Headline aside, it sounds like the real news is just how difficult this problem is - even for Apple. Back in 2020-2021, the rumor was that a Watch might include Rockley glucose monitoring[1], possibly in 2022-2024. If this article is correct, Apple is nowhere near that:
> Apple’s system — more than 12 years in the making — is now considered to be at a proof-of-concept stage, said the people, who asked not to be identified because the project is confidential. The company believes the technology is viable but needs to be shrunk down to a more practical size.
> Engineers are working to develop a prototype device about the size of an iPhone that can be strapped to a person’s bicep. That would be a significant reduction from an early version of the system that sat atop a table.
…
> Before shifting to TSMC, Apple had worked with Rockley Photonics Holdings Ltd. to develop the sensors and chip for the technology. In 2021, Rockley publicly disclosed its work with Apple, stoking interest in the supplier. Apple later ended the partnership, and Rockley filed for bankruptcy last month.
> it sounds like the real news is just how difficult this problem is - even for Apple
I've worked in this space for 5 years now, and this is not news to any of us. Today, a tiny, noninvasive device, that is accurate enough to make insulin dosing decisions, is pure science fiction. It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
What is interesting about this though is the possibility of using this device for non-diabetics who don't need extremely accurate glucose readings. A rough approximation of someone's blood glucose levels is enough to learn how your body reacts to different types of foods and exercise, and would be helpful for amateur athletes who can't afford to purchase real continuous glucose monitors, as well as pre-diabetics for whom CGMs aren't covered by insurance.
I'm fascinated by the fact that this seems incredibly hard, yet not so impossible that Apple is trying.
Is there an ELI5 of the basic principle of how it would work (or at least the direction being pursued), and what the main obstacle is, and why we think we'll be able to overcome it to some degree?
Besides athletes, I can't help but think it could be a huge step forwards for weight loss as well. I'm aware of the concept (for non-diabetics) of only eating once your blood sugar is below a certain level, and never eating so much that it goes over a certain higher level.
Replying to my own comment: I found a 2021 paper that goes over all the different technologies being considered, and the wide variety is frankly staggering. Table 10 lists ten different principles under consideration (fluorescence, spectroscopy, etc.) with their various pros/cons. Not ELI5, but as close as you might get:
Seems like spectroscopy seems particularly promising, and according to the article, that's the approach Apple is taking. (Makes sense for a watch.)
And from the paper, the challenges with spectroscopy are signal interference -- scattering, water absorption, and distinguishing between glucose and other sugar components. So it ultimately sounds like a fiendishly complex signal processing problem. Which is exactly the kind of problem that is very very hard yet maybe not impossible.
The IMHO gold standard book to get an understanding of the history of non-invasive glucose monitoring and the different technological approaches is "The Pursuit of Noninvasive Glucose: Hunting the Deceitful Turkey" by John Smith: https://www.researchgate.net/profile/John-Smith-241/publicat...
We - at DiaMonTech - working on a solution with mid-infrared spectroscopy and showed good accuracy in a published paper in the "Journal of Diabetes Science and Technology". We plan another clinical trial this year, but yes, this took some time. We started in 2015 and still have some work to do.
Important nuance here is the difference b/w the parent poster's "accurate enough to make insulin dosing decisions" criteria (extremely difficult+risky)
vs
"useful enough signal for general population / those at risk of type 2 diabetes / those with diabetes who don't require insulin treatment / etc" (much larger market for Apple w/ greatly reduced requirements)
^^ This - the ECG & Blood Oxygen levels are "good enough" for the public to consume and track, but perhaps not quite at the level of monitors used in medical settings to make care decisions.
Yeah I don't know about ECG but I checked my (non apple) watch with a real finger-clip SpO2 from the doctor and while it's pretty accurate under highly controlled situations (sitting still and positioned perfectly) it's really lousy under real-world conditions, moving around etc.
And I didn't just check the bog standard 98% measurement but also tried to hold my breath etc.
I can't speak for the Apple Watch, but the O2/BPM readings on some other watches are often dropped/delayed with the operating system taking priority. I was trying to use the heart rate data for a pet project and found its practically useless, on Samsung's watches its just enough data to show a few fancy numbers and thats about it.
On the contrary, the Apple Watch ECG is quite accurate, not quite enough to replace the system the doctor makes me wear, but enough that apple can get a general idea of any defects and tell you to go to the doctor. The "regular" hear rate sensor isn't anywhere near good enough to be taken seriously, but its leaps ahead my previous samsung.
I dream of the day where my Apple Watch can replace the myriad of annoying wires and sensors I have to wear to monitor myself. Even then, the Apple Watch has greatly helped me out when I've fallen and need assistance, and I've gifted several to my family just in case.
ECG is a relatively easy thing to measure, so that single axis they measure is quite accurate. But the conclusions one can make from that is limited (you basically take a video from a single point). Doctors use 12 axes instead to get a real-time, 3D vector of the heart.
To be honest, “real finger-clip” sensors are similarly fuzzy in their results - after all they work the exact same way. Maybe using percentiles is not ideal as it gives a sense of more accuracy than what makes sense.
They don't work quite the same way. The finger clips shine through the entire finger. The illuminator is on one side and the sensor on the other. The wrist-based sensors rely on reflections through the skin which is a lot more iffy.
To be fair, the Verily folks did design the algorithm that predicts where your blood sugar will be in X minutes in Dexcom CGMs, which lives on. Dexcom now owns the patent.
> nothing beats an actual blood sample
Technically, interstitial fluid can get you pretty dang close, which is considered minimally invasive.
to say google discontinued a project after a short period of time does not exactly speak to the level of difficulty or if that difficulty was even the reasoning for the discontinuing. someone at G could have just gotten bored or moved to a different department, or a new darling employee stole focus, or whatever other reasonings we've heard when G projects are shuttered.
Nothing beats a blood sample, but interstitial fluid (which is invasive kind of) is good enough for insulin dosing. Most CGMs (Dexcom, Freestyle, etc) work this way. They don't sample blood, they sample the fluid between cells.
