Apple Monitoring Blood Glucose(mondaynote.com)
mondaynote.com
Apple Monitoring Blood Glucose
https://mondaynote.com/apple-monitoring-blood-glucose-9e6f7bb0b467
141 comments
Here in Germany the Dexcom G4 system with Animas Vibe insulin pump became fully covered by the health insurance last November and a couple of weeks ago I got my system working. It is a pretty amazing improvement to my life: both the pump and CGM.
The G4 transmitter has a 2.4 GHz radio and I built an extra device with Wixel and Bluetooth to transfer the data so my Android phone so xDrip+ and my Android watch can display the glucose values real time. It works so great that my A1c levels been going down from over 7% to 5-6%.
If you are in Europe and have a Type 1 Diabetes, you should ask your doctor about your options.
The G4 transmitter has a 2.4 GHz radio and I built an extra device with Wixel and Bluetooth to transfer the data so my Android phone so xDrip+ and my Android watch can display the glucose values real time. It works so great that my A1c levels been going down from over 7% to 5-6%.
If you are in Europe and have a Type 1 Diabetes, you should ask your doctor about your options.
If you have an insulin pump (best if it's an older one, since newer ones are harder to hack) you should look into OpenAPS (open artificial pancreas system) https://openaps.org/. People have code/schematics available to build a closed loop system between CGM<>insulin pump which automatically adjusts the dosage based on glucose levels and keeps you in range better than even the best attempts at manual dosages. Seems like you've already done half the work, which is connecting the CGM to a device you can run custom code on.
Medtronic just came out with their first closed loop system (https://www.medtronicdiabetes.com/products/minimed-670g-insu...), but OpenAPS has been around for years, and not sure how Medtronic will go about getting the 670 approved in Germany.
Medtronic just came out with their first closed loop system (https://www.medtronicdiabetes.com/products/minimed-670g-insu...), but OpenAPS has been around for years, and not sure how Medtronic will go about getting the 670 approved in Germany.
The Medtronic 670g was my other option, but I took the Animas Vibe + Dexcom G4 just because it's easier to hack, lots of German Diabetes hackers use it, its CGM seems to be more accurate and you can use the G4 sensors way longer than the 670g.
670g is a closed loop system, but what it does is it stops giving you the basal insulin when it thinks you are getting a hypoglycemia soon. What it doesn't do is to give you correct amount of insulin automatically when you've been eating carbs or doing exercise to keep your glucose level in the 5.5 mmol/l target. And with the new Fiasp insulin automatic adjustments would be possible.
To be able to build the OpenAPS, you must have an older Medtronic pump which are not covered by German insurance anymore. My Animas doesn't allow to tweak the insulins remotely.
670g is a closed loop system, but what it does is it stops giving you the basal insulin when it thinks you are getting a hypoglycemia soon. What it doesn't do is to give you correct amount of insulin automatically when you've been eating carbs or doing exercise to keep your glucose level in the 5.5 mmol/l target. And with the new Fiasp insulin automatic adjustments would be possible.
To be able to build the OpenAPS, you must have an older Medtronic pump which are not covered by German insurance anymore. My Animas doesn't allow to tweak the insulins remotely.
The 670G completely controls basal rates; the "suspend on low" functionality arrived in a previous generation. But it won't keep your blood glucose at 5.5 mM -- it targets 6.7 mM, and there doesn't seem to be any way to change this. :-/
Sounds nice. I still think I'm going to manage my insulins manually until the next generation of artificial pancreas. This system what I have is already the biggest ever improvement for my diabetes I've ever had.
Isn't it a bit scary to run the auto-insulin code on an android phone?
I do not have an insulin pump and I'm presuming you don't with my response. The pumps I have seen make noise when they are pumping and also have an alarm (I'm not sure if that's from the pump or the reader) if your levels are on either extreme. I'm guessing malfunctioning code would only execute once by pumping too much or not pumping at all and the user would figure it out very quickly.
I'd argue the users can't identify anything if they are rendered unconscious:
https://en.wikipedia.org/wiki/Diabetic_coma
You definitely don't want anything buggy with medical devices.
https://en.wikipedia.org/wiki/Diabetic_coma
You definitely don't want anything buggy with medical devices.
I agree about the importance of medical devices but I don't think diabetic coma happens as easily as you think for most (if they are on one of those full-systems). From what I've seen from insulin pumps/systems:
1. There is a max rate that it can pump
2. There are alarms that go off if the numbers are above or below your settings (I believe there are also max and mins for those so you can't accidentally set it to a 'fatal' number)
3. The systems seemed 'independent.' The reader did not take for granted that the pump was pumping, but rather continually monitored glucose levels and would still set off an alarm if the numbers weren't within the bounds.
1. There is a max rate that it can pump
2. There are alarms that go off if the numbers are above or below your settings (I believe there are also max and mins for those so you can't accidentally set it to a 'fatal' number)
3. The systems seemed 'independent.' The reader did not take for granted that the pump was pumping, but rather continually monitored glucose levels and would still set off an alarm if the numbers weren't within the bounds.
Unfortunately I can't get this in the UK. I asked, but they only give out to kids or people who poorly manage their T1. :(
As an American this is the single biggest fear I have about a nationalized healthcare system. I've been using the Dexcom CGM for 4 years and never had to pay more than a standard co-pay. It seems to me systems like the NHS are set up to serve the majority and people people with (relatively) rare diseases get screwed.
When parent says "I can't get this" they mean {I can't get this free, but I could buy it and I wouldn't have to pay the sales tax}.
In England there are some weirdness with treatment for people with diabetes.
If you use insulin of medication to manage your diabetes you're entitled to free prescriptions. This is free from the time you're diagnosed to your death, and for all medications not just insulin. (But not free dental or optician care)
Prescriptions are low cost in England. Currently they cost:
http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptionc...
>> The current prescription charge is £8.60 per item (£17.20 per pair of elastic hosiery). A three monthly PPC is £29.10 and will save you money if you need more than three prescribed items in three months. A 12-month certificate is £104.00 and will save you money if you need more than 12 prescribed items in a year.
(I think this is right, but it might have changed) I feel that it's an injustice that glucose monitors and test strips and these new devices are not covered by this medical exemption certificate, and that people with diabetes need to pay for them, even if they don't have to pay the 20% VAT.
England has an independent organisation called NICE that decides on best current practice treatment (with an eye to cost effectiveness). Clinical Commissioning Groups (the local organisations that commission NHS services) need to pay regard to NICE guidance. Here's their standard for type one diabetes: https://www.nice.org.uk/guidance/ng17
Here's their list for blood glucose management: https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendati...
In England there are some weirdness with treatment for people with diabetes.
If you use insulin of medication to manage your diabetes you're entitled to free prescriptions. This is free from the time you're diagnosed to your death, and for all medications not just insulin. (But not free dental or optician care)
Prescriptions are low cost in England. Currently they cost:
http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptionc...
>> The current prescription charge is £8.60 per item (£17.20 per pair of elastic hosiery). A three monthly PPC is £29.10 and will save you money if you need more than three prescribed items in three months. A 12-month certificate is £104.00 and will save you money if you need more than 12 prescribed items in a year.
(I think this is right, but it might have changed) I feel that it's an injustice that glucose monitors and test strips and these new devices are not covered by this medical exemption certificate, and that people with diabetes need to pay for them, even if they don't have to pay the 20% VAT.
England has an independent organisation called NICE that decides on best current practice treatment (with an eye to cost effectiveness). Clinical Commissioning Groups (the local organisations that commission NHS services) need to pay regard to NICE guidance. Here's their standard for type one diabetes: https://www.nice.org.uk/guidance/ng17
Here's their list for blood glucose management: https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendati...
You can get still get private coverage in the UK (e.g. Bupa), the NHS is there for people who don't want that.
Can you pay for it yourself with their discount?
