2700 nm.
M. Robinson, K. Ward, R. Eaton, D. Haaland, Method and apparatus for determining the similarity of a biological analyte from a model constructed from known biological fluids, U.S. Pat. No. 4,975,581 (Dec. 4, 1990) describe a method and apparatus for measuring a concentration of a biological analyte such as glucose using infrared spectroscopy in conjunction with a multivariate model. The multivariate model is constructed form plural known biological fluid samples.
J. Hall, T. Cadell, Method and device for measuring concentration levels of blood constituents non-invasively, U.S. Pat. No. 5,361,758 (Nov. 8, 1994) describe a noninvasive device and method for determining analyte concentrations within a living subject utilizing polychromatic light, a wavelength separation device, and an array detector. The apparatus utilizes a receptor shaped to accept a fingertip with means for blocking extraneous light.
S. Malin, G Khalil, Method and apparatus for multi-spectral analysis of organic blood analytes in noninvasive infrared spectroscopy, U.S. Pat. No. 6,040,578 Mar. 21, 2000) describe a method and apparatus for determination of an organic blood analyte using multi-spectral analysis in the near-IR. A plurality distinct nonoverlapping regions of wavelengths are incident upon a sample surface, diffusely reflected radiation is collected, and the analyte concentration is determined via chemometric techniques.
R. Messerschmidt, D Sting Blocker device for eliminating specular reflectance from a diffuse reflectance spectrum, U.S. Pat. No. 4,661,706 (Apr. 28, 1987) describe a reduction of specular reflectance by a mechanical device. A blade-like device “skims” the specular light before it can impinge on the detector. A disadvantage of this system is that it does not efficiently collect diffusely reflected light and the alignment is problematic.
R. Messerschmidt, M. Robinson Diffuse reflectance monitoring apparatus, U.S. Pat. No. 5,636,633 (Jun. 10, 1997) describe a specular control device for diffuse reflectance spectroscopy utilizing a group of reflecting and open sections.
R. Messerschmidt, M. Robinson Diffuse reflectance monitoring apparatus, U.S. Pat. No. 5,935,062 (Aug. 10, 1999) and R. Messerschmidt, M. Robinson Diffuse reflectance monitoring apparatus, U.S. Pat. No. 6,230,034 (May 8, 2001) describe a diffuse reflectance control device that can discriminate between diffusely reflected light that is reflected from selected depths. This control device may additionally act as a blocker to prevent specularly reflected light from reaching the detector.
Malin et. al., supra describe the utilization of specularly reflected light in regions of high water absorbance such as 1450 and 1900 nm to mark the presence of outlier spectra wherein the specularly reflected light is not sufficiently reduced.
K. Hazen, G. Acosta, A. Abul-Haj, R. Abul-Haj, Apparatus and method for reproducibly modifying localized absorption and scattering coefficients at a tissue measurement site during optical sampling, U.S. Pat. No. 6,534,012 (Mar. 18, 2003) describe a mechanical device for applying sufficient and reproducible contact of the apparatus to the sampling medium to minimize specular reflectance. Further the apparatus allows for reproducible applied pressure to the sampling site and reproducible temperature at the sampling site.
It is well known that many physiological constituents have near-IR absorbance spectra that are sensitive in terms of magnitude and location to localized temperature. This has been reported as impacting noninvasive glucose determinations. Hazen, et. al., supra.
Index of fraction matching between the sampling apparatus and sampled medium is well known. Glycerol is a common index matching fluid for optics to skin. A number of patents disclose more specific coupling fluids with important sampling parameters.
R. Messerschmidt, Method for non-invasive blood analyte measurement with improved optical interface, U.S. Pat. No. 5,655,530 (Aug. 12, 1997), and R. Messerschmidt Method for non-invasive blood analyte measurement with improved optical interface, U.S. Pat. No. 5,823,951 describe an index-matching medium for use between a sensor probe and the skin surface. The index-matching medium is a composition containing perfluorocarbons and chlorofluorocarbons.