The latest generation products have an MARD of around 8%, which is good enough to make insulin dosing decisions.
They don't currently send data directly to Apple watches (it goes through the iPhone first), but that's largely a regulatory approval issue, not a technical one.
> I've worked in this space for 5 years now, and this is not news to any of us.
The reason it's your comment I'm replying to is because you indicate you actually worked in this field.
Whenever these discussions surrounding noninvasive monitoring of blood solute concentrations come up I keep wondering why anyone is surprised taking a hard route is hard, and why there seems little attention to seeking easier routes of noninvasive optical sensing.
Please do shoot my comment if it is nonsensical, so that I can stop caring next time I read such a discussion, but I would like a mechanistic explanation why the lips wouldn't be easier.
From an a priori perspective, it would certainly be desirable to have any type of noninvasive monitoring in the form factor of a watch. There is nothing wrong with dreams or hope. Yet to me it sounds like a dream was interpreted too literally: starting from some hypothetical dreamer exclaiming "imagine testing concentration X or Y, but noninvasively! sure wearing a device would may come with some inconveniences, but if the advantages outweigh the inconveniences, it would find a niche" and "after all people have been wearing watches too".
An idea that started as an analogy: just like a personal wearable watch had advantages compared to an immobile pendulum clock, perhaps we can devise the analogous personal wearable device that performs the duties of some large inconvenient measuring setup, workflow, discipline,....
I can't shake the feeling that the analogy has been taken too literally, as if the original dream insists the blood glucose meter has to be integrated into the watch and located on the same or similar place on the body...
Blood is red.
Lips are red.
The color of the lips is the color of the blood.
Acknowledging the inconvenience of mounting a device or perhaps an optical fiber to your lips, it may constitute a more tractable milestone.
What is the reason all the 'failed' startups avoid the lips and make life hard on themselves by choosing to do spectroscopy (in the widest sense: plain, Raman, ...) through the highly variable noisy medium of skin (different pigmentations by genetics, different pigmentations by varying exposure to sun within an identical individual, different states of skin like sweating, the intinsic noise incurred by imaging through a robustly thick layer of skin, scattering like mist, ...).
It almost looks like attempting an artificially troubling tour de fource, akin to painting a masterpiece... with your toes. I think its possible eventually, fundamentally speaking, but it doesn't sound like a wise choice to make, at least not initially.
(I wrote failed in quotes, because in reality after bankruptcy IP is transferred, experience was gained by employees, some of which end up at different companies in the same space, others end up in new disciplines where they gain a new applicable insight that nobody previously connected to blood glucose monitoring, etc...)
Then there's the social issue of the first iterations of the tools potentially working better for less pigmented skin...
> It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases ...
I have some serious question marks surrounding the near-term viability of stem cell regrown organs.
As an unethical thought experiment consider freshly born twins, and removing their pancreas and putting each in a chamber where you would otherwise grow the artificial pancreas. How fast would you notice harmful levels of sugar purely from observation of the kept-alive pancreas? (without cheating and using knowledge of healthy blood sugar levels). If it would take many many experiments or very long durations to detect these problems (for glucose or otherwise), then one doesn't really have the engineering confidence of how long it would last, what the side effects are, ... i.e. blanket statements that stem cell derived organs will arrive earlier than affordable democratized noninvasive sensing could be true, could be false, but isn't proven by a blanket statement. The burden of proof doesn't lay with the reader.
> ... and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
Which type of diabetes?
Type 1:
The root of the problem is an unsuitable autoimmune response, during V(D)J the immune system rolls the dice to construct a generator of randomly chosen but from then on specific antibody. Due to natural selection library of segments for V(D)J recombination has a strong bias for resulting in antibodies that match foreign pathogens and potentially endogenous cancers while simultaneously also having a strong bias for not matching normal endogenous or symbiotic features. So usually nothing goes wrong.
We all carry a different but similar library of segments for V(D)J, so our immune systems display slightly different statistics for expressing antibodies.
Imagine an individual has the flu and its immune system ramps up the production rate of new generators of antibodies, each generator corresponding with a randomly chosen but from then on fixed type of antibody, usually safe but not guaranteed. Perhaps this individual has bad luck and besides generating suitable antibodes for the flu, it has also generated a low probability antibody that happens to attack the pancreas. Over time the pancreas starts to degrade and fail. The person now has type 1 diabetes. The pancreas damage is a symptom, not the cause.
Even if you grow a new pancreas, and replace the damaged one with the freshly grown one, the immune system cells generating the regrettably bad antibodies are not filtered out of the body, so after a while the type 1 diabetes will recur! Your proposal does not straight-up cure diabetes type 1
(how hard or easy does it sound to locate and filter the specific immune system cells that result in the autoimmune disease without also removing those that represent your acquired immunity of diseases the individual was exposed to throughout life? if such a thing were easy, curing HIV would be easy by simple filtration of every last HIV genome from a human body, so it does not sound that easy at all)
The reason it needs to be a watch (I have also done several years of research in this field, by the way) is that devices only provide a benefit if you use them.
There are decades of research with all kinds of wild wearable devices in all kinds of form factors that can do amazing things. They have gone over like a lead balloon with the consumer.
Socially, it is acceptable to wear exactly one piece of technology on one wrist. People with very dangerous medical conditions might be convinced to wear a well hidden device under their clothes but it's a big ask and compliance won't be as high as you'd expect.
That's just how people are, so as engineers we have to make products to fit that.
Imagine selecting diabetes patients at random, and asking them one by one:
"You are currently already by necessity accepting the monitoring of blood glucose invasively with device X, here is a less invasive device Y that sits under your lip, or perhaps has a fiberoptic cable running up to your lip. Would you switch to this lip-oriented device today? Or would you rather profusely refuse to use this device Y until some more distant unspecified future date where the technology Z finally robustly works through thicker layers of skin while continuing to use the more invasive device X?"
I don't claim but tend to believe they would take improvement Y over X while waiting for Z.
You actually claim they wouldn't.
