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Microdialysis technique in monitoring of the patient's metabolic state

Wójcicki J. M., Ciechanowska A., Sabalińska S., Gutowska M.

Biocybernetics and Biomedical Engineering

2007

Vol. 27, no. 1-2

53-64

Frequent daily monitoring of the blood glucose level is not an adequately efficient method to maintain long-term normoglycemia and especially to prevent hypoglycemia in many diabetic patients. Continuous glucose measurement systems are currently being developed. The minimally invasive methods are mainly connected with measurements in the interstitial fluid (ISF). With the electroenzymaitic sensor implanted, the ISF glucose continuously reacts with the sensor’s enzyme, and the resulting current is proportional to the glucose concentration. Another possibility can be application of the microdialysis technique (MDS) - technique to monitor the biochemistry of the extracellular space in living tissue. The aim of the study was to review systems for continuous glucose measurements using the microdialysis technique and to present preliminary results of an application of this technique to monitoring of the patient’s metabolic state in ketoacidosis. The first prototype of a system for continuous glucose measurements,was designed and developed in Ulm. Currently, a few similar systems with application of the microdialysis are being developed and tested. The most interesting of them are Accu Chek (Roche Diagnostics), GlucoDay (Menarini) and Gluc-Online (Roche/Disetronic). The MDS technique can be applied, for example, to characterize the patient’s metabolic state in ketoacidosis during application of the standard treatment by measurements of the biochemical parameters, like glucose, lactate and glycerol, in the interstitial fluid. This study was performed by the authors in cooperation with the Clinic of Gastroeneterology and Metabolic Diseases, Medical University in Warsaw. The first presented results indicate that, after the initial hydration, the glycemia, glycerol and lactate levels correlated in a very different way with the reference measurements from blood. No distinct delays between the measurements performed in the studied compartments were observed. It can be stated that the analysis of the courses of the biochemical compounds, involved in the glucose metabolism, in the interstitial and in the blood compartments may be helpful to better understand the pathophysiology of the diabetic ketoacidosis, and consequently, its application can lead to an improvement of the current standard treatment.