Noninvasive Monitoring of Glucose Levels: Is Exhaled Breath the Answer?

Monitoring of blood glucose levels is clinically important in the management of diseases affecting insulin secretion and resistance, most notably diabetes mellitus and cystic fibrosis. Typically, blood glucose monitoring is an invasive technique that may cause distress and discomfort, particularly in the pediatric population. Development of noninvasive methods of monitoring blood glucose is therefore indicated, particularly for use in children. Using respiratory fluids (the liquid present in the lumen of the airways and alveoli) to estimate blood glucose levels indirectly is one potential method. Glucose concentrations in respiratory fluids are typically low, maintained by the equilibrium between paracellular leakage of glucose from the lung interstitium and active cotransport of glucose by epithelial cells. Measurement of glucose in respiratory fluid by collection of exhaled breath condensate is therefore a potentially clinically useful method of estimating blood glucose levels if it can be shown that there is good agreement between these values. This article reviews the research in this area.

[1]  P. J. Barnes,et al.  Exhaled breath condensate: methodological recommendations and unresolved questions , 2005, European Respiratory Journal.

[2]  Todor A Popov Human exhaled breath analysis. , 2011, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[3]  David C Klonoff,et al.  A review of continuous glucose monitoring technology. , 2005, Diabetes technology & therapeutics.

[4]  R. Heine,et al.  Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: psychological comorbidity and general well-being. , 2001, Journal of psychosomatic research.

[5]  P. Thomas,et al.  Elevated Levels of Oxidative Stress Markers in Exhaled Breath Condensate , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[6]  W. Hop,et al.  Hydrogen peroxide in exhaled air of healthy children: reference values. , 1998, The European respiratory journal.

[7]  V. Basevi Standards of Medical Care in Diabetes—2010 , 2010, Diabetes Care.

[8]  G. Martet,et al.  Glucose transport and equilibrium across alveolar-airway barrier of rat. , 1996, The American journal of physiology.

[9]  J. Shaw,et al.  Epidemiology of childhood type 2 diabetes and obesity , 2007, Pediatric diabetes.

[10]  G. Mcgarraugh The chemistry of commercial continuous glucose monitors. , 2009, Diabetes technology & therapeutics.

[11]  N. Evans,et al.  In vivo glucose monitoring: the clinical reality and the promise. , 2005, Biosensors & bioelectronics.

[12]  S. Finkelstein,et al.  Diabetes mellitus associated with cystic fibrosis. , 1988, The Journal of pediatrics.

[13]  H. M. Saraoglu,et al.  Determination of Blood Glucose Level-Based Breath Analysis by a Quartz Crystal Microbalance Sensor Array , 2010, IEEE Sensors Journal.

[14]  D. Baines,et al.  Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients , 2005, Thorax.

[15]  D. Baines,et al.  Hyperglycemia and cystic fibrosis alter respiratory fluid glucose concentrations estimated by breath condensate analysis. , 2007, Journal of applied physiology.

[16]  B. Philips,et al.  appearance of glucose in upper and lower respiratory tract secretions , 2003 .

[17]  D. Geddes,et al.  Clinical importance of cystic fibrosis-related diabetes. , 2004, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[18]  C. Saudek,et al.  Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. , 2003, Diabetes.

[19]  J. Round,et al.  “When someone stabs you”: children’s perspectives of venepuncture , 2009, Archives of Disease in Childhood.

[20]  Diederick E. Grobbee,et al.  The global burden of diabetes and its complications: an emerging pandemic , 2010, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[21]  G. Saumon,et al.  Glucose transport in the lung and its role in liquid movement , 2007, Respiratory Physiology & Neurobiology.

[22]  W. Tamborlane,et al.  A tale of two compartments: interstitial versus blood glucose monitoring. , 2009, Diabetes technology & therapeutics.

[23]  Novel Noninvasive Breath Test Method for Screening Individuals at Risk for Diabetes , 2009, Diabetes Care.

[24]  J. Morton,et al.  Early Glucose Abnormalities in Cystic Fibrosis Are Preceded by Poor Weight Gain , 2009, Diabetes Care.

[25]  David Smith,et al.  Can volatile compounds in exhaled breath be used to monitor control in diabetes mellitus? , 2011, Journal of breath research.

[26]  Giovanna E Carpagnano,et al.  Increased leukotriene B4 and interleukin-6 in exhaled breath condensate in cystic fibrosis. , 2003, American journal of respiratory and critical care medicine.

[27]  Carlos Eduardo Ferrante do Amaral,et al.  Current development in non-invasive glucose monitoring. , 2008, Medical engineering & physics.

[28]  Massimo Corradi,et al.  Biomarkers of Neutrophilic Inflammation in Exhaled Air of Cystic Fibrosis Children with Bacterial Airway Infections , 2005, Pediatric pulmonology.

[29]  Q. Jöbsis,et al.  Exhaled breath condensate in children: Pearls and pitfalls , 2004, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[30]  B. Philips,et al.  Effect of hyperglycaemia on glucose concentration of human nasal secretions. , 2004, Clinical science.

[31]  Ratnawati,et al.  Exhaled breath condensate nitrite/nitrate and pH in relation to pediatric asthma control and exhaled nitric oxide , 2006, Pediatric pulmonology.

[32]  E. Baraldi,et al.  Safety and success of exhaled breath condensate collection in asthma , 2003, Archives of disease in childhood.

[33]  Simone Meinardi,et al.  Noninvasive measurement of plasma glucose from exhaled breath in healthy and type 1 diabetic subjects. , 2011, American journal of physiology. Endocrinology and metabolism.

[34]  P. Jones,et al.  Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease , 2006, Thorax.

[35]  David Smith,et al.  A longitudinal study of ammonia, acetone and propanol in the exhaled breath of 30 subjects using selected ion flow tube mass spectrometry, SIFT-MS , 2006, Physiological measurement.

[36]  C. Toumazou,et al.  Glucose sensors: a review of current and emerging technology , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[37]  S. Heller,et al.  Frequency and motives of blood glucose self-monitoring in type 1 diabetes. , 2009, Diabetes research and clinical practice.

[38]  T. Olds,et al.  Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008 , 2010, International Journal of Obesity.