I say let the patients speak for themselves.
Perhaps your claim is correct and no suitably large niche of patients would switch to the lip-oriented device.
Perhaps you are wrong and you have confirmed my suspicion of the miscommunication between patients and engineers.
Your rebuttal does not prove compliance of a less invasive lip oriented device would be lower than current invasive devices.
Diabetes falls under dangerous medical conditions, and they have a variety of wearable devices now for continuous glucose monitoring that are popular. They're invasive though, can allow other people to learn about your medical history just by looking at you (depending on what you're wearing/which device you have), can complicate intimacy and contact sports, and in general the patients would be much happier if a smart watch could do it without specialized hardware.
There is a lot (a lot) of history here that I think would help you test your assumptions on this.
> There is a lot (a lot) of history here that I think would help you test your assumptions on this.
A 2017 survey found only 32% of the US population wears a watch daily, so for a large fraction wearing a glucose monitor in the form of a watch would also constitute a change, and correlate with diabetes patients. Under the lip or monitoring the inside of the cheeks, etc may be even less conspicuous than wearing a watch. Perhaps you might wish to test your assumptions too, and again, neither me nor you should be the arbiters in this matter: the patients ought to be the ultimate arbiters.
I don't understand why a person would contort themselves into less defensible or self-contradictory stances. It would seem engineers or others involved in the field would welcome the suggestion that perhaps there is a more tractable way, that might simultaneously be more acceptable by the patients themselves.
Observe I don't accuse you of causing the miscommunication. Everyone is prone to following the herd, including me.
While it isn't proven the patients would prefer a miniaturized device under the lips (or somehow reversibly attached to a teeth in a way that it doesn't interfere with eating, kissing, etc..) let us suppose for a moment that it actually turned out to be the case, after a survey or after actual trials.
In this case it's not the fault of the average employee or engineer in the field that they were designing thick-skin CGM devices before the survey or trials were done.
The real question in that case is: who was or wasn't aware before the survey that the red mucous membranes were easier? If not why not? It's obvious these tissues are redder due to better visibility of blood. Those that were aware before the eventual survey: did they yes or no tell their superiors? why not? if they did, they are absolved, but the line of questioning now transfers to the superior. Why didn't they order a survey asking for patients concerns about the idea, and if they would consider switching to such a product if properly executed? Why didn't they consult the patients?
> prove compliance of a less invasive lip oriented device would be lower than current invasive devices
I can't prove it, but I think it actually makes a lot of sense. The interstitial CGMs like Libre/Dexcom are invasive (brief pinch on application) but they last up to 2 weeks and you can set and forget. I'd think any other non-invasive device that requires carrying it around, running wires, and being even a little pro-active would lose on convenience alone.
You could get some traction I'm sure, but the majority of people are going to gravitate towards the easiest solution, and applying a patch once every 10-14 days is pretty darn easy. Even if Apple could check glucose I'd still prefer a CGM patch so I don't have worry about always wearing the watch.
That's the thing, people will wear an accessory, but different people will wear different accessories and will absolutely refuse to wear others.
It makes it very hard for a business when, for instance, very few men are willing to wear your bangle or people can't wear your glucose monitoring hat inside nice restaurants.
It's likely that different wearable forms will become more common and accepted, but that is one of those predictions you hear every year for the last thirty years and it's true to an extent but also there is a long way to go.
Doesn't seem like a big problem since enthusiasts and early adopters are precisely the type of folks who would most likely break established norms in using the product.
Maybe one day it will be common for men to wear bangles on each arm, or for hat wearing to be common indoors via their actions.
For example, no one carried around headphones out-and-about before the Walkman.
I don't think anyone who is in the know would be surprised about that. Noninvasive blood glucose monitoring is a multi billion dollar product, should anyone be able to figure it out at all. It's fiendishly difficult, and quite possibly impossible to do it sufficiently accurately, even more so over long periods of time. C8 MediSensors was trying to do it 10 years ago, but ultimately went under. Even with Apple's budget, it's a herculean task.
You’re underselling it. Measuring blood at millimoles per liter precision through skin on a watch sized device is Theranos-esque physically impossible product-market fit. Tricoder level of science fiction.
I mean, it's the no stick part that's tricky. Small, watchface size glucose monitors that transmit wirelessly exist. They're just...disposable. Wear it for about 14 days... stick on another $150 device.
I have the Freestyle Libre system. The probe that "pokes through your skin" only happens once every two weeks, and my experience is that inserting a new Freestyle sensor hurts less than the average finger stick blood test. Before I got the Freestyle Libre I was doing finger sticks 4 or more times a day. With the Freestyle Libre I am checking my blood glucose an average of 20 times a day, and if I download the data from the Reader I can see glucose readings every 15 minutes, 24 hours a day.
I'm waiting to go back to them, a bit of a juggle to get insurance to pay until the current sensor or maybe transmitter runs out. I got angry at their customer service when I knocked a sensor off, so I tried the Dexacom g6, but their software is insanely bad. On top of that their sensors are only for 10 days which is much more of a scheduling hassle. And after all the pain of their icky software the killing point is they have an unsilenceable "6 hours to sensor expiration" alarm that can and will go off in the middle of the night, unless you actually power down the device or your phone. I hated their device and the phone connected anyways. The Freestyle had much better software with sophisticated graphs showing trends over long time periods to spot typical low and high time periods.
You can silence the expiration warnings in Settings > Alerts > Scheduled, disable Always Sound. You will still be alerted for critical lows and actual sensor failure. I know you moved to Freestyle but other Dexcom users might be reading.
Yeah, I think they're a huge advance for people who are already used to stabbing themselves. But they're still invasive in the sense that they have to keep the probe inside your body for 2 weeks. If Apple can nail the light-through-the-skin approach, the audience size jumps by 1-2 orders of magnitude.
Type 1 diabetic here, they’re not close to as invasive as insulin pumps and a lot of people use those. Honestly the real problem with CGMs is they aren’t accurate enough, and they bias high - I suspect so they can pretend they eliminate hypos more than they do. (Having said that, CGMs are well worth it even with those drawbacks. They’re only invasive on the initial application.)