There's https://www.freestylelibre.co.uk/libre/ which I believe you can just order online (I'm considering one myself). You have to scan the sensor yourself(it stores the data between scans) so it doesn't trigger alarms like the dexcom but for gathering data about how exercise/diet effects your levels it should do the job nicely I think.
edit: The starter pack costs £159.95, see https://www.freestylelibre.co.uk/libre/products/starter-pack...
edit: The starter pack costs £159.95, see https://www.freestylelibre.co.uk/libre/products/starter-pack...
These were recently included in the coverage given by the danish government (at least in my area) and this is probably the biggest quality of life improvement I have received in at least 10 years of diabetes. Even though it's not as clever as some of the other systems, being able to get an idea of the level without having to find a secluded spot and prick my finger is a really great feeling. It also means I can actually check my levels while at a party for example, where previously I would put it off for a bit because it was inconvenient.
German insurance companies cover these too and I had them about six months before switching to Dexcom system. The NFC scanner provided is not accurate at all. The values are what they are and you can't calibrate them. Luckily if you own an Android phone with NFC reader you can use xDrip+ to scan the values and xDrip+ allows calibrations, so the measurements reflect your blood sugar much more accurately.
I'm having trouble with not feeling hypoglycemias and I'm having them quite often at night. Freestyle Libre by default doesn't automatically measure your glucose levels, but there is a hack with Sony Smartwatch 3, a strap and very custom and hacky android version which enables the NFC reader in Sony and you can get alarms to your phone on low glucose levels. It worked and saved me a couple of nights, but the Libre chips break easily and the system was kind of a drag to use in the end.
I'm having trouble with not feeling hypoglycemias and I'm having them quite often at night. Freestyle Libre by default doesn't automatically measure your glucose levels, but there is a hack with Sony Smartwatch 3, a strap and very custom and hacky android version which enables the NFC reader in Sony and you can get alarms to your phone on low glucose levels. It worked and saved me a couple of nights, but the Libre chips break easily and the system was kind of a drag to use in the end.
The sensors are quite pricey to get, each lasting roughly 2 weeks. Unfortunately the sensors aren't available on prescription yet. Let's hope this changes.
I suspect it's only a matter of time, if it leads to better management of blood sugar levels the long term cost savings will be huge.
Europe is not a country. I'd wager less prosperous countries do not cover such devices.
My partner is type 1 diabetic, and CGMs were a game changer for her (they started rolling out in Switzerland last year).
She's been using the FreeStyle Libre (https://www.freestylelibre.co.uk/libre/), which uses NFC and on select markets has an Android app available, but here we still have to use the handheld reader.
She's been using the FreeStyle Libre (https://www.freestylelibre.co.uk/libre/), which uses NFC and on select markets has an Android app available, but here we still have to use the handheld reader.
The Libre only gives you a reading when you manually check it, right? Or did I misunderstand that? I wouldn't want to lose the low/high/rate of change alerts the Dexcom gives. Even if you're sleeping, it'll wake you up if the blood sugar starts getting low.
Officially, it stores 8 hours of data in five minute intervals and you have to read it with an NFC device, so automatic alarms are a no-go.
If you want to hack, it is possible to turn the Libre to have automatic alerts. I did it, it's not perfect, but if you have nightly hypos which you don't notice, this can be helpful:
https://github.com/pimpimmi/LibreAlarm/wiki
http://www.freestylesticker.com/product/freestyle-libre-cgm-...
If you're in Europe, I have one modded Sony Smartwatch 3 which I can sell :)
If you want to hack, it is possible to turn the Libre to have automatic alerts. I did it, it's not perfect, but if you have nightly hypos which you don't notice, this can be helpful:
https://github.com/pimpimmi/LibreAlarm/wiki
http://www.freestylesticker.com/product/freestyle-libre-cgm-...
If you're in Europe, I have one modded Sony Smartwatch 3 which I can sell :)
> they started rolling out in Switzerland last year
Wow, do you know why this is? The Dexcom G4 is already 5 years old and is absolutely a life-saving system.
Wow, do you know why this is? The Dexcom G4 is already 5 years old and is absolutely a life-saving system.
That's because there are so few of us Type 1 diabetics and not enough political pressure to get the new stuff faster. There are some activist doctors and nurses that help in Germany, but we also got the G4 for free only on last November.
The insurance companies are conservative and see the systems as very expensive investments and the technology is something scary in a country which is still very suspicious about Internet and computers in general.
The insurance companies are conservative and see the systems as very expensive investments and the technology is something scary in a country which is still very suspicious about Internet and computers in general.
There were also some privacy/bureaucratic slow downs (my girlfriend had to sign a monster of T&C regarding data sharing with her doctor).
I find the non-official Android Libre reader app 'Glimp' useful. Even though I have the official one, I keep both installed, because Glimp does less smoothing/extrapolation of the readings.
I seriously recommend testing xDrip+ with the Libre. Better results and you don't need to carry an extra reader device with you all the time:
https://github.com/NightscoutFoundation/xDrip
Pull requests are welcome too :)
https://github.com/NightscoutFoundation/xDrip
Pull requests are welcome too :)
In what way does it offer better results?
There's an official android app for libre too, i'm not sure if it's available everywhere though.
There's an official android app for libre too, i'm not sure if it's available everywhere though.
The libre measures the glucose from the interstitial fluid, which doesn't map directly to the value measured from blood. Think about coordinates, where X is the value from interstitial fluid and Y is the value from blood. You must draw a line somewhere to map the values correctly and the Libre is calibrated in the factory. For me the Libre reader was just an ok indicator about the trend, but the actual value was sometimes not even near the value shown. It's ok between the normal range 4.0-8.5 mmol/l, but I'd be suspicious about every value outside of that range.
With xDrip you can input values measured from blood and the software will try to estimate as accurate values as possible, meaning that in the best case you can be quite sure about the reading, but always better to check from blood.
Remember, that calibration should happen only when the levels are steady and you should calibrate from the whole range to trust the readings. Anyways at least 2-3 measurements per day from blood is suggested, even with the more expensive CGM's.
With xDrip you can input values measured from blood and the software will try to estimate as accurate values as possible, meaning that in the best case you can be quite sure about the reading, but always better to check from blood.
Remember, that calibration should happen only when the levels are steady and you should calibrate from the whole range to trust the readings. Anyways at least 2-3 measurements per day from blood is suggested, even with the more expensive CGM's.
It is quite annoying when you are getting intimate though.
The libre or the pump? I usually just unplug the pump for sex and take some extra insulin when I plug it back. Small price to pay for the luxury of steady sugars.
The libre. I am afraid to tightly grab that arm and it's distracting when caressing that arm so I just keep my hands away from it which creates this weird spot I am afraid to touch...
One of the linked articles has some more technical details on how non-invasive blood sugar measurement works (for the GlucoWise device currently in development):
The glucose levels are extracted by a non-invasive technique which transmits low-power radio waves through a section of the human body, such as the area between the thumb and forefinger or the earlobe. These areas have adequate blood supply and are thin enough for waves to pass through the tissue. These signals are then received by a sensor on the opposite side of the GlucoWise device, where the data about the characteristics of the blood within the flesh are collected and analysed.
The other non-invasive technique that has received a lot of press is, of course, Google/Novartis' contact lens. That device measures blood sugar from tears.
Most other blood sugar measurement systems require either blood draws from a pin prick or a sensor attached to your body that measures sugar content in the subcutaneous fluid as a proxy for blood sugar.
The glucose levels are extracted by a non-invasive technique which transmits low-power radio waves through a section of the human body, such as the area between the thumb and forefinger or the earlobe. These areas have adequate blood supply and are thin enough for waves to pass through the tissue. These signals are then received by a sensor on the opposite side of the GlucoWise device, where the data about the characteristics of the blood within the flesh are collected and analysed.
The other non-invasive technique that has received a lot of press is, of course, Google/Novartis' contact lens. That device measures blood sugar from tears.
Most other blood sugar measurement systems require either blood draws from a pin prick or a sensor attached to your body that measures sugar content in the subcutaneous fluid as a proxy for blood sugar.
