Comment by tzs
1 day ago
I find it hard to believe that this patent was keeping Apple from adding blood glucose sensing. Yes, I know a patent on blood oxygen level sensing stopped Apple, but there is a huge difference between oxygen level sensing and glucose sensing.
For oxygen sensing there are numerous readily available inexpensive stand-alone sensors available at any drug store or online. They are non-invasive and painless. Yes, a continuously wearable sensor would be better for some people but most people don't need that. Accordingly it is something that while nice wouldn't really sell a lot of watches, and so something that might not be worth licensing if it is under patent.
Glucose sensing on the other hand is a literal pain to test and has ongoing costs due to consumables used for the testing. Non-invasive painless glucose sensing on a watch is a feature that would sell a lot of watches. I think demand would be high enough, even if they have to raise prices, that it would easily be worth it.
we're building an artificial pancreas for hospitals, so I know a good bit about CGMs. Noninvasive blood sugar sensing is horrifically difficult. Every few years, people come along and say "oh this is just some simple DSP on spectroscopic information, piece of cake" before inevitably running up against:
- skin conductivity changes over time
- the ways in which skin tone changes signal absorption (which itself changes over time)
- the ways in which different levels of fitness affect blood flow, material density etc.
You also can't use it in a hospital setting, due to how your skin and bloodflow changes during serious conditions like sepsis (though I'm guessing they're not thinking about that market).
Really smart people have been trying to use Raman spectroscopy to solve this problem for decades at this point (early patents go to early 2000s). Apple is an extremely strong hardware vendor, and I wish them luck, but I would not hold my breath for this. Plus, I'm guessing they will not open the signal up for looping, which would really leave the T*DM community out to dry.
Honestly, none of those sound like blockers for the use case I and many other diabetics would like - monitoring for general blood sugar responses (rough curve) after eating. Sure, you wouldn't be able to use the measurements to dose insulin or even measure your actual (numeric) glucose level, but measuring my A1C every three months is good enough to do that in mine and many other cases. I've had my blood sugar controlled through diet and metformin with it being in the range of 5.9 - 6.2. I could do so much better if I had a better understanding of how my body, specifically, reacts to certain foods, mealtimes, routines (exercise after eating), etc.
It would be super helpful to know (relative to other foods) how my body reacts to claimed low-carb foods. Is there a large spike (don't need to know the number) or is it a much more flat curve? How long in general does it take for the line to return to pre-meal levels? What does that trend look like over many months? Heck, I could even run a rudimentary and simple test to do comparative insulin response to a known amount of carbs to see if my insulin response is improving over time (using the period of the curve). I would love to get an alert that hey, we think your glucose level shot up a lot (don't care how much) so that I can remediate it through exercise then and there and avoid that food or timing going forward.
Really hoping the people in Medtech don't make perfect the enemy of good in this case. Although maybe what you listed would still be blockers for even getting general glucose curves. I've been planning on getting a CGM for at least a few months to achieve all of this, but it would be great to just have it in a watch or other simple wearable.
Agreed that the value of a CGM is in the change information, and that adding a CGM is probably the biggest quality of life increase for anyone with diabetes. Highly pro CGM if you can get it!
The issue with spectroscopic approaches is the amount of noise can be really hard to disentangle, to the point that you might get really unreliable trend information, where it might even be dangerous if you're making dosing decisions off it. And even if you aren't, getting incorrect trend information doesn't really help you any more than just not knowing it.
It sounds like you're a T2 diabetic, in which you're not taking insulin and high blood sugar over long periods of time is your risk profile.
Unfortunately T1 diabetics and insulin dependant T2 diabetics will get killed by a machine that tosses out numbers that can be considerably off to the point no manufacturer is going to make the risky product.
the whole point was the tech is not accurate at the moment, you're better off with a random number generator on your watch
I work in a related area. Non-invasive blood glucose has been a holy grail for analytical science, for decades, and remains a brutally difficult problem.
Yup. But there's hope that computational techniques can extract the signal from the noise.
If they can it'll be huge. Maybe even Ozempic-huge. There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level.
>There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level.
That doesn't work, even if it were true. You can also manage your weight by never allowing the weight on the scale to go over a certain level.
4 replies →
Indeed, there's always a hope that more advanced computation will crack this nut in the future. That's been a constant for a quarter century too.