But I do applaud the team for working on the technology nonetheless.
I'm not so confident on this bias claim. Biasing high would be an extremely risky decision for a glucose monitoring company, because it encourages insulin dosing which could be deadly.
Biasing low would be the move if scared of risky downsides.
When performing calibrations I typically found my (accurate) blood finger prick monitor to be 1 mmol/L lower.
It’s not enough of a difference to be deadly, as the sibling comment suggests, and the clinician guidance is to always eat something if you are feeling hypo, and at or near that level.
The upshot is that I set my CGM-linked pump to target 1 mmol/L higher to compensate.
Apple has an amazing opportunity given the history of these devices.
Another T1D here with 2 decades direct experience with Medtronic, Tandem, Dexcom, and Abbott. I'm an outlier, but that doesn't make this story less empirical. I've got many years of data to prove it and while I can't match real autonomy's millions-of-points-per-second firehose, I do have years of hundreds of point-per-day.
It's n-of-1 for sure, but one way of looking at that is just that there's a lot of latency on the data gathering, particularly in emerging stories in healthcare where the entire system is weaponized against the truth reaching wide audiences, but I digress. Back to the objective facts vs. the subjective reality.
I'd just like to confirm the findings here in that it's a wicked problem, just like T1D:
The fact that CGM or non-invasive requirements follow suit should be of little surprise to anyone.
It's challenging enough that I wore 2 CGM's concurrently over the past year: Dexcom G6 and Freestyle Libre 2. They both have poor data veracity, particularly at the times that I need them most - when fasting; that would be sleep and exercise. Both critical periods for any diabetic. I should know because the former put my T1D brother-in-law in an early grave.
I realize that some people have great success with these devices and that's something we should celebrate. However, we should not celebrate the fact that there are legitimate lawsuits against these companies. I've been outspoken about the risks given my family history, exercise, and experience working in medical devices that have a history of injuring patients:
The amount of time that I spent on the phone with Dexcom support was excessive and frequently at all hours of the night since the problem would present with alarms that cannot be disabled and are able to disable do-not-disturb mode on the smart phone and sound like an alarm system from the Austin Powers series.
That leaves the patient with two choices: tolerance (which is unrealistic at 3 AM) and powering the phone completely off, which silences it while having the side effect that alarms can't save the patient from potentially life-threatening hypoglycemia given that alarms emanating from the Tandem t:slim X2 alone are not sufficiently intense to wake me.
Dexcom has responded to this crisis by following the letter of the law: since I first reported the problem, they have replaced 2-3 dozen sensors under warranty while following the typical corporate communication playbook of not admitting design flaws or any legal culpability while not admitting the rather serious problem of the fact that, when the G6 is used in concert with a hybrid closed loop system such as the Tandem t:slim X2, inaccurate sensor readings on the low side have the potential to underdose the patient, and inaccurate sensor readings on the high side have the potential to overdose the patient. This is because near-autonomous, near-realtime basal rate adjustment is responding to sensor measurement that can often be at odds with reality and not closely monitored at times like sleep and exercise.
This isn't just theory!
I've seen both of these scenarios play out while exercising and sleeping - two events that cannot be precluded, are frighteningly difficult to handle given failures in the aforementioned design of the alarm system, and no one at either Tandem or Dexcom seems to admit, document, or address which is distressing given that these are FDA-regulated devices in markets that aren't Therac 25 but have the potential to end badly in large populations.
I've tried to alleviate the problem by wearing two different CGM sensors concurrently. I wore an Abbott Freestyle Libre 2 from spring through fall 2022 in addition to my Dexcom G6 where I have little choice given the joint venture design chosen by Tandem. That has done little to alleviate the problem since both sensors tend to move in parallel showing the same inaccurate readings in fasted states around sleep and exercise.
Worse, the only evidence I've seen that anyone in the mobile software design side of equation understands the problem is xDrip and the various people working in OpenAPS:
I don't believe they are getting the attention, credit, or remuneration they deserve.
I hope that the situation does not turn out like American insulin pricing, where the first person to perish not being able to afford insulin was documented several years ago:
If we think social media needs regulated, I'm pretty sure what we call healthcare in the United States qualifies for better regulation than that given FDA's lack of oversight.
It's no longer watch-sized. The Freestyle Libre3 monitor is precisely the same size as a pair of stacked pennies (US). I'm wearing one right now. The previous Libre2 sensor was much larger, and you had to tap your reader device against the sensor in order to transmit data via NFC.
In contrast, the Libre3 transmits via Bluetooth, and does so once per minute, without me having to do anything else. The non-insurance retail cost is about $70 per sensor. With insurance, it can be much lower.
For me, the size difference is a real game changer. This thing is so much easier to wear and live with.
For me, the automatic update once per minute is also a real game changer. I don't need to tap the sensor with my phone to get a reading, I just open the app on my phone and the data is already there.
By all accounts, the Dexcom G7 is about the same size, and because Dexcom plays nicer with other devices, that's the way you want to go if you're trying to close the loop on the CGM plus automatic insulin dosing.
For now, I'm super happy to have the Libre3. The app needs some improvement, but this is already a World Series + Super Bowl winner.
I wouldnt mind a disposable/consumable layer at the bottom of my apple watch that provides CGM capabilities. Apple watches are already way smaller than traditional fashionable watches, and i'm more than happy to wear something bulkier/sportier that has integrated CGM capabilities.
If the disposable layer transmits wirelessly in a close range (possibly being powered by the watch itself), then the watch is free to move around a bit and you get accurate measures.
Noninvasive, with any sort of accuracy that can be used for anything, is most likely impossible.
So back to "invasive"... what can we do... embedding a device under your skin, right around where your watch goes, that can be powered and communicate with the watch. While also making sure the device is not rejected by the body and stays in place.. AND has no other adverse side-effects. I think this is where it'll ultimately end up for the people who want it. sub 10 min procedure to put it in and should last for quite some time (maybe dissolves after 5 years for upgrades?)