Apple's recent obsession with health monitoring is weird from a branding standpoint. Losing appeal with young people is the nightmare of any technology company, becoming known as that gadget for geriatrics is another level of dejection.
I read that this focus is particularly driven by Tim Cook's fascination with the space. It sort of confirms my idea of him as not a very image conscious CEO, especially in contrast with Jobs who was a legend at imbuing Apple with coolness and desirability.
I read that this focus is particularly driven by Tim Cook's fascination with the space. It sort of confirms my idea of him as not a very image conscious CEO, especially in contrast with Jobs who was a legend at imbuing Apple with coolness and desirability.
I don't have any data on hand to back this up, but I don't think younger people are necessarily averse to monitoring their own health. I think personal health monitoring devices fit well with the devices the younger generation already uses to help maintain their identity and concept of self.
I agree if it's poorly implemented or marketed it won't be adopted, but Apple probably has a shot at getting it right.
I agree if it's poorly implemented or marketed it won't be adopted, but Apple probably has a shot at getting it right.
I agree. I've only seen middle aged office workers wear stuff like Fitbit, posture correction, sleep tracking type of things. Young people don't have to worry about 'sitting is new smoking' .
There is a nerdy segment that loves tracking all of this health data forever and ever.
There is also the segment that just wants to lose weight, and that can apply at all ages. A continuous glucose monitor is also a great way to monitor keto diets or similar. Keep yourself under a certain glucose level continuously and your body will be forced to use fat sources!
There is also the segment that just wants to lose weight, and that can apply at all ages. A continuous glucose monitor is also a great way to monitor keto diets or similar. Keep yourself under a certain glucose level continuously and your body will be forced to use fat sources!
What if Tim Cook is a strategy genius? The health care market is gigantic, and if in the long-run, Apple can get a piece of that market, they'd be set for a long time...
I am deeply skeptical that anything other than R&D and patents will come out of this move by Apple. I am bearish on the prospects of using technology in healthcare. Primarily for these reasons:
1. Regulation: it is very hard to innovate at the pace of the consumer-electronics industry while satisfying FDA regulations.
2. For general purpose applications, signals and measurements are highly noisy and sensors are still deeply in the academic realm, working only in very special use-cases, as opposed to 'in the wild'. It is a different matter for special applications such as Type-I diabetes or other diseases because devices are critically important and patients are willing to tolerate discomfort (of wearing probes, pumps, etc.)
3. In general, predictive power of algorithms tends to be lower for non-genomic health care applications because of variability across individuals, errors in installing devices, rarity of certain types of data for training and validation, etc.
4. Some of the key benefits are hard to grasp for users because of the slow time scales over which things like weight loss occur, and also due to the multi-factorial/multi-component nature of human well-being.
1. Regulation: it is very hard to innovate at the pace of the consumer-electronics industry while satisfying FDA regulations.
2. For general purpose applications, signals and measurements are highly noisy and sensors are still deeply in the academic realm, working only in very special use-cases, as opposed to 'in the wild'. It is a different matter for special applications such as Type-I diabetes or other diseases because devices are critically important and patients are willing to tolerate discomfort (of wearing probes, pumps, etc.)
3. In general, predictive power of algorithms tends to be lower for non-genomic health care applications because of variability across individuals, errors in installing devices, rarity of certain types of data for training and validation, etc.
4. Some of the key benefits are hard to grasp for users because of the slow time scales over which things like weight loss occur, and also due to the multi-factorial/multi-component nature of human well-being.
Athletes are the branding antidote to these concerns - they're extreme users in their own right and love to track all the things. One step down from the halo-effect of athletes is the 'Athleisure' segment of the fashion market (think Lululemon and the like), which shows broad interest in healthy living in desirable/cool demographics that have high correlation with Apple purchasers.
On the contrary, going into health will reinforce the brand, not dilute it. Apple has always been an aspirational lifestyle brand. Given the growing scope of computing in our lives - work, social, leisure, health - the lifestyle that Apple sells is only going to get more complete and compelling.
There's also a growing trend of QS and tracking health data points, and increasingly not just among geeks. You can see it in the nutrition space as well, where people are optimizing food, getting bloodwork, etc. These fields are ascendant and glucose tracking matters there too.
On the contrary, going into health will reinforce the brand, not dilute it. Apple has always been an aspirational lifestyle brand. Given the growing scope of computing in our lives - work, social, leisure, health - the lifestyle that Apple sells is only going to get more complete and compelling.
There's also a growing trend of QS and tracking health data points, and increasingly not just among geeks. You can see it in the nutrition space as well, where people are optimizing food, getting bloodwork, etc. These fields are ascendant and glucose tracking matters there too.
I think it could be Apple moving with it's current market demographic. I started out an apple fan boy in highschool. I waited in line for iPhones religiously and insisted all my and my family's laptops were MacBooks. Now I'm old (31) and hitting the range where my doctor starts mentioning baseline cardiac physicals and other regimated health tests that just come with age (I'm healthy, BTW).
If the idea is to cater to the shifting age if it's fanboys it may be a great play. The young generation moves from obsession with Emojis and Instagram to having diabetes and heart disease pretty quick. Why not cater to the shift when you already have the customer. 3M isn't making glucose testing sexy like only Apple can.
If the idea is to cater to the shifting age if it's fanboys it may be a great play. The young generation moves from obsession with Emojis and Instagram to having diabetes and heart disease pretty quick. Why not cater to the shift when you already have the customer. 3M isn't making glucose testing sexy like only Apple can.
I think this is just the right move. It's the only good reason to own an Apple or Android Watch, to monitor your health. The current solutions require quite a many devices to get the information to your watch. If Apple nails it with their product for us Type 1 diabetics, I'm ready to switch from Android.
I don't think you could say for the general young generation.
Google, Apple and Samsung have been vie for these feature in 2014.
It is not uncommon to focus on health space when the technology is mature, we can't live and worry about our health.
What is the point if you have the greatest smartphone watch and still lead unhealthy lifestyle?
Google, Apple and Samsung have been vie for these feature in 2014.
It is not uncommon to focus on health space when the technology is mature, we can't live and worry about our health.
What is the point if you have the greatest smartphone watch and still lead unhealthy lifestyle?
Generally speaking, if you're leading an unhealthy lifestyle, buying a new gadget will not change that. I'm sure there's plenty of anecdata to counter this, though.
I disagree, most people tend to unknowing overwork or having excessive intake. There are situations when someone tried to add artificial sweetness, the gadget are there to inform you in time rather than months.
Hostpitals has been participating in health research because they want to make these accessible for you 24 hours.
Hostpitals has been participating in health research because they want to make these accessible for you 24 hours.
If I had a device that let me know the health impact (from an insulin sensitivity standpoint) of a food I ate without invasive stuff, I'd use it in a heartbeat, and I'd listen (except for cheese - if it said cheese would bad, I'd ignore that bit).
The good news is that almost all cheeses have not effect on blood glucose levels!
If Apple doesn't make this someone else will.
If Apple doesn't make decent laptops and desktops then who else can?
This is what bothers be about Tim Cooks priorities in health and celebrities next to his apathy towards computers. (I don't consider the iPad a computer I consider it a device)
If Apple doesn't make decent laptops and desktops then who else can?
This is what bothers be about Tim Cooks priorities in health and celebrities next to his apathy towards computers. (I don't consider the iPad a computer I consider it a device)
The business problem is that the world has increasing apathy towards computers.
“When we were an agrarian nation, all cars were trucks, because that’s what you needed on the farm,” Jobs said at [the] D8 conference in 2010. “But as vehicles started to be used in the urban centers, cars got more popular. Innovations like automatic transmission and power steering and things that you didn’t care about in a truck as much started to become paramount in cars. … PCs are going to be like trucks. They’re still going to be around, they’re still going to have a lot of value, but they’re going to be used by one out of X people.”