M. Robinson, R. Messerschmidt, Method for non-invasive blood analyte measurement with improved optical interface, U.S. Pat. No. 6,152,876 (Nov. 28, 2000) and M. Rohrscheib, C. Gardner, M. Robinson, Method and apparatus for non-invasive blood analyte measurement with fluid compartment equilibration, U.S. Pat. No. 6,240,306 (May 29, 2001) describe an index-matching medium to improve the interface between the sensor probe and skin surface during spectroscopic analysis. The index-matching medium is preferably a composition containing chlorofluorocarbons. The composition can also contain perfluorocarbons.
T. Blank, G. Acosta, M. Mattu, S. Monfre, Fiber optic probe guide placement guide, U.S. Pat. No. 6,415,167 (Jul. 2, 2002) describe a coupling fluid of one or more perfluoro compounds where a quantity of the coupling fluid is placed at an interface of the optical probe and measurement site. Notably, perfluoro compounds do not have the toxicity associated with chlorofluorocarbons.
Blank et. al., supra describe the utilization of a guide in conjunction with a noninvasive glucose analyzer in order to increase precision of the location of the sampled site resulting in increased accuracy and precision in a noninvasive glucose determination.
In all of the related technology of this section, no suggestion of automated analysis is made. Further, no suggestion is made for a fluoropolymer hydration inducer or for a coupling fluid reservoir within the guide. Both of these guide features ease the use of a bioanalyzer such as a near-IR based noninvasive glucose analyzer. In addition, to date no FDA device has been approved for the utilization by an individual or a medical professional for noninvasive glucose concentration determination.
Noninvasive glucose analyzers reported to date generally require precision in sampling in order to accurately determine glucose concentrations in the body. The measurement is complicated by every manual step required in the spectral acquisition process utilized in a given glucose determination. Complications include any of a requirement of time, a step requiring manual dexterity, or movement of measurement apparatus that may be bulky, fragile, or sensitive in terms of returned analytical signal. Elimination or automation of steps required for a noninvasive glucose determination is beneficial for at least one of increasing marketability of the analyzer, increasing the number of people who may utilize the analyzer, reduction in time requirements associated with a glucose determination, and increased precision and/or accuracy of a glucose determination. Specifically, preparation of the sampling site in terms of temperature, historesis of applied pressure, hydration, and optical scattering parameters involving actions from the user that may be any of technically challenging, time consuming, and error inducing.
What is desired is a mechanism for reducing user input through methods and apparatus such as a hydration inducer and a coupling agent enhancement integrated into a guide used in conjunction with a noninvasive glucose analyzer.
A placement guide apparatus and method for use in conjunction with an optically based noninvasive glucose analyzer is disclosed. Two coupling agents are incorporated into the guide. The first is a hydration inducing plug used for optical coupling of the measurement apparatus to the sampling site. The second is a fluorocarbon mixture used for optical coupling of the measurement apparatus to the sampling site.
The guide has a mount, an aperture defined by the mount, and an optical coupling apparatus, namely a hydration inducing plug. The mount has a contact surface at one end, at least a portion of the contact surface being contact with a sampling site. The aperture is adapted to receive an optical probe, which is part of the optically based noninvasive analyzer. The hydration inducing plug is securely attached, from the aperture, to the mount at the contacting end. The outer surface of the hydration inducing plug is aligned with the mount's contact surface and is in direct contact with the sampling site. When the optical probe is coupled into the aperture, the hydration inducing plug acts an optical interface between the optical probe and the sampling site. The hydration inducing plug is made of a material or materials, such as fluoropolymer, having properties that include at least one of being near-IR transmissive, hydrophobic, refractive index matching, and insulating.
In one embodiment, the hydration inducing plug is an evenly flat member, the edge of which is securely attached to the mount of the guide. When the optical probe is coupled with the guide, both the incidental optics and the collection optics are in direct contact with the inner surface of the hydration inducing plug.
In another embodiment, the hydration inducing plug includes multiple layers. Each of the layers may have its own physical properties. The multiple layers may be evenly or unevenly heat compressed. In an uneven heat compression case, the central area of the plug is made thinner than the surrounding area.