My understanding is this isn't possible because of the size/invasiveness.
We need significantly better power sources that are either have lots of energy capacity, xor some energy capacity and able to charge while inside the body.
Either version they need to be small enough that the procedure is cheap and the body doesn't reject the device. Additionally, anything like this would need to go through regulatory bodies for medical devices, and would not be approved for "healthy people" (i.e. significantly reduced adoption).
But then youre still dealing with measuring it penetrating the skin and all the variables that have to with it - sensor position, changes in temperature and blood flow, etc.
We do it with pulse ox pretty well, but +\- 2-3% O2 sat and repositioning isnt a big deal.
Having the watch move and misreadibg blood sugar can have serious consequences.
Its a valid ideal but then you get into the fun world of toxicity, pharmacodynamics, dosing, inter-patient variability, compliance, drug-drug interactions.
The article mentions pre-diabetes screening as a potential application - could that plausibly be accomplished with less precision than is required for a bolus calculation?
Movano plans to ship an Oura-style smart ring this year, but it won’t have the glucose monitor. (One might suspect the “moonshot” glucose RF chip story is meant to keep investors excited through the zero-revenue stage until hopefully the more ordinary smart ring takes off.)
The chance that a ring form factor wearable will be the first to reliably, non invasively measure glucose is zero. Yes they got SpO2 and HR, those are easy and well established technologies. But blood glucose? Forget it.
A ring form factor is too aggressive and difficult of a target.
on the contrary, I wouldn't be too surprised to find that this burst of innovation is happening to coincide with a bunch of patents held and buried by big pharma coming near their expiration period.
up until now there has been zero financial incentive for stakeholders to promote a method of blood glucose measurement which bypasses the need for consumables, and every incentive to prevent such a solution.
You can’t bury patents, a patent is a public record. That’s the whole point of patents: an incentive to disclose your invention.
If we knew how to do this, but valid patents blocked the broader commercialization of it, then we would not be reading stories about breakthroughs in basic implementations. We’d be reading stories about how companies have products ready to go once the countdown timer hits zero.
Apologies, I didn't mean "hide". I meant "bury". As in, obtain the patent as a means to prevent others from exploiting the technology, but refrain from licensing it or exploiting it yourself, because it would undermine your main moneymaker product.
So, pharma companies trying to obtain "non-invasive glucose monitoring" patents like crazy, to stop other companies from creating such things, because they want to keep selling pinpricks which rely on a consumable model.
Having said that, now that everyone's into "bullshit subscription models", perhaps the era of "bullshit consumables" may be coming to an end.
This isn't a 3d-printing type problem where the problem was basically solved twenty years ago but locked behind patent protection. It's really an incredibly hard problem. C8 sold a battery-powered miniaturized Raman spectrometer that strapped to your belly about a decade ago. It was a technological tour de force, but it went under. Battery tech is better, but we're just waiting for some particularly clever team to figure out a different optical stack that is small enough to wear comfortably, delivers enough power to be effective, and is robust enough to wear 24 hours a day.
It's interesting you mention that because Abbott (maker of the Freestyle sensor) is trying to hire like crazy for a project named Lingo. It's pretty much the same technology that will be offered to non-diabetics to offer health monitoring via blood chemistry.
Granted, at least they make progress and have actually health products. I had a colleague who left UCSF to work for Verily....we were all quite impressed at the time. But now, I realize I haven't heard heads or tails from him for 4-5 years now...
I'm sure if it were easy the medical world would have done it ages ago. There's a huge market for this kind of device and medical markups are even more royal than Apple's.
A breakthrough would be well welcome, but I would stress for everyone who reads any potential news about non invasive blood glucose monitoring from a small wearable to be very skeptical. It is an extremely difficult task, one which numerous startups have attempted and failed using Apple's approach of optical absorption spectroscopy. I'd wish anyone working on the project the best of luck, as it would be truly ground breaking if it could work, but I fear that it will take many, many, more years if it's even possible to do so with any real reliability.
Are you familiar with Loop? I believe they are currently just intercepting the Dexcom notifications rather than connecting directly over BLE by default for the G6/G7. However the xDrip + xDrip4iOS projects have gotten the G5/G6 BLE protocol to a state of being fairly well understood.
Out of curiosity, why do that? The Dexcom app already has the ability to generate detailed logs that you can just email to yourself. It’s actually a very handy feature.
There is an entire open-source ecosystem around having direct access to your diabetes data, which predates the commercial availability of things like sharing glucose data live with others. The Nightscout Foundation (https://en.wikipedia.org/wiki/Nightscout) and Tidepool (https://www.tidepool.org/about) are two nonprofit organizations who lead development on open-source products (Nightscout and Tidepool, respectively) which help with this.
While the manufacturer-provided ecosystems function okay, they give you limited data mobility in case you switched to a different diabetes-related product like a CGM or insulin pump. They also introduce a dependency on on a cloud SaaS platform managed by said manufacturer, which can impose limitations, such as not allowing for real-time access to your data (Dexcom requires an approval process to get real-time data from their API: https://www.dexcom.com/webapi) and can have uncertain reliability (Dexcom had a notable outage in 2019, for instance: https://www.wsj.com/articles/diabetes-blood-sugar-data-outag...).
Conversely, you can run a Nightscout server on a Raspberry Pi in your home, or on a cloud server, for yourself and have full access to your data.
I’m familiar with tidepool and nightscout etc., I’m asking about using that functionality with a modern Dexcom device and app.
It is categorically untrue that you have to enable the cloud option to store/create logs and reports with the G6/G7. The app creates fantastic and easily digestible logs/reports on your phone, without any cloud processing.
Considering that, despite knowing for decades that pulse oximetry gives inaccurate results for people with darker skin, Covid showed us that we still can't/don't properly account for skin pigmentation during treatment[1]... I am not hopeful that they will be able to solve the challenge of measuring something MUCH more difficult and in a consumer format. Then again, Apple Maps shows us they might just release it anyways...