“When we were an agrarian nation, all cars were trucks, because that’s what you needed on the farm,” Jobs said at [the] D8 conference in 2010. “But as vehicles started to be used in the urban centers, cars got more popular. Innovations like automatic transmission and power steering and things that you didn’t care about in a truck as much started to become paramount in cars. … PCs are going to be like trucks. They’re still going to be around, they’re still going to have a lot of value, but they’re going to be used by one out of X people.”
Yeah can't really argue against that logic, just arguing for someone to fulfil my needs to do my job.
Maybe it's time for a new "truck" company that focuses on the needs of the few and Apple can ditch computers and focus on the needs of the many.
Maybe it's time for a new "truck" company that focuses on the needs of the few and Apple can ditch computers and focus on the needs of the many.
Except reading the article says the team behind this was initially kicked of by Jobs...
And personally, I don't think it's all that weird. I think it fits perfectly with branding, but maybe I'm less aware of it.
And personally, I don't think it's all that weird. I think it fits perfectly with branding, but maybe I'm less aware of it.
Research labs have been trying this for years with every spectroscopy known to man - the signal is just too weak. I don't see any reason to think Apple has figured something out that labs of optics experts can't do on the benchtop.
Just consider Apple as yet another lab of optics experts, but with 100x the funding, 10y of material science advancements, and years instead of months of dedicated effort. It's not that hard to believe that this team could finally succeed.
Indeed, I design similar equipment for industrial use. Non invasive blood glucose has been a holy grail of analytical technology for decades. Lots of smart people have gone bankrupt trying to solve this problem. The sensors are probably good enough already. Algorithms for sorting out massive libraries of spectral data exist. It's a hard problem. That's not saying Apple doesn't stand a chance, but that they're entering a very mature space.
I think machine learning coupled with increase in sensitivity of the signals could make a difference.
Why would machine learning be able to overcome a lack of statistical power?
It's not clear whether there's actually a lack of statistical power, or simply a lack of sufficient modelling of the noise.
Did you miss the part about sensitive sensors? A single sensor may not be enough to classify accurately but multiple sensors measuring different things can sometimes work. Such sensor fusion has worked incredibly well for IMU's and also in self-driving cars.
That's how the Glucotrack claims to work. From their site:
GlucoTrack uses ultrasonic, electromagnetic and thermal technologies to non-invasively measure glucose levels in the blood. GlucoTrack is intended for use by Type 2 and pre-diabetics.
GlucoTrack combines the following technologies:
Ultrasound (speed of sound change within the tissue);
Electromagnetic (conductivity of the tissue);
Thermal (heat capacity of the tissue).
It's not approved by the FDA, but it appears to be selling in Australia, New Zealand, Spain, China, Korea, Italy and some others.
GlucoTrack uses ultrasonic, electromagnetic and thermal technologies to non-invasively measure glucose levels in the blood. GlucoTrack is intended for use by Type 2 and pre-diabetics.
GlucoTrack combines the following technologies:
Ultrasound (speed of sound change within the tissue);
Electromagnetic (conductivity of the tissue);
Thermal (heat capacity of the tissue).
It's not approved by the FDA, but it appears to be selling in Australia, New Zealand, Spain, China, Korea, Italy and some others.
It wouldn't, but maybe there is enough statistical power, but it's just tricky to process?
Yeah let's get some AI in there to help out, maybe building the front end in react native will solve some problems no one though of. We could get the data with graphql to solve some issues.
Except, it actually does. ML is just advanced statistical modeling which performs complex computation over large amounts of data to give out better results. Because Apple can afford to do things at scale and use their marketing prowess to buy sensors at an economical price, they can afford to use multiple sensors to give out a reasonably accurate metric. All the technologies that you mentioned do solve problems they are intended to solve. Why so much negativity?
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Apple appears to be working on blood glucose monitoring as a way to address Type 2 Diabetes.
Either the article is very wrong, or Apple is doing something very cute here.
Type 2 diabetics do check their blood glucose -- occasionally. For non-insulin-using diabetics (aka. most type 2s) medical plans typically cover less than one test per day, because the evidence is that testing more frequently doesn't accomplish anything. (Blood glucose testing in T2D basically answers the question "is the treatment working, or do I need to talk to my endocrinologist", while blood glucose testing in T1D is essential for answering the question "how much insulin should I inject right now".)
So the idea of a continuous glucose monitoring system for type 2 diabetics is pretty much nonsense from a medical perspective; sure, they'll get pretty graphs, but those graphs won't provide any medically actionable information. So my first instinct was to think that the article was very wrong.
But maybe Apple is being very cute. The reason we don't have any non-invasive blood glucose tests is that nobody has managed to make them accurate enough to meet FDA requirements for tests to be used for diagnostic and treatment purposes. But if Apple markets this as being for type 2 diabetics... well, they can perfectly reasonably put a sticker on the box saying "for entertainment purposes only", since that's the only thing type 2 diabetics would be using a continuous glucose monitor for anyway! FDA requirements circumvented -- and once Apple gets a large installed used base, they get a huge pile of data which they can use to help them develop a later version which is accurate enough.
Either the article is very wrong, or Apple is doing something very cute here.
Type 2 diabetics do check their blood glucose -- occasionally. For non-insulin-using diabetics (aka. most type 2s) medical plans typically cover less than one test per day, because the evidence is that testing more frequently doesn't accomplish anything. (Blood glucose testing in T2D basically answers the question "is the treatment working, or do I need to talk to my endocrinologist", while blood glucose testing in T1D is essential for answering the question "how much insulin should I inject right now".)
So the idea of a continuous glucose monitoring system for type 2 diabetics is pretty much nonsense from a medical perspective; sure, they'll get pretty graphs, but those graphs won't provide any medically actionable information. So my first instinct was to think that the article was very wrong.
But maybe Apple is being very cute. The reason we don't have any non-invasive blood glucose tests is that nobody has managed to make them accurate enough to meet FDA requirements for tests to be used for diagnostic and treatment purposes. But if Apple markets this as being for type 2 diabetics... well, they can perfectly reasonably put a sticker on the box saying "for entertainment purposes only", since that's the only thing type 2 diabetics would be using a continuous glucose monitor for anyway! FDA requirements circumvented -- and once Apple gets a large installed used base, they get a huge pile of data which they can use to help them develop a later version which is accurate enough.
This is analysis show real lack of imagination. Continuous glucose monitoring is extremely useful, even for pre-diabetics, let alone type 1 or type 2 diabetics. It does provide actionable information. Action isn't just inject some insulin (even though type 2 diabetics eventually go on insulin). Action can be don't eat. Or action can be go for a run/cycle etc. Or action can be adjust your medicine dose. Or drink a lot of water, or any other of the things available to immediately lower or increase your blood sugar.
High glucose doesn't have many symptoms unless it is ridiculously high. If you have blurred vision, hot flashes etc, then it's really really high. But there are things you can do before it gets that high. And knowing you are trending in that direction is useful. Going for a long walk can help. Going for an hour or two bike ride can lower your sugar below normal.
On the other extreme, if you just changed your medicine regimen (higher dose or doctor put you on new kind of medicine that works better for you), you are at risk of lowering your glucose too much. Esp. dangerous for medicine taken before going to bed. Recognizing low glucose is much easier (shaking, dizziness) but not when you are sleeping. Being alerted if you are trending below normal and keeping some candy next to you is always wise.
Continuous monitoring helps in all these scenarios.
High glucose doesn't have many symptoms unless it is ridiculously high. If you have blurred vision, hot flashes etc, then it's really really high. But there are things you can do before it gets that high. And knowing you are trending in that direction is useful. Going for a long walk can help. Going for an hour or two bike ride can lower your sugar below normal.
On the other extreme, if you just changed your medicine regimen (higher dose or doctor put you on new kind of medicine that works better for you), you are at risk of lowering your glucose too much. Esp. dangerous for medicine taken before going to bed. Recognizing low glucose is much easier (shaking, dizziness) but not when you are sleeping. Being alerted if you are trending below normal and keeping some candy next to you is always wise.
Continuous monitoring helps in all these scenarios.