In another embodiment, there is a hole in the center of the hydration inducing plug, so that when the optical probe is coupled with the guide, the collection optics of the optical probe is fittingly coupled into the hole and has direct contact with the sampling site, while the incident optics of the optical probe maintains direct contact with the surrounding area of the hydration inducing plug. To increase detection, the hydration inducing plug may be shaped as an optical convexity. In that case, the incident photons travel in the air for a short distance before they reach the inner surface of the plug.
Yet in another embodiment, the guide contains one or more reservoirs for containment of an optical coupling fluid that may be near-IR inactive. A guide incorporating at least one of these couplers allows for increased ease of use and increased in precision and accuracy of near-IR based noninvasive glucose determinations. The modified guide allows for automated, semi-automated, or simplified sampling associated with a near-IR based noninvasive glucose analyzer or for separate optical analyses that use a guide.
The hydration inducing plug, also called hydration inducer coupler, replaces an older plug that has to be manually removed between samples. The removal and replacement after sampling of the plug results in several issues such as: (1) time involved; (2) manually dexterity; (3) introduction of pressure transients; (4) introduction of temperature transients; (5) possibility of loss of removable item; and (6) possibility of introducing contaminants to the sampling site. The hydration inducing plug according to the invention mitigates all of these issues.
The guide coupling fluid reservoir simplifies application of a coupling fluid. To date, application of coupling fluid to a measurement site has been achieved by manually placing an externally stored fluid onto the sampling site. There are many issues related to this including: (1) time involved; (2) manual dexterity requirements; (3) external storage space required; (4) portability concerns such as carrying the coupling fluid for use with a portable analyzer; (5) introduction of pressure transients, such as bumping the sampling site when applying the coupling fluid; and (6) introduction of temperature transients, such as applying a cold coupling fluid to the sampling site. The coupling fluid reservoir scheme according to the invention allows for automated, semi-automated, or simplified coupling fluid application that mitigates all of these issues.
The guide may be attached to the skin surface as in Blank, et. al., supra and as in the co-pending T. Blank, G. Acosta, M. Mattu, M. Makarewicz, S. Monfre, A. Lorenz, T. Ruchti, Optical sampling interface for in-vivo measurement of tissue, U.S. patent application Ser. No. 10/170,921 (filed Jun. 12, 2002). Typically a thin film double sided adhesive is used to couple the guide to the sampling site with a hole punched into the adhesive that correlates in position to the sample site actually probed by photons collected by the glucose analyzer. The adhesive may be a moleskin adhesive layer. The adhesive may be used to help contain the coupling fluid as discussed below.
In the embodiment pictured in
The hydration inducing plug 104 serves many of the same purposes as a previously described separate element, herein referred to as the old plug or traditional plug. The old plug was first introduced in Blank, et. al., supra. The old plug basically serves as a hydration inducer or accelerator and is made of polycarbonate. As mentioned above the old plug has many potential issues, such as requiring time and ability from the user and introducing the risk of error introduction in the sampling process through parameters, such as introduction of temperature and pressure transients at the sampling site.
The use of the hydration inducing plug 104 that is attached to the guide and that does not need to be removed and replaced between samples has multiple advantages. First, as the hydration inducing plug 104 is always present, it may not be lost. Second, it acts as a natural barrier to contaminants reaching the sample site. Third, it is maintained at skin temperature by the body and does not introduce a temperature transient at the sample site as a removed plug that become cold would do when replaced at the sampling site. Fourth, since the hydration inducing plug 104 is flexible and does not need to be replaced, the risks of pressure transients associated with replacing the older plug in contact with the sampling site are mitigated. Fifth, as the hydration inducing plug 104 is passive it does not require time to remove and replace nor does it require manual dexterity to do so. Sixth, external storage of a fluid and applicator devices is not required.
The skin sample 101 is coupled to the glucose analyzer through the guide as pictured in
In all embodiments within this specification, the desirable properties of the hydration inducing plug 104 include at least one of: (1) hydrophobic; (2) insulating; (3) mechanically flexible and strong; (4) near-IR transmissive from 1100 to 1900 nm; and (5) index of refraction matched.
