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Adamson T.L.,Arizona State University | Eusebio F.A.,Arizona State University | Cook C.B.,Occupational and Aerospace Medicine | Labelle J.T.,Arizona State University
Analyst | Year: 2012

Self-monitoring of blood glucose is the standard of care in management of hyperglycemia among patients with diabetes mellitus. To increase the sensitivity and specificity of current devices, a novel method of detecting glucose using electrochemical impedance spectroscopy (EIS) technology is explored. The enzyme glucose oxidase (GOx) was fixed to gold electrodes and a sine wave of sweeping frequencies was induced using a wide range of concentrations of glucose. Each frequency in the impedance sweep was analyzed for the highest response and R-squared value. The frequency with both factors optimized is specific for the glucose-GOx binding interaction and was determined to be 1.17 kHz in purified solutions in both higher and lower ranges of glucose. The correlation between the impedance response and concentration at the low range of detection (0-100 mg dL-1 of glucose) was determined to be 3.53 ohm/ln (mg dL -1) with an R-squared value of 0.90 with a 39 mg dL-1 lower limit of detection. The same frequency of 1.17 kHz was verified in whole blood under the same glucose range. The above data confirm that EIS offers a new method of glucose detection as an alternative to current technology in use by patients. Additionally, the unique frequency response of individual markers allows for modulation of signals so that several other markers important in the management of diabetes could be measured with a single sensor. © 2012 The Royal Society of Chemistry.


Adamson T.L.,Arizona State University | Cook C.B.,Occupational and Aerospace Medicine | LaBelle J.T.,Arizona State University
Journal of Diabetes Science and Technology | Year: 2014

Multiple markers are used to assess glycemic control in patients with diabetes mellitus (DM). New technology that permits simultaneous detection of multiple biomarkers combined with those used at the point of care indicative of glycemic control, including glycemic variability determined from 1,5-anhydroglucitol measurement, could provide better management and further insight into the disease. This platform was based on previous research involving glucose detection and uses electrochemical impedance spectroscopy to detect a range of 1,5-anhydroglucitol concentrations at an optimal binding frequency. The enzyme pyranose oxidase was fixed to gold electrodes while a sine wave of sweeping frequencies was induced in purified solutions and in variable presence of whole blood. The optimal binding frequency for the detection of 1,5-anhydroglucitol was found to be 3.71 kHz. The impedance response compared to the concentration of target present was found to have a logarithmic slope of 7.04 with an R-squared value of 0.96. This response includes 2 experimental sets, a single test of a low concentration range and a high concentration range with 5 replicates. The relative standard deviation of the high range varied from 28% to 27% from lowest to highest concentrations. Best detection in complex solutions was found in lower blood concentrations of 0.5% and 1%, but maintained relatively high accuracy in concentrations 5% and 10%. The sensor platform was successfully evaluated at a high dynamic range of 1,5-AG in purified solutions. In the presence of whole blood, lowest percentages yielded the best results indicating that filtering interferents may be necessary in final device architecture. © 2014 Diabetes Technology Society.


Kuhle C.S.,Occupational and Aerospace Medicine | Truitt F.,Occupational and Aerospace Medicine | Steffen M.,Occupational and Aerospace Medicine | Undavalli C.,Knowledge and Evaluation Research Unit | And 5 more authors.
Journal of Occupational and Environmental Medicine | Year: 2013

Objective: To improve patient satisfaction with care at an occupational medicine clinic by promoting agenda-setting before the visit. Methods: We distributed agenda-setting form to 77 randomly selected patients attending an occupational health clinic and used another randomly selected sample of 36 patients as control group. Patients completed a survey regarding the acceptability of this procedure and whether they felt clinicians addressed their important concerns. Results: Most patients found the formhelpful (73%) and wanted it offered in future visits (74%). There was no statistically significant difference in terms of the proportion of patients expressing greatest satisfaction by answering, "strongly agree" (intervention [86%], control [97%]; odds ratio, 0.17; 95% confidence interval, 0.02 to 1.38; P = 0.06). Conclusion: Agenda-setting can improve patient experience before occupational visits but does not improve postvisit satisfaction. Copyright © 2013 by American College of Occupational and Environmental Medicine.


Karlin N.J.,Occupational and Aerospace Medicine | Dueck A.C.,Occupational and Aerospace Medicine | Cook C.B.,Occupational and Aerospace Medicine
Endocrine Practice | Year: 2012

Objective: To determine the prevalence of diabetes mellitus, glycemic control, and impact of diabetes on overall survival in an academic oncology practice. Methods: Data on cancer patients (1999 to 2008) were retrieved from the institutional cancer registry and linked to electronic files to obtain diabetes status and hemoglobin A1c (A1C) values within the first 6 months of cancer diagnosis. Overall survival by cancer type with and without diabetes was compared using Cox regression. Results: Excluding skin and hematologic malignancies, 15,951 cancer cases were identified. Overall diabetes prevalence was 6.8% (n = 1,090), declining over time (P<0.001). Diabetes was common among patients with pancreatic (9.8% [61 of 624]), colorectal (7.7% [89 of 1,151]), or bladder cancers (7.6% [68 of 899]). Patients with diabetes were older (mean age, 70 versus 66 years; P<0.001) and more likely to be male (66.3% [723 of 1,090] versus 60.2% [8,949 of 14,858]; P<0.001). The mean A1C among diabetic cancer patients was 6.8% and did not differ across cancer types (P = 0.80). Only 58.6% (331 of 565) of diabetic cancer patients had all A1C <7.0% during the first 6 months following cancer diagnosis. Pancreatic cancer patients with coexisting diabetes had better overall survival than pancreatic cancer patients without diabetes (hazard ratio, 0.60; 95% confidence interval 0.44 to 0.80; P<0.001). Conversely, diabetic prostate cancer patients had worse overall survival than prostate cancer patients without diabetes (hazard ratio, 1.36; 95% confidence interval 1.05 to 1.76; P = 0.02). Conclusion: In this academic oncology practice, diabetes was common, glycemic control often was suboptimal, and survival varied by cancer type. Additional study is needed to optimize glucose management and investigate mechanisms underlying age, sex, and survival differences. Copyright © 2012 AACE.


Newcomb R.D.,Occupational and Aerospace Medicine | Molella R.G.,Occupational and Aerospace Medicine | Varkey P.,Occupational and Aerospace Medicine | Sturchio G.M.,Occupational and Aerospace Medicine | And 3 more authors.
Journal of Occupational and Environmental Medicine | Year: 2012

Objectives: To determine whether preplacement recommendations following an occupationally focused medical history is different from those following an occupational consultation. Methods: This was a retrospective cohort study of 172 applicants to our institution. Results: Following provider review of occupational history survey alone, none of the applicants had restrictions recommended. In comparison, only 163 applicants (94.7%) were recommended to be hired without restrictions following provider review of the same patient's occupational history and examination (P = 0.0078). Conclusion: A well-designed questionnaire is useful for screening applicants for preplacement examinations and assures sufficient detail to allow for a large proportion of individuals to proceed to employment without an occupational examination. However, in this study, a small but statistically significant portion (5%) of applicants required occupational examinations for appropriate work recommendations. Copyright © 2012 by American College of Occupational and Environmental Medicine.

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