> testing more frequently doesn't accomplish anything
totally anecdotal but I test aprox 10 times per day and have reduced an A1C of 8.2 at diagnosis to 5.5 (non diabetic). I'm extremely sceptical that you can optimise your plan sufficiently with a test once per day, it's a akin to having a speedometer on your car that only gives you a speed once during the entire journey.
totally anecdotal but I test aprox 10 times per day and have reduced an A1C of 8.2 at diagnosis to 5.5 (non diabetic). I'm extremely sceptical that you can optimise your plan sufficiently with a test once per day, it's a akin to having a speedometer on your car that only gives you a speed once during the entire journey.
Are you T1 or T2? I was specifically talking about T2s; testing multiple times a day can be useful to get a sense of daily patterns, but those patterns will tend to persist from one month to the next so there's no need to test many times a day every day.
I'm T2. I use the levels to make small adjustments throughout the day.
Some examples: In the morning I go for a cycle, I use the levels to decide what distance to do and also during the ride to ensure I don't hypo (I'll eat some fruit if my levels are getting too close to 70). After lunch I go for a walk, depending on how my level is looking it will either be 3km or 5km. In the evening I generally check my level about 10pm, if it's looking too high then I'll add an additional walk in.
There are many other details where I use my levels to adjust my behaviour, at this point it's all automatic but I couldn't do it without knowing what my level is at any point in time (needless to say I'll be queuing outside the Apple store if they do actually release an Apple Watch with a glucose monitor).
Some examples: In the morning I go for a cycle, I use the levels to decide what distance to do and also during the ride to ensure I don't hypo (I'll eat some fruit if my levels are getting too close to 70). After lunch I go for a walk, depending on how my level is looking it will either be 3km or 5km. In the evening I generally check my level about 10pm, if it's looking too high then I'll add an additional walk in.
There are many other details where I use my levels to adjust my behaviour, at this point it's all automatic but I couldn't do it without knowing what my level is at any point in time (needless to say I'll be queuing outside the Apple store if they do actually release an Apple Watch with a glucose monitor).
I think your use of the word "cute" is a bit disingenuous and at odds with the conclusion you draw. "Cute" implies misleading, whereas the scenario you outline isn't misleading at all.
It makes total sense to start where they are starting; they'll get teams of data in a very short space of time (from diabetics and non-diabetics alike) and be able to iterate quite quickly from there.
As a non-diabetic, I want this so much. The impact of sugar and insulin on health is finally getting the attention it needs and I think this could be the innovation that makes health trackers actually useful.
It makes total sense to start where they are starting; they'll get teams of data in a very short space of time (from diabetics and non-diabetics alike) and be able to iterate quite quickly from there.
As a non-diabetic, I want this so much. The impact of sugar and insulin on health is finally getting the attention it needs and I think this could be the innovation that makes health trackers actually useful.
Well, I think it is cute, in that I'm sure every type 1 diabetic who can afford it will immediately buy one of these -- whether they're FDA approved or not.
I would hope that Type 1 diabetics wouldn't get this and being relying on it 100% without consulting their doctor and reading appropriate literature. Apple is also way too visible to be misleading on this.
maybe this could be a qualitative way of understanding the body's insulin response to a meal, and to adjust one's diet accordingly (more meals, lower GI foods, etc)?
An effective population-level way to address type 2 diabetes could be dietary feedback from glucose levels, for pre-diabetic people.
> For non-insulin-using diabetics (aka. most type 2s) medical plans typically cover less than one test per day
My T2 father's plan covers 4 a day. He has a pretty lousy insurance plan, too. He hates having to prick his finger four times a day, so he often skips. He also hates all things Apple, but he still asked me what I knew about it.
If the next iPhone allows him to stop pricking his fingers four times a day, he'll buy one the day its released. I doubt he'd be the only one.
My T2 father's plan covers 4 a day. He has a pretty lousy insurance plan, too. He hates having to prick his finger four times a day, so he often skips. He also hates all things Apple, but he still asked me what I knew about it.
If the next iPhone allows him to stop pricking his fingers four times a day, he'll buy one the day its released. I doubt he'd be the only one.
In the US my insurance covers the 4 test strips per day my endocrinologist prescribes for type 2. This was true for the 3 years I was able to use oral medication before switching to insulin.
As a type II diabetic I would love it if Apple got in the continuous monitoring field; namely because it will help the field as a whole get better. It is largely dominated by one company with an invasive method.
As an aside to the article Type II is caused by diverse reasons; not just weight. Weight is deffinately a factor; but there are other genetic and physiological factors that contribute to how well your body uses/produces insulin. The article doesn't help mitigate this by referring to Type II as a "Lifestyle" i.e. Shaming disease.
Diabetics have a enough to deal with then to be rudely told it's their fault and they simply have to 'exercise'. A little compassion goes a long way.
As an aside to the article Type II is caused by diverse reasons; not just weight. Weight is deffinately a factor; but there are other genetic and physiological factors that contribute to how well your body uses/produces insulin. The article doesn't help mitigate this by referring to Type II as a "Lifestyle" i.e. Shaming disease.
Diabetics have a enough to deal with then to be rudely told it's their fault and they simply have to 'exercise'. A little compassion goes a long way.
This article talks about type 2 diabetes, but I'm wondering why a non-invasive continuous blood glucose monitor would not be just as useful and desirable for type 1s as well. A friend of mine has type 1, and more than once, she's expressed hopeful anticipation for a future combined non-invasive blood glucose monitor and insulin pump -- effectively an external artificial pancreas to take over the functionality of her broken natural one.
It would be very desirable, but all of the many companies who have tried to get accurate results non-invasively have failed. With Apple's resources, perhaps they'll lick the problem, but I wouldn't bet on it.
So to answer your question: Probably because if a Type 1 Diabetic uses a non-invasive glucose monitor to determine their insulin dosage, much of the time they will overdose, and possibly fall into a coma or die.
So to answer your question: Probably because if a Type 1 Diabetic uses a non-invasive glucose monitor to determine their insulin dosage, much of the time they will overdose, and possibly fall into a coma or die.
A co-worker of mine is doing a similar kinda thing but with circulating tumor cells, so I have some 3rd hand knowledge of these kinda tests.
Fact of the matter is that the human body is, chemically and pathologically speaking, fucking bulletproof. Our bodies are just super freaking good at maintaining homeostasis. This means that a lot of tests like blood-glucose, cancer diagnosis, etc that are trying for non-invasive blood testing just have a HUGE parameter space to contend with. Apple's idea may work with calm light-skinned office workers, but will it work with sweating dark-skinned day laborers? African Americans are the population most at risk for DM-II. How about if your blood pressure goes all wonky? What about someone going through a growth spurt? Does it work when you put your arm in motor oil? What about people without arms? Lives aren't 'edge cases'; your device MUST cover all those real people with families and children. I'll believe their device when it passes FDA approval and the clinical data is out there for us all to see and argue over.
Fact of the matter is that the human body is, chemically and pathologically speaking, fucking bulletproof. Our bodies are just super freaking good at maintaining homeostasis. This means that a lot of tests like blood-glucose, cancer diagnosis, etc that are trying for non-invasive blood testing just have a HUGE parameter space to contend with. Apple's idea may work with calm light-skinned office workers, but will it work with sweating dark-skinned day laborers? African Americans are the population most at risk for DM-II. How about if your blood pressure goes all wonky? What about someone going through a growth spurt? Does it work when you put your arm in motor oil? What about people without arms? Lives aren't 'edge cases'; your device MUST cover all those real people with families and children. I'll believe their device when it passes FDA approval and the clinical data is out there for us all to see and argue over.
> your device MUST cover all those real people with families and children
Are you talking from a regulatory standpoint? Why couldn't Apple (or anybody) make a device that works on a limited range of skin colors? If you can't help everybody, does that mean you shouldn't help anybody?
Are you talking from a regulatory standpoint? Why couldn't Apple (or anybody) make a device that works on a limited range of skin colors? If you can't help everybody, does that mean you shouldn't help anybody?