Some examples of materials that fulfill all of these criteria are fluoropolymers. Fluoropolymers are available in almost any shape and thickness. For example, fluoropolymer films are available from about 25 μm thick to 1 to 3 mm in thickness. Certainly, thicker layers are available. Particular examples of fluoropolymers include Teflon® and Teflon® AF. The term Teflon is used in this specification to represent a fluoropolymer due to the wide recognition of the properties of Teflon, but many additional fluoropolymers have the characteristics described herein.
A fluoropolymer such as Teflon is hydrophobic. As a result, Teflon placed on the surface of the skin results in hydration of the covered skin sample site from the deeper internal layers of skin out towards the surface. The use of a hydrophobic barrier may result in both the increased degree of hydration of the surface structures of the skin and a reduction in the required time to achieve a given hydration level. Both of these are important in the performance of noninvasive glucose analyzers as it results in an increased average depth of penetration of the incident photons due to fewer locations of strong index of refraction differences between dry tissue and air pockets. This results in less scattering and hence deeper average photon penetration. Further, a consistent hydration level results in more precise sampling.
Teflon is a poor thermal conductor. This means that the sampled surface may be insulated from environmental temperature variations. This is important because temperature fluxuations affect the wavelength and magnitude of near-IR absorbance of many skin constituents such as water, protein, and glucose. These changes in optical properties have been reported as detrimental to chemometric procedures, such as mean centering and multivariate analysis such as PCR or PLS, which are commonly applied in near-IR based noninvasive glucose determinations.
Very thin films of Teflon are available or may be prepared that have great flexibility and are strong. This allows the Teflon to couple readily to the sample site without resulting in alterations of the sampling site due to mechanical rigidness. The importance of applying minimal physical perturbations to the sampling site has been outlined in Hazen, et. al. supra and M. Makarewicz, M. Mattu, T. Blank, G. Acosta, E. Handy, W. Hay, T. Stippick, B. Richie, Method and apparatus for minimizing spectral interference due to within and between sample variations, U.S. patent application Ser. No. 09/954,856 (filed Sep. 17, 2001).
Teflon AF is greater than 90% transmissive from 400 to 2000 nm, as reported in http://www.dupont.com/teflon/af/unique.html. This allows incident photons from the sampling probe to penetrate through the hydration inducing plug into the sampling region of the skin. As is obvious to those skilled in the art, the transmittance of the sampling photons through the hydration barrier is critical if the hydration barrier is to be left in the optical path during sampling.
Teflon AF has a refractive index of around 1.32 at room temperature. The refractive index of Teflon AF has been reported as varying from 1.29 to 1.316 as temperature decreases from 300 to 100° C. according to the documentation in http://www.dupont.com/teflon/af/unigue.html. Notably, this is nearly equivalent to the refractive index of fluorocarbons such as Fluorinert and FC-40 that have been reported to be utilized as near-IR coupling agents in noninvasive glucose determination (discussed below). The refractive index and transmission characteristics of Teflon AF result in optical throughput similar to systems that utilize coupling fluids such as FC-40.
In one embodiment of the invention, the optically transparent plug may mitigate or eliminate the need for a coupling fluid. That is, the plug acts as an optical coupler based upon having a refractive index between that of the skin and of the surrounding medium through which the incident photons or collection photons are traveling. For example, 2.8% of normally incident photons traveling from air with a refractive index of 1.0 to skin with a refractive index of 1.4 is reflected. With an intermediate layer, such as Teflon AF, the percentage of reflected photons for the same case reduces to 1.8%. Hence, more photons may penetrate into the sample and the resulting signal to noise may increase. This is exactly one of the purposes of an optical coupling fluid, such as a fluorocarbon molecule like FC-40. In this case, the hydrophobic nature of Teflon results in hydration of the interface between the Teflon and skin. Because water has an index of refraction of 1.33 which is between the 1.30 and 1.4 indices of Teflon AF and skin, this may further increase the percentage of incident photons penetrating into the sample.