Things like Apple Maps are a special case, where improvement is driven by public exposure. Yes, Apple’s maps were full of errors upon initial release, but improvement was fairly rapid (albeit entirely opaque, unlike a typical open source project).
Today, I find that while Waze does the best driving navigation and Google Maps is unbeatable as a modern yellow pages, Apple Maps is equal to or superior in nearly every other way. It’s walking and public transport modes are, in my experience, consistently superior to anything else.
Especially over the last few years around most of the east coast, for me Apple Maps has become far better than google maps for everything, except reviews. Especially for biking and public transport as you said.
Almost-always-correct store open hours are the killer app for me with Google Maps. I also love the way Street View can show you historical vision.
I find the reviews in Google Maps to be (like Yelp, TripAdvisor etc) to be thoroughly useless. Tourism-driven companies are loaded up with manipulated reviews; cafes and restaurants get ratings that often bear no resemblance to reality. The sad fact is, even where reviews are genuine, the people who leave reviews on a mainstream site like Google Maps are not a representative sampling.
If Apple Maps gives you bad information, you usually can correct the wrong turn you take without too much difficulty.
If glucose monitoring gives you bad information, you could easily lose body parts, die, or other bad outcomes (In the last 10 years, one of my friends died, after apparently having lost several toes in an earlier episode. Another friend was rescued by the police after driving on the highway for several hours in a disoriented state. Both of them were medical professionals and presumably using best practices in their monitoring).
So you've just proven that medical technology in general suffers from problems of edge conditions and individual variability, but you expect that Apple needs to create a literally perfect product.
Not literally perfect, but with the awareness that the stakes are considerably higher than generally with their products, both from an ethical and a product liability point of view (Apple's vast resources could prove problematic on the latter aspect, as they would represent a particularly deep pocketed target for potential litigation).
Others have demonstrated optical sensors for blood pressure and blood alcohol content. 24/7 monitoring of HR, Resp., glucose, BP, & alcohol will be interesting.
I worked in this field, or very close to it, for a few years. The issue is that demonstrations are relatively easy, but validation and achieving acceptable performance over the entire range of the human population and entire range of operating conditions is very hard.
Yes, you can build a wearable device that mostly gets your blood pressure right, most of the time. What are you supposed to do with that? It's not a useful product (and the FDA won't let you sell it, for that reason).
If you can't depend on the results, you can't quantify in exactly what way the results are erroneous, and you don't have an enormous volume of clinical data and outcome studies, etc. with your device that allows you to draw clinical conclusions about your results regardless of their errors, you have nothing actually useful.
Very skeptical about this. I'm working with heart rate monitors and different physiological signals. The wrist-based smart watches are still sometimes way off compared to an ECG baseline, depending on skin type and how they are worn.
Even step counting with them is not accurate at all.
Can't imagine that Blood Glucose tracking will work anytime soon for a large population.
I used the Libre FreeStyle 2 system for 6 weeks. A revelation about diet, especially carbohydrates and blood sugar levels. Not sure it picked up my only Hypo and erratic data capture/loss over the whole period. Unexplained by Abbott. I'm Type 2 self inflicted. I'd like to use but not sure it's value at GBP 1500 per annum.
This is welcomed news! I'm diabetic (type 2). While I have it under control and don't need continous monitoring or insulin, it would be nice have data on levels monitored.
I've considered implantable monitoring like Eversense CGM but it's costly and the implants only last for 90 days and requires doctor's visit to "install" it. At the moment - I resort to finger testing whenever I feel off or want to know the measurement.
I would be willing to do an implant (chip?) if it can last for say a year+ with Apple Watch, for example, tracking the data and sending me alerts as needed.
For me, the danger is that I don't feel when my blood sugar is off. Or even when it's way off. I can be as high as 300 or as low as 50, and I don't feel the difference.
That's where I need a CGM, preferably like the Freestyle Libre3.
Those are actually invasive in that they require something inserted into the skin. It’s extremely small and is supposed to be painless, but it’s still invasive.
Yep the FreeStyle Libre 2 is great. I bought one a few weeks ago to satisfy my curiosity. I'm a non-diabetic. It was around EUR 70 including shipping and lasted exactly 2 weeks. Sensor insertion was easy, quick and painless. 1-minute resolution with 8 hour memory between swipes. Curiosity satisfied!
I bought a Libre 3 a couple weeks ago—I’m not diabetic, but there is some early Alzheimer’s in the family that might be related to diabetes.
…so far, I’m finding it wildly inaccurate. It shows trends well enough, but blood glucose is anywhere from 0-40 mg/dL off from a finger prick test depending on the day. I couldn’t imagine relying on this thing as a diabetic.
I was primarily struck by the awesomeness of this whole autonomous glucose regulation thing. My last meal is usually around 18:30 in the evening and during the night glucose would fluctuate around 4.5 mmol/l between 4.0 and 5.0 in 1 hour periods, like a crappy PID controller that needs a firmware update. Other nights it would be flat instead of fluctuating, but unfortunately two weeks were too short for a controlled experiment, meal repeats and figuring out what caused the difference.
Some nights it would show a couple of hypo's where glucose would drop to 3.5, quickly to be countered by an increase. I didn't notice a thing.
Additionally every morning before my alarm went off, I could see my glucose increasing, most likely preparing for wakeup, all by itself. Amazing!
It gave me a new-found respect for these otherwise invisible processes happening in this fleshy vessel on autopilot with closed cockpit doors. I only got to peek through a small window during 2 weeks.
Now imagine having that entire responsibility yourself, having to do it all manually. That's what we type 1 diabetics do every day!
The nighttime fluctuations could be legit changes in glucose level, but could also be weird sensor issues. The sensor will often give low readings when lying on it in your sleep. These are referred to as 'compression lows'.
The morning glucose spike you noticed is called the 'dawn phenomenon'. I inject a little insulin every morning to counteract it.
For me, I found that sleep quality was correlated with my blood sugar levels dipping too low during sleep (which I was able to address by eating fewer low quality carbs during the day).