Regardless of the soundness of the logic of your reply, the way that idea would be seen by darker-skinned communities (especially like the African-american community in the US that is highly affected by DM-II) would be something like "Apple made a racist product and wants black people to die". Additionally, if the device only works on non-sweating, not moving, healthy, white/asian office workers out of bright sunlight who have not recently eaten nor have gone more than 5 hours without eating, it's not really something that helps anyone who would need it.
People with darker skin aren't idiots. Current products like Fitbit trackers already work poorly on dark skinned people, so it's not anything new. I don't think that community is going to call Apple (or, more generally, physics) racist.
Also, I think you underestimate the market size of light skinned office workers with significant disposable income that don't need blood glucose monitoring but want it anyway. I'm one of them.
I wouldn't be surprised if Apple launched multiple devices. The $500-$600 watch would give blood glucose trends or some other derivative information. The $2000-$3000 watch would be the one that gives a medically useful measurement. They could iterate quickly on one and work through the ponderous regulation with the other. Maybe they would even license the technology to Medtronics or some other medical device company and let somebody else deal with the headaches.
Also, I think you underestimate the market size of light skinned office workers with significant disposable income that don't need blood glucose monitoring but want it anyway. I'm one of them.
I wouldn't be surprised if Apple launched multiple devices. The $500-$600 watch would give blood glucose trends or some other derivative information. The $2000-$3000 watch would be the one that gives a medically useful measurement. They could iterate quickly on one and work through the ponderous regulation with the other. Maybe they would even license the technology to Medtronics or some other medical device company and let somebody else deal with the headaches.
Wait, why would you want blood-glucose monitoring that is not medically proven to work or be reliable?
Like, yeah, maybe it works in a very limited set of situations, but that's the same as a broken clock that only tells the right time twice a day; you'd never know when the monitoring device is working 'correctly'. It would be a random number generator, effectively, if it was not proofed.
Besides, if you aren't a diabetic, why would you care? The human body is highly variable, from person to person, and even inside of a person after meals. All it would do, if it were accurate 'enough', is say some number that you can't control. Like, you aren't gonna take any insulin shots to mess with it, that would likely kill a normal person. I can't see any actual use for a healthy person. Trying to 'game' that (assumed reliable) number would just put you into a coma; we're supposed to have spikes in the concentration, that's how vertebrates work. Playing 'what-if' games with number would be like Russian Roulette, each experiment may kill you.
https://en.wikipedia.org/wiki/Blood_sugar
http://www.webmd.com/diabetes/daily-control-17/slideshow-blo...
http://www.everydayhealth.com/type-2-diabetes/symptoms/surpr...
Also, I'm not saying that people with dark skin are idiots. I'm saying that the 'optics' of Apple releasing that thing aren't 'good' as a large percentage of their 'customers' that have DM-II are dark-skinned, though not all by any means.
Like, yeah, maybe it works in a very limited set of situations, but that's the same as a broken clock that only tells the right time twice a day; you'd never know when the monitoring device is working 'correctly'. It would be a random number generator, effectively, if it was not proofed.
Besides, if you aren't a diabetic, why would you care? The human body is highly variable, from person to person, and even inside of a person after meals. All it would do, if it were accurate 'enough', is say some number that you can't control. Like, you aren't gonna take any insulin shots to mess with it, that would likely kill a normal person. I can't see any actual use for a healthy person. Trying to 'game' that (assumed reliable) number would just put you into a coma; we're supposed to have spikes in the concentration, that's how vertebrates work. Playing 'what-if' games with number would be like Russian Roulette, each experiment may kill you.
https://en.wikipedia.org/wiki/Blood_sugar
http://www.webmd.com/diabetes/daily-control-17/slideshow-blo...
http://www.everydayhealth.com/type-2-diabetes/symptoms/surpr...
Also, I'm not saying that people with dark skin are idiots. I'm saying that the 'optics' of Apple releasing that thing aren't 'good' as a large percentage of their 'customers' that have DM-II are dark-skinned, though not all by any means.
Perfect is the enemy of good. My Fitbit counts steps, but it isn't all that accurate from an absolute standpoint. Still, I find the day-to-day variances interesting.
Same goes for blood glucose monitoring. I'd like to see if I can find correlations between my mood, productivity, sleep, fasting, etc... and my blood glucose levels. Like step tracking, the absolute number doesn't matter.
Cook has already said that blood glucose measuring would be useful for people before they have diabetes. That's what makes me think it isn't necessarily a medical device they are building. At least not for version 1.
The last article is one of the things that would be super interesting for me to see. How do blood glucose levels change when I drink a diet soda vs water, for example.
Same goes for blood glucose monitoring. I'd like to see if I can find correlations between my mood, productivity, sleep, fasting, etc... and my blood glucose levels. Like step tracking, the absolute number doesn't matter.
Cook has already said that blood glucose measuring would be useful for people before they have diabetes. That's what makes me think it isn't necessarily a medical device they are building. At least not for version 1.
The last article is one of the things that would be super interesting for me to see. How do blood glucose levels change when I drink a diet soda vs water, for example.
The problem is that the number you are getting is useless, there is no relative measure. Yes, maybe for you and for your particular fitbit recently, you may believe hat it 'works'. But you are very likely an outlier, there is no reason to believe some device like the glucose one will work for you or just about anyone else. The tech is essentially vaporware.
Also, giving people even psuedo-medical diagnoses is just irresponsible; either it works or it does not. You can't tolerate psuedo-random number generators with health in any way. This is why 23andMe has to licence their genetic counselors on what the results mean, as the data can be very easily misunderstood by even very well educated people.
Harvard just released a study on the fitbit, even the best of them were far off on something as simple as calorie counting: https://med.stanford.edu/news/all-news/2017/05/fitness-track...
Also, giving people even psuedo-medical diagnoses is just irresponsible; either it works or it does not. You can't tolerate psuedo-random number generators with health in any way. This is why 23andMe has to licence their genetic counselors on what the results mean, as the data can be very easily misunderstood by even very well educated people.
Harvard just released a study on the fitbit, even the best of them were far off on something as simple as calorie counting: https://med.stanford.edu/news/all-news/2017/05/fitness-track...
I really can see an ever increasing shelf in Apple stores that stocks medical monitoring devices, compatible with the Apple Watch and iPhone.
And if I'm to be almost offensively practical, this is a huge business opportunity. We're all hypochondriacs to some degree, and it's a market that's currently being served by some pretty dodgy outfits, offering magic bullet solutions. And the incumbents are making a ton of money. It's probably not a good idea to give people tools to self diagnose themselves on a daily basis. But it's inevitable, and a logical path for the consumer electronics industry to follow.
And if I'm to be almost offensively practical, this is a huge business opportunity. We're all hypochondriacs to some degree, and it's a market that's currently being served by some pretty dodgy outfits, offering magic bullet solutions. And the incumbents are making a ton of money. It's probably not a good idea to give people tools to self diagnose themselves on a daily basis. But it's inevitable, and a logical path for the consumer electronics industry to follow.
While a lot of comments revolve around the efficacy of accurately monitoring for T1/2 diabetes and the past noninvasive trials and tribulations thereof, consider that the market for such a product is very limited by Apple's measure (10's of millions for an addressable market, versus billions for phones/watches). It seems much more interesting if they were chasing a general metabolic health or pre-diabetic application where the annoyance and lethargy of the FDA/medical community can be skipped entirely.
Cross pollination between life sciences and consumer electronics will deliver amazing opportunities for chronic disease patients. Non-Invasive blood analysis can deliver new treatment opportunities for diabetes patients. This is an amazing field to innovate in indeed.
My startup enigma.bio is working on low power laser spectroscopy blood analysis techniques inside the tympanic canal for the last 3 years. Seeing interest in the field from large players is exciting.
My startup enigma.bio is working on low power laser spectroscopy blood analysis techniques inside the tympanic canal for the last 3 years. Seeing interest in the field from large players is exciting.
Are there any uses for this information for "normals", people with no particular danger of diabetes?