It is possible to construct the coupler out of more than one layer. Individual film layers of different fluoropolymer sheets are pictured in
As shown in
In the formation of the sheets, a press may be used. The press may be heated. To reduce formation of air bubbles between layers, the press may be under a vacuum. The press may be optically smooth to increase light throughput of normally incident radiation. Similarly, the press may be optically rough if diffuse light is preferred. This may be useful for the application of reducing the amount of light propagating through the length and/or width of the sheet as in a light pipe or in reducing specular reflectance. The press may be the outer dimensions of an optic. This would allow the layers to be pressed into a light directing optic. Finally, the varying thickness would allow incident light to be wavelength separated. That is, as light is passed through the material, it would be wavelength separated by refraction.
The stacked layers of fluoropolymer sheets discussed above may be coupled to a number of other substrates and used to increase incident light throughput. For example, the fluoropolymer films may be attached to filters, longpass filter, shortpass filter, bandpass optics, lenses, optics, and/or fiber optics and used as a cheap method of anti-reflection coating.
In another embodiment, the hydration inducing plug may be shaped into a light directing optic. This is presented schematically in
In another embodiment, as shown in
In another embodiment as shown in
Advantages of a Coupler Integrally Coupled to the Guide
Previously, a traditional plug or older plug has been used in the placement guide. The plug has several purposes. First, the plug is utilized to increase hydration of the sampling site. Increases in hydration may initiate in the deeper layers of the outer skin and progress towards the outer layer of the skin. Second, the plug acts as a barrier to foreign objects such as dirt from contaminating the sampling site. Third, the plug acts as an insulator stabilizing the sample site temperature.
In any of the above configurations, a hydration inducing plug of a material such as a fluoropolymer or Teflon, applied over the sampling site has several advantages:
First, the older traditional plug is an object that may be misplaced whereas the hydration inducing plug according to the invention is attached securely to the mount of the guide.
Second, a hydration induced such as a Teflon film is always in contact with the sampling site and/or coupling fluid. This means that the localized pressure is constant. Removing and replacing the traditional plug often results in small localized pressure transients, which may adversely affect the precision of a near-IR based noninvasive glucose analyzer. The importance of applying minimal physical perturbations to the sampling site has been outlined in Hazen, et. al., supra and M. Makarewicz, M. Mattu, T. Blank, G. Acosta, E. Handy, W. Hay, T. Stippick, B. Richie, Method and apparatus for minimizing spectral interference due to within and between sample variations, U.S. patent application Ser. No. 09/954,856 (filed Sep. 17, 2001).
Third, the old plug is a bulky item that is quite thick. The protrusion from the surface of the skin makes it easy to bump or jar. This physical jarring is transferred to the sampling site. As mentioned above, this may be quite detrimental to the noninvasive glucose determination.
Fourth, the old plug has to be physically removed and replaced by the user. This requires time and manual dexterity. As the hydration inducing plug according to the invention is integrally part of the guide, this step becomes unnecessary.
Fifth, while both the traditional plug and the new hydration inducing plug according to the invention act as an insulator, the removal of the plug away from the sampling site allows it to change temperatures. This results in a localized temperature transient when replaced onto the sampling site.
Guide Reservoir Embodiments
The guide may contain one or more cavities or reservoirs in the mount of the guide for containing a coupling agent.
Coupling Agent Properties
Index Matching The coupling fluid itself may be any index of refraction matching solution. However, it is preferably near-IR inactive. That is it is preferably a chlorofluorocarbon molecule or a chlorofluorocarbon polymer. Because the chlorine in a chlorofluorocarbon is associated with toxicity, it is preferable that the coupling fluid be a fluorocarbon molecule, a fluorocarbon polymer, a fluorocompound, or a mixture of any of these. Some specific examples are FC-40, FC-70, and FC-72 available from 3M. The index of refraction of FC-72, FC-40, and FC-70 is 1.251, 1.290, and 1.303, respectively. This is intermediate between skin with a refractive index of 1.44 and air with a refractive index of 1.0 and thus, according to Fresnel, may increase the percentage of normally incident photons penetrating into the skin. In the case where a Teflon hydration inducing layer is used, the FC-compounds with an index of refraction ranging from about 1.25 to 1.31 is well matched to Teflon AC with an index of refraction of 1.29 to 1.32. The coupling fluid may alternatively serve the purpose of partially penetrating into the skin to provide better optical coupling more internalized layers of skin. For example, the fluorinert may wet the keratinocytes, displace air pockets, and generally level the rough surface.