In general you'll be able to basically see in real time the glycemic impact of all the foods you eat. Which would probably be helpful to a lot of people - you can find all the info online, but having the physical real time stats in front of you makes a difference.
But mostly its what you'd expect. High carb, fast digesting meal -> blood sugar spikes, then drops in accordance with you feeling tired afterwards. Eat keto -> blood sugar is mostly stable.
I think they might have been able to get one because they're in Europe, while in the US it requires a prescription. But you can just find a doctor who will prescribe one for you. (You will still have to pay out of pocket regardless).
Could be wrong on the above but that's been my understanding/experience.
The device itself is a one time use device that has a this mechanical mechanism to inject a thin needle underneath your skin and lasts for a couple of weeks
Insulin being a protein (which all look ~similar spectroscopically), it is not possible to measure in a no-prick format as you need physical access to it for separation/measurement (e.g. via antibody-like molecule or activity assay)
Insulin levels are massively overlooked. You can have normal blood glucose but excessive insulin levels due to insulin resistance, which leads to type 2 diabetes.
As another poster mentioned, it won't happen either invasively or non-invasively any time soon. Insulin levels aren't even part of a standard blood test in most places due to the cost.
I'm in a peripherally related field. Many have been the bankruptcies related to non-invasive blood glucose measurement. Best of luck, and I sincerely hope it's solved, but it's a hard, hard problem. The amount of confounding variation in the data is unbelievable.
If the monitoring is continuous though, could meaning be found in all the variations? Especially given how much context the watch has about your heart and breathing and current activity?
You can see why Dexcom seems to ramping up their marketing now (at least I'm seeing more of their ads where I never saw them before); will be a big blow to them if Apple incorporates it into the watch (unless they're using Dexcom tech inside)
> You can see why Dexcom seems to ramping up their marketing now
I'm not convinced this is really going to matter. I'd love to be able to measure how much different foods affect my blood sugar. But because I don't have diabetes and am not at high risk for diabetes (based on my A1C), the Dexcom is absurdly expensive as just a toy to satisfy my curiosity. But if I could buy a $19 thigh strap for my iPhone to do this then I'd jump on that in a heart beat.
Do you know whether Apple is planning on making the glucode detection on the watch suitable for patients with diabetes or will it be more of a "non-medical informational" feature.
I don’t know but my experience with other medical devices in this space supports your supposition that this will not be certified for medical use.
My understanding is that it’s a “safety” concern (read: liability). Because it would be providing “medical” advice the requirements around design are skewed to ensure that it doesn’t kill people rather than being permissive about the user experience [1]. Out of context, this seems sensible (therac anyone?) In practice this means that sensors like the Dexcom or Medtronic have “features” like alerts that cannot be silenced until the device is calibrated with blood. This makes sense from a safety perspective but is not particularly forgivable at 3am when the thing refuses to stop beeping until you feed it blood. I would guess that Apple will try, but they may find that their desired UX may not be compatible with the requirements imposed by the FDA process.
[1] This personal anecdote is old. I hope things have improved.
Do microneedles count as a prick? I know it sounds like it should but I honestly don't know if the current competition considers themselves to be a prick.
Along this topic of Apple Watch, does anyone have a "killer"/"can't live without now"/"actually makes the watch more useful" app they use (other than watchOS defaults)?
My take is the watch is more successful because I don't need any special apps to take full advantage of it.
I love what apple has built around it - health and fitness monitoring primarily but also siri integration (setting reminders, alarms, timers etc).
Generally on the health and fitness aspects the only accessories I find useful are a connected scale and connected blood pressure monitor (both from withings). The data is shared from the withings app to the health app (and I don't let the withings app read any data from health) so I can see that info along with everything else.
I do wish either the health or fitness apps on iPhone had better analytics, data visualization, and comparison tools or made them easier to find. They do have some good ones but it takes more taps than I'd like and I wish there were more breakdowns.
Makes it very easy to track this data over the longterm automatically - especially BP which I can then show my doctor at my annual physical of how I'm doing especially since white coat syndrome can affect readings they take.
I find having this data very motivating and I can use it to calibrate my days and weeks.
AutoSleep has been invaluable to me. To the best of my knowledge stock watchOS won't track sleep unless you set or schedule the Bedtime mode, which is annoying -I might forget to toggle it each night, or the schedule will kick in when I plan on staying up. AutoSleep automatically detects whenever I go to bed and wake up, along with history/metrics for a flat fee and no subscription.
I don't deeply trust many of the metrics but anecdotally it's very accurate for the amount I'm sleeping, which is mainly what I'm concerned with
I had a Beddit which was a device made by a company that Apple bought. I find the sleep tracking and general activity tracking at least vaguely interesting. Though if I have a bad night's sleep I know it--sometimes better than the Watch indicates. But the more we can track things and be aware of those things changing, the better I guess. With the Ultra's battery life I have found using the Apple Watch most days and nights a more matter of habit experience.
WorkOutDoors is brilliant for offline mapping. I’d used it as a running tracker until very recently when I went back to the builtin Workout app (just because it’s simpler and builtin). The builtin Compass app is decent now for setting waypoints and tracking your hikes so you can find your way back. WorkOutDoors is great at both of those, but also allows you to upload maps from your phone so that you still get good trail coverage even when you’re out in the middle of nowhere, so long as you’ve planned ahead a little.
WorkOutDoors is also my answer to this question. I can provide more controls to my runs and hikes than the native apps. I do heart rate zone running, and can set low and high heart rate alerts. Loading GPX files for hikes is also really handy.
Ping authentication is really nice.. I can leave my phone anywhere in the house and still validate VPN authentication requests.
Wallet -- wrist tap to pay.
These alone would keep the watch on my wrist.
That Google doesn't let me authenticate Gmail app 2FA by phone seems.. silly (does it? have I missed that?).
Apple Watch + WOD/Workout + Wallet + Air Prods Pro + Music is go good for runs. I have music, I can say “Hey Siri, remind me to…” when inspiration hits, and I can stop to buy a bottle of water if I want.