For example, I am interested in calorie tracking, but the various apps out there mostly seem to cover franchise food. They can't accurately say anything about the sandwich I made in my kitchen.
For example, I am interested in calorie tracking, but the various apps out there mostly seem to cover franchise food. They can't accurately say anything about the sandwich I made in my kitchen.
Well yes. You might not know it but these days there is sugar (in any variation) in almost all our food. Increased blood sugar levels over long time lead to diabetes, tracking might help people to understand the risk their diets might impose.
I can imagine wearing bracelets for each metric you want to monitor, it'll be a sign of health and wealth and be as popular as those snag bands you kids used to wear in the playground.
Loyal to Dexcom for the night and day changes their product made to the quality of life for my mother. But very glad to see Apple putting a foot into these waters.
This is all well and good, but is it accurate?
Don't Theranos us Apple.
Don't Theranos us Apple.
That is key. I don't see how. At first I thought maybe a sweat related method? Perhaps some odd electronic field trick no on has tried? Unlike heart rate I doubt a camera and bright light would suffice.
I do know I would buy them for my parents immediately once they are shown to work. Would not even pause. Blood sugar is spooky and you are toast if it goes low and no one is around to help
anecdotal section : My mother has been taking insulin since the 80s, she uses a pump currently. The real danger in blood sugar is when levels get low. She has caught her self in the low 40s but if it had happened at night she would be in real trouble. You just simply go to sleep and never wake from it. High numbers while dangerous are sustainable and your conscious throughout.
She has had a few episodes where it went out of control (600+) that took a hospital visit days to get under control with a drip. Same routine, you go in and tell them your level. They don't believe you. They test three times then freak out. You are in heart ward and even then they cannot get it back and turn from blaming your diet to going "We don't know". The point is, even highly regulated/monitored things happen and doctors don't know all the whys.
I do know I would buy them for my parents immediately once they are shown to work. Would not even pause. Blood sugar is spooky and you are toast if it goes low and no one is around to help
anecdotal section : My mother has been taking insulin since the 80s, she uses a pump currently. The real danger in blood sugar is when levels get low. She has caught her self in the low 40s but if it had happened at night she would be in real trouble. You just simply go to sleep and never wake from it. High numbers while dangerous are sustainable and your conscious throughout.
She has had a few episodes where it went out of control (600+) that took a hospital visit days to get under control with a drip. Same routine, you go in and tell them your level. They don't believe you. They test three times then freak out. You are in heart ward and even then they cannot get it back and turn from blaming your diet to going "We don't know". The point is, even highly regulated/monitored things happen and doctors don't know all the whys.
Astro Teller of Google X used to do that sort of thing at BodyMedia. It wouldn't surprise me if Google also has some projects in the works.
Verily (formerly Google X Life Sciences) has several projects they are working on in this space, including miniaturized CGMs and glucose sensing contact lenses.
https://verily.com/projects/
Disclaimer: I work for Verily, but I know nothing about these projects.
https://verily.com/projects/
Disclaimer: I work for Verily, but I know nothing about these projects.
If this device is covered by insurances, this could become a potential cash cow.
Even if it isn't, I think it would still be a cash cow. I've never owned an Apple watch before, but if they got this working, I'd buy one in a heartbeat (assuming it's less than $1500). FWIW, I'm not diabetic, I just want the data.
I'm sure it's helpful for diabetics, but it won't be long at all before Apple is selling that data to your health insurer - who will f you.
Any reason to believe they'd actually do this? Apple are one of the few companies that seem to genuinely value customer privacy[1]; They make their money selling your products, not selling your personal information after all. If this were a Google or Facebook product on the other hand...
[1] I could point to numerous examples of this (removing APIs used to track individual iOS devices, fighting the government on proposed encryption backdoors, etc), but I think the onus is on you to rather provide evidence to suggest this is something they would do :)
[1] I could point to numerous examples of this (removing APIs used to track individual iOS devices, fighting the government on proposed encryption backdoors, etc), but I think the onus is on you to rather provide evidence to suggest this is something they would do :)
This is an ridiculous suggestion. Apple's products have had minimal data reporting and a focus on privacy. They even conceded awkward UI and bugs around messaging for the sake of keeping it secure. Their advertising project failed partially because of their unwillingness to track users. They famously took the US government to court and won in order to prevent them from being forced to unlock a phone, for fear of the precedent it would set.
What possible reason could you have to assume that they would sell health data, for which all of the same reasoning applies as well as it being more heavily regulated by the government?
What possible reason could you have to assume that they would sell health data, for which all of the same reasoning applies as well as it being more heavily regulated by the government?
[deleted]
> I'm excited to see where it goes.
BREAKING NEWS FROM THE FUTURE (Reuters):
Hundreds of thousands Apple users die within hours after IoT glucose measurement + insulin pump device overdoses insulin during WannaDie cyberattack. Apple urges all surviving users to update the system immediately. Surviving users and family members of deceased will get 10 year full Apple subscription and special $20,000 memorial gift card after signing settlement agreement online. update: WaPo reports that CIA has been aware of the vulnerability for 5 years.
BREAKING NEWS FROM THE FUTURE (Reuters):
Hundreds of thousands Apple users die within hours after IoT glucose measurement + insulin pump device overdoses insulin during WannaDie cyberattack. Apple urges all surviving users to update the system immediately. Surviving users and family members of deceased will get 10 year full Apple subscription and special $20,000 memorial gift card after signing settlement agreement online. update: WaPo reports that CIA has been aware of the vulnerability for 5 years.
We detached this subthread from https://news.ycombinator.com/item?id=14391166 and marked it off-topic.
This is far less funny than you make it out to be, and you'd probably be shocked at the state of 'security' in medical devices today.
Thank goodness, specialist embedded systems are immune from Malware.
Thank goodness.
Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Power Defenses https://spqr.eecs.umich.edu/papers/icd-study.pdf
>Our study analyzes the security and privacy properties of an implantable cardioverter defibrillator (ICD). Introduced to the U.S. market in 2003, this model of ICD includes pacemaker technology and is designed to communicate wirelessly with a nearby external programmer in the 175 kHz frequency range. After partially reverse-engineering the ICD's communications protocol with an oscilloscope and a software radio, we implemented several software radio-based attacks that could compromise patient safety and patient privacy....
Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Power Defenses https://spqr.eecs.umich.edu/papers/icd-study.pdf
>Our study analyzes the security and privacy properties of an implantable cardioverter defibrillator (ICD). Introduced to the U.S. market in 2003, this model of ICD includes pacemaker technology and is designed to communicate wirelessly with a nearby external programmer in the 175 kHz frequency range. After partially reverse-engineering the ICD's communications protocol with an oscilloscope and a software radio, we implemented several software radio-based attacks that could compromise patient safety and patient privacy....
Together with self-driving cars that have also perfected data protection.
Well, if the issue is some "cyberattack", then consider how many Android users would have died...
If anything, here's where the "walled garden", signed and sandboxed, etc nature of App Store makes much sense...
If anything, here's where the "walled garden", signed and sandboxed, etc nature of App Store makes much sense...
I am, as the quoted post, excited to see Apple enter the area. Many medical devices would benefit from the medical product redesign and in general more convenient ways to handle well understood medical situations.
However, this also opens up to new dangers, e.g. the easy access to cheap SDR units allows one to try to do serious mischief by jamming / hacking / reprogramming those IoT style units. This should not kill the tech, just something for the users to be aware of.
However, this also opens up to new dangers, e.g. the easy access to cheap SDR units allows one to try to do serious mischief by jamming / hacking / reprogramming those IoT style units. This should not kill the tech, just something for the users to be aware of.
I have a Garmin right now. The heart rate monitor gives more reliable readings, the battery is better etc.
If apple makes an Apple Watch 3 with an optional blood glucose monitoring band, I'd switch back though!
If apple makes an Apple Watch 3 with an optional blood glucose monitoring band, I'd switch back though!
I think the term "consumer base" is not heartless but in fact pretty accurate.