Thermal: The reservoir(s) 402 within the guide has several thermal advantages. First, the guide material about the reservoir acts as an insulator to environmental conditions. For example, if the subject steps outside into a cold environment, there can be a delay in the cooling of the coupling fluid due to the insulator. An optional additional insulator such as a wrap or sleeve may be used in the event that the guide provides insufficient insulation. Second, the proximity of the reservoir to the skin allows for the coupling fluid to be naturally maintained at or near the skin temperature. This is advantageous as changes in the temperature of the sampling site may be detrimental to near-IR based noninvasive glucose determinations. Hence, application of cold coupling fluids to the sampling site just prior to noninvasive sampling may degrade analytical performance of a glucose analyzer by changing the sample site temperature. In the system as presented in
Mechanical: It should be appreciated that the schematic of
Optical: The intent of the photon traces in
Delivery. The coupling fluid is directed to the sample site by at least one of: (1) gravity; (2) diffusion; (3) a guiding channel; (4) a mechanical pump; (5) manually applied pressure; and (6) an electromechanical system such as an intelligent polymer system.
Embodiments described below may use one or more of these delivery forces. The energy used by these systems may be provided by one or more of a manually applied force, an internal power supply such as a battery, an external power supply, or natural forces, such as diffusion or gravity.
These delivery systems reduce chances for contamination and insure adequate delivery of the agent to the sampling site.
One embodiment of a coupling agent cavity in a guide lock and key mechanism is indicated conceptually in
The optical coupling agent (fluid) then travels inward toward the center of the sampling site. Optionally, a hydration inducing plug such as one described above may be used. In this case, the optical coupling fluid would preferably flow and spread between the outer surface of the hydration inducing plug and the skin surface of the sampling site.
In the embodiment pictured in
Another possible configuration of such a guide with one internal reservoir or cavity for containing a coupling fluid is presented in
In the configurations as presented in
The guide's lock base, i.e. the unit including the mount together with the hydration inducing plug and any other accessories such as the adhesive layer(s), physical guiding component(s), coupling agent reservoir(s), and coupling fluid may be a disposable. The guide unit may be an item applied to a sampling site for the period of about one day, one waking day, or shorter period such as about two, four, or eight hours. For professional use, such as use in conjunction with a glucose tolerance test, the guide unit may be attached for a fraction of a day such as for two, four, or six hours. Alternatively, the guide unit as a whole may be an apparatus that is periodically removed from the sampling site and later replaced, perhaps with new adhesives.
The optical unit, i.e. the optical probe, coupling into the guide base may be created in a number of optical configurations. For example, fiber optics may be used to deliver light to the sample and/or to collect light from the sample. Notably, other optical configurations may be employed. For example, hollow tubes may be used for guiding the excitation and/or collected photons. In addition, photons may be traveling through air rather than through a fiber. This is particularly true for the incident photons.
People come in various dimensions in terms of physical length or width of a body part and curvature of that body part. Accordingly, guides may be used that have varying dimension, and curvatures. Guides may be supplied in large, medium, or small sizes each with a varying radius of curvature. Existing guides range from approximately 0.5 to 1.5 inches in diameter. Larger guides are readily developed. It is desirable to manufacture smaller guides as the noninvasive glucose analyzer is engineered to smaller sizes.
A number of individual elements are presented in this invention. It is important to note that many of these elements or features may be used in conjunction with one another. The invention is intended to employ at least one of: a plug, a multi-layer coupling hydration inducing plug, a coupling layer that is pressed into a non-flat sheet, a plug with a hole, an optically shaped coupling plug, a coupling fluid reservoir, and channels for diffusion or manual control of delivery of a coupling fluid.
In view of the different possible embodiments to which the principle of this invention may be applied, it should be recognized that the preferred embodiments described herein with respect to the drawings are meant to be illustrative only and should not be taken as limiting the scope of the invention. One skilled in the art will readily appreciate that other applications may be substituted for those set forth herein without departing from the spirit and scope of the invention.
Accordingly, the invention should only be limited by the Claims included below.