There are multiple apps I "can't live without" but they are all default apps.
(Not really "can't live without" but that, to me, justify the cost of buying and the routine of wearing.)
I do sometimes want to track or do some things in a certain way that the default apps don't... but I can ever seem to find an existing app to do it either. The apps exist but don't work the way I want any better than the built-in ones.
(Since I'm a developer, I sometimes whip up a prototype watch app myself, though I have to admit that while some have proved useful for a while, none have become a killer app for me, no matter how much I thought I wanted it originally. I do like my couch to 5K app.)
I can't help but feel there could be a better hiking app out there but I've tried the usual suspects and end up just coming back to the default exercise app.
Cellular calls that actually work are amazing for the watch, especially on vacation. I can call my SO from the pool to bring more bee... sun tan lotion.
I can also use the watch to pay for stuff anywhere. I can go on a jog and reward myself with ice cream half way (stupid: yes, fun: also yes) without needing to carry my phone or wallet with me.
That combined with a list of curated apps that can notify me on the watch help me not check my phone as often. If my watch vibrates it's something I actually need to take action on, and it's easier to quickly glance at it compared to a phone.
The cellular modem plus Workout app plus Airpods Pro have been amazing for me. I can either talk to my friend while running. He's running in NYC and I'm running in the Bay Area so we do virtual running together. The accountability keeps each other honest. I've been able to consistently run nearly every Saturday for over a year now because of this. I'm a weight weenie when it comes to running and don't want to have to carry my phone with me.
Wait, are you saying you are able to let the iPad connect to a hotspot shared by the Apple Watch alone? That would be really cool, but I can't find anything online supporting the claim. I've got all the hardware, too...
Repeat Timer Pro. It lets me set 25 second timers every 25 minutes, for as many intervals as I want. I use it to encourage myself to rest my eyes and stretch my legs for 25 seconds every 25 minutes. It notifies me with just a little vibration. I think it cost $5, but there are probably free apps that do this too.
Can't say I've found anything. Even the default apps leave a lot to be desired (like lacking note dictation to Siri on default watch apps)
I like that the watch provides some benefits like sleep tracking + vibrating alarm for a calmer wakeup, and buzzing on my wrist while using maps on silent to remind me a turn is coming.
I can live without the benefits the watch provides. Sometimes I take it off for days because I find wearing watches hurts/annoys my wrists (I had pocket watches until cellphones/PDA's took over for this reason). Although I am amazed that it's more comfortable than other smart watches/fitness bands I've tried to wear in the past.
Heh -- Apple Watch + Loop (https://github.com/LoopKit/Loop) handles all my insulin dosing, so technically definitely a killer app that I can't live w/out.
I've turned off all other features/notifications on my Apple Watch, it just does this, and it's the most valuable product I use (since I no longer have to pull out an insulin pump in a meeting, look at some other screen to see glucose values, etc etc etc).
Deliveries. Getting the bong on my wrist that something (and what it was) was dropped off has always been super useful, and it’s the exact kind of thing where being interrupted is useful.
I believe Marco (Overcast creator) said if you disable bluetooth on your phone (likely in settings, not from control center), the watch will stop trying to sync slowly over bluetooth, and switch to wifi.
Mobile payments. Just tap my watch to the NFC terminal. That alone is worth it, although other phones could do that. Apple key is also useful, just in case I forget my key fob.
pretty much any half-decent watch can do that nowadays. I'd not trust a no name brand w/ bank card details but the feature is not exclusive in any way.
I tried to use it as a sleep monitor, but you have to plan your charging carefully because it won't last a full day and night on a single charge. Also, despite it knowing I was sleeping, it would randomly vibrate when I received whatsapps during the night, so I needed to remember to put it to sleep before sleeping myself.
Speaking of messaging, I monitored several whatsapp groups, but I don't need to answer all messages. I did that on my PC; if I received a notification in my PC, but didn't interact with it, my phone would ding a few second later, and if I ignored that too, my watch would ding/vibrate a few seconds later. This is probably Meta's implementation, but getting triple notifications made day-to-day a bit more annoying.
I also tried to use it to track exercise, which I usually do at home. I saw no advantages compared to regular timing and counting, and didn't find the gamification of exercise engaging, because I was already doing it.
I got the watch during the pandemic, primarily for the oxymeter and ECG in case I had COVID (which I had). The oxymeter worked well, but the ECG wasn't enabled in my country until late 2022.
Maybe it's become better now, but I sold mine before it became too old. Except for the automatic health monitoring, it made things a bit more of a hassle instead of making them simpler.
Huh. I wore a Series 3 for years (just finally sold it last week) and never had an issue with charging/sleep tracking. I was in the routine of plopping it on the charger for 90 min or whatever as soon as I got home from work.
Also, mine would automatically go into “Sleep Focus” (previously “Do Not Disturb”) during sleep time, which muted notifications. Not sure why yours wouldn’t do that.
Do you want to get those notifications in all three places in case you only have one of the devices with you? I’d just turn WhatsApp notifications off everywhere but my computer if I were you (if I were me I’d just turn them ALL off ;)
Mark Gurman is an incredible reporter who has covered Apple for years and has many inside scoops and sources. I couldn't say one thing or another about the publication, but anything Mark writes I take seriously.
> Apple’s system — more than 12 years in the making — is now considered to be at a proof-of-concept stage, said the people, who asked not to be identified because the project is confidential. The company believes the technology is viable but needs to be shrunk down to a more practical size.
> Engineers are working to develop a prototype device about the size of an iPhone that can be strapped to a person’s bicep. That would be a significant reduction from an early version of the system that sat atop a table.
…
> Before shifting to TSMC, Apple had worked with Rockley Photonics Holdings Ltd. to develop the sensors and chip for the technology. In 2021, Rockley publicly disclosed its work with Apple, stoking interest in the supplier. Apple later ended the partnership, and Rockley filed for bankruptcy last month.
[1]: Related conversations: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...