Nonsense. Tell this to humans that die when their blood glucose is insanely high (500mg/dl), go into DKA and they are SKINNY!!! You’re suggesting 20 calories can make you obese because it raises blood glucose lol! 3-5 grams (12-20 calories) of a mild-glycemic index carbohydrate can send your blood glucose well above 120mg/dl and you would not gain weight because of an extra 12-20 calories. Additionally, 1,200 calories from fat (133 grams of fat) will not spike your blood glucose until 5-12 hours later and you you can gain weight, but that signal is lost because the rise in blood glucose happens 1-3 meals, or even the next day after eating the high fat meal. Blood glucose is VERY important but not predictive of weight. Diet, (the amount and macro composition of calories) is predictive of weight and exercise is predictive of weight. The are other factors, but those are the main predictors.
2 replies →
> Glucose sensing on the other hand is a literal pain to test
I’d be hard-pressed to believe that someone trying the newest Dexcom G7 CGM would find it more discomforting than a mosquito bite. And for that literal pain you get 10 days of constant readings on your phone.
> I think demand would be high enough, even if they have to raise prices, that it would easily be worth it.
This is probably correct but I don’t think many non-diabetic people would see an actual benefit from CGM data. It’s the kind of thing people love to think is useful but in reality it’ll be just one more thing to ignore.
I have type-1 diabetes, brought on late in life after going through a miserable 2 years of stress after my wife was in a coma due to medical negligence. She came out of it, but the damage was done, she won’t recover, and she is a shadow of who she was. Prolonged extreme stress can trigger type-1 diabetes, and once you have it, you have it for the rest of your life.
Right now, I’m on glipizide which manages (along with a low-carb diet) the situation, but I need the GCM so I know when this “honeymoon” period (before I start needing insulin) starts to end.
Unfortunately I have an extreme needle phobia too. My insurance doesn’t cover the G7, just the G6, so I don’t know if it’s different, but if I try to apply the G6, my heart rate will massively speed up, I will start to hyperventilate, and typically pass out when I click the button on the applicator. I’m out for only a few minutes, but it’s not a pleasant experience… I have to make sure I’m lying on a bed to do it now, after learning the hard way that it’s possible to fall when just sitting down, and head wounds don’t stop bleeding when you’re unconscious.
I would dearly love the ability to measure glucose non-invasively. It’s actually nowhere near as bad for me if I don’t have to click it myself, but my wife wouldn’t understand what to do, and my son is too young for me to feel comfortable asking. Theres no-one else around to help, so sometimes I make a dr appt, for a 10-second “click”. Most of the time I just put up with it. The hope is that the phobia starts to diminish, but so far it hasn’t, and yes I’ve tried psychologists.
Every 10 days, and [sigh] as I write, I recall that today is the day. Again.
The G7 has a smaller applicator. To me it looks less "needly" than the G6 did. The libre applicator is even smaller. There's less of a need to look at the underside because the applicator is set on the skin without having to pull free the sticker. That could make it easier for you.
But obviously they all have a needle because they need to get something under your skin. Which is I guess what triggers you.
1 reply →
I’m T1 as well and the G7 is night and day better than the G6. Total game changer for me.
Hopefully you get access to it soon.
> you get 10 days
Isn't that the key point and means Dexcom/Libre would cost you (or your insurance company) several thousands of dollars/pounds/euros/etc every single year. For many people they already have an iphone and just need an Apple watch which could last for several years.
Right… my comment was arguing against the assertion that testing is a literal pain, not a metaphorical pain in the wallet.
Yes, obviously if Apple could figure out how to get accurate BG numbers on an iPhone it would be better than the currently available CGMs.
> I’d be hard-pressed to believe that someone trying the newest Dexcom G7 CGM would find it more discomforting than a mosquito bite.
Not diabetic, but I've tried a set of two of these out of curiosity. The insertion pain is nothing, but having something bonded to your skin with adhesive constantly is kind of a pain.
I also got some irritation at the insertion sites around the 1-week mark, though that might have been because I don't have much fat on that area of my arm.
The market is likely for folks that are unaware that they have some glucose issue.
I agree with the idea that the market that this will be sold to is people who believe they will benefit from CGM data.
My point is that CGM data is very very very unlikely to change behavior in the overwhelming majority of people.
1 reply →
Huh? The G7 requires an app on your phone. Being slim and hitting muscle when using any kind of subcutaneous device burns like hell.
The CGM that wins is the one that doesnt stop working when batteries die. Or piercing the skin.