Why not spending the probably huge amount of money in a cure instead of monitoring devices ?
Well, because why kill the Golden Egg Goose ? Millions of people who have to take pills every day are good recurent money. If you cure them, no more cash.
(Well it's the middle of the night, I can't sleep and fill a little bit bitter...)
One more thing. I'm a bit scared with all the private companies collecting personal medical datas. But maybe I've read too much science fiction.
Why not spending the probably huge amount of money in a cure instead of monitoring devices ?
Well, because why kill the Golden Egg Goose ? Millions of people who have to take pills every day are good recurent money. If you cure them, no more cash.
(Well it's the middle of the night, I can't sleep and fill a little bit bitter...)
One more thing. I'm a bit scared with all the private companies collecting personal medical datas. But maybe I've read too much science fiction.
Agreed about private companies and collecting of data, but in the case of Apple, none of your HealthKit data is transmitted (it's all stored on your iPhone and/or Apple Watch).
Any app that reads/writes HealthKit data is required to provide a privacy policy before it passes App Store approval.
Additionally, apps can only access that data after a full-screen permissions screen is displayed, and the user manually toggles on the categories of Health data that the app can access.
In my experience, the bar for getting apps that use HealthKit is at least slightly higher than for non-HealthKit apps.
Any app that reads/writes HealthKit data is required to provide a privacy policy before it passes App Store approval.
Additionally, apps can only access that data after a full-screen permissions screen is displayed, and the user manually toggles on the categories of Health data that the app can access.
In my experience, the bar for getting apps that use HealthKit is at least slightly higher than for non-HealthKit apps.
Didn't knew about that. If true (and I trust you on this one) that's a little relief.
I think this idea is pretty odd. If someone had a cure for diabetes, you'd bet they'd charge an arm and a leg for it. The patents alone would be incredibly valuable.
From a non-monetary standpoint, dehumanizing companies is always a bit frustrating. They consist of people, like you and me. Most people aren't sociopaths and the idea that business leaders are entirely sociopathic is worth challenging. I don't think most people would want to withhold a cure for recurring revenue. Charge for it, yes, but not withhold it.
From a non-monetary standpoint, dehumanizing companies is always a bit frustrating. They consist of people, like you and me. Most people aren't sociopaths and the idea that business leaders are entirely sociopathic is worth challenging. I don't think most people would want to withhold a cure for recurring revenue. Charge for it, yes, but not withhold it.
I never said someone found it and is hiding it. I'm just a bit sad that there's probably more money that goes in treatment than in cure research.
It's economically understandable but humanly sad.
It's economically understandable but humanly sad.
Also, withholding cure for a big disease is not necessarily a stable equilibrium on the market - the first company to release such a cure would mop the floor with their competitors.
This is only true if a one-off sale of the cure is significantly more profitable than a reliable income stream from products that help manage the disease without curing it.
For that to be true the cure would have to be more expensive than management by at least an order of magnitude - assuming monthly refills for management and an annual reporting cycle - but still not so expensive that it became unaffordable.
For that to be true the cure would have to be more expensive than management by at least an order of magnitude - assuming monthly refills for management and an annual reporting cycle - but still not so expensive that it became unaffordable.
Can someone provide links to examples of companies withholding cures in exchange for profit? If not, the idea of this is nothing but conspiratorial.
If it's true, though, it's worth knowing.
If it's true, though, it's worth knowing.
I wasn't being conspiratorial, so much as adding some detail to a market-based model.
As in the other post below, I don't believe magic bullet cures are possible for most diseases.
Following that economic logic further, it's much cheaper and easier to produce a not-very-effective but marketable palliative than it is to aim for a Nobel-winning medical moonshot.
I don't know of any suppressed super-cures, but evidence confirming the limited effectiveness of (e.g.) SSRIs is easy to find and hard to argue with.
Similarly questionable outcomes have been noted in other fields. E.g. novel anticoagulants:
https://en.wikipedia.org/wiki/Dabigatran
As in the other post below, I don't believe magic bullet cures are possible for most diseases.
Following that economic logic further, it's much cheaper and easier to produce a not-very-effective but marketable palliative than it is to aim for a Nobel-winning medical moonshot.
I don't know of any suppressed super-cures, but evidence confirming the limited effectiveness of (e.g.) SSRIs is easy to find and hard to argue with.
Similarly questionable outcomes have been noted in other fields. E.g. novel anticoagulants:
https://en.wikipedia.org/wiki/Dabigatran
My original statement was about how much money goes in treatment research vs in cure research. Not about some conspiracy :-)
> If you cure them, no more cash
This is pretty shortsighted. Because:
- it's not like you would cure everyone at once anyway
- there are always people who will develop the disease eventually so you can always make money in the long run
- if you are the only effective treatment you can pretty much make the price you want, and collect massive profits that can be invested in the develop of other drugs or solutions.
Never heard of vaccine companies going bankrupt, for example.
This is pretty shortsighted. Because:
- it's not like you would cure everyone at once anyway
- there are always people who will develop the disease eventually so you can always make money in the long run
- if you are the only effective treatment you can pretty much make the price you want, and collect massive profits that can be invested in the develop of other drugs or solutions.
Never heard of vaccine companies going bankrupt, for example.
I've never heard of successful vaccine companies going bankrupt.
But vaccines are an exception in medicine. Serious conditions rarely have magic bullet cures.
E.g. "cancer" isn't one condition, it's a set of loosely related problems. It's very unlikely indeed there will ever be "a cure for cancer", but not at all unlikely that specific cancers will become much more treatable.
That doesn't stop companies promising to develop magic bullet cures - or magic bullet anything - and getting huge interest from investors. (See also Theranos, etc.)
But vaccines are an exception in medicine. Serious conditions rarely have magic bullet cures.
E.g. "cancer" isn't one condition, it's a set of loosely related problems. It's very unlikely indeed there will ever be "a cure for cancer", but not at all unlikely that specific cancers will become much more treatable.
That doesn't stop companies promising to develop magic bullet cures - or magic bullet anything - and getting huge interest from investors. (See also Theranos, etc.)
You might want to look into Gensym (sp?) and their Hepatitis cure. The company got a big boost when they released the cure but now they are being pummeled by the market and analysts as the need for their cure is declining (fewer cases). There is no money in cure, money is in turning medical issues into chronic diseases. US pharma research is focused on chronic management and not cure. When was the last time a cure originated from US based research?
> There is no money in cure
That's also because state put caps as to how much vaccines are supposed to cost, which makes them less profitable than they should be. However if you were to consider the cost of a one-time vaccine versus treating some illness for the rest of your life, it's expected consumers would go for the vaccine unless it's prohibitively expensive.
That's also because state put caps as to how much vaccines are supposed to cost, which makes them less profitable than they should be. However if you were to consider the cost of a one-time vaccine versus treating some illness for the rest of your life, it's expected consumers would go for the vaccine unless it's prohibitively expensive.
First, these things are not easily exchangeable. Yes, it is important researching for cures as well as for treatments in the absence of "cures". But with diseases, which are caused by bad habits mainly, a device like the Apple Watch can be part of the cure, if it helps preventing the disease. And, of course, as long as we don't know how to cure, we should at least optimize the treatments.
The "CGM" (continuous glucose monitor) has really come into it's own over the last 10 or so years, and I would encourage all diabetics (but especially type 1) to use one. Currently the only 2 real options on the market are:
- http://www.dexcom.com/ - Connects directly to your phone using bluetooth and will send glucose warnings etc as notifications.
- https://www.medtronicdiabetes.com/products/enlite-sensor - Designed to work with Medtronic (who is a market leader) insulin pumps.
Both these options are expensive (even with insurance for many), invasive, and not really tailored towards "casual" glucose monitoring. I think if Apple enters the space with a non-invasive tool it'll be a huge boon for causal glucose monitoring. I also think it could be a more accessible option for people who are interested using a CGM to treat their diabetes but can't/won't use one of the existing options due to cost or inconvenience.
This seems like a win win and I'm excited to see where it goes.