7 ms·

I don't understand how having ubiquitous sensors is the "holy grail for treating diabetes."

by leoh 10y ago

ivanbakel 10y ago
Seriously. You'd think genetic therapy, or even just a sensor-injector automatic combo (which to my knowledge already exist) might be more worthy of the title. But then, it's evident that the article is giving Apple too much credit already - even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying.
- MBCook 10y ago
  You don't think an Apple Watch (which starts at about $350) which could monitor your glucose more or less continuously would be far more preferable to a huge chunk of people then occasionally sticking themes with a lance and then trying to record the reading of a portable meter they have to carry around? Don't forget you have to buy the little strips. Let's ignore the idea of insurance paying for this or any other kind of help. I imagine the Apple Watch would end up paying for itself for a type one diabetic within what, a year or two? I know those little testing strips aren't cheap. But the Apple Watch would give you much better monitoring, no pain, no testing, far more data… Oh yeah and every feature that the people who already have an Apple Watch like. As others have mentioned in this thread, I'm sure it's INCREDIBLY easy to get small children to test their blood glucose when necessary. I imagine this would easily be worth it to a lot of parents as well.
  - ivanbakel 10y ago
    I think the technology would be better put to use on something other than the Apple Watch, unless an equivalent sensor minus Apple's other contributions also somehow starts at $350. You're conflating the sensor with an overpriced and rather useless piece of technology, which I say as the owner of one. I'm in full support of a non-invasive sensor for diabetics, but if we manage to come up with one, I would be against giving it an Apple price tag.
    - MBCook 10y ago
      Apple could invent this an then license the sensor to other people. They gave away health kit. And they could choose not to license it to their competitors, only medical companies. But surely they'd put it on their own devices as well. Seems like a weird attitude though: If company X can afford to (possibly waste) billions of dollars to make a medical breakthrough in Y, I don't want them to because then they'd use it themselves and charge money.
      - ivanbakel 10y ago
        Where did I say that I don't want Apple to pursue this research? I just said that I don't want it to be solely available on Apple devices, and I certainly wouldn't support a company being congratulated for providing a medical service at an incredible cost.
- jpttsn 10y ago
  > even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying What a curious set of priorities.
- tracker1 10y ago
  Not a gimmick at all... if I could track my blood sugar in even 5 minute intervals, it would be nice to know, and help a lot. As it is, I'm LADA, which has aspects of type 1 and 2, and my body is also very adept with gluconeogenesis... even if I have nearly no carbs (no refined sugars, no bread/pasta, minimal overall intake) for a few days, my blood sugar can start spinning out. It's about keeping things as level as possible. Also, genetic therapy could be amazing... but it's still, afaik a very long way off.
  - ivanbakel 10y ago
    I was referring to the Watch itself as a gimmick, which I think it currently is.
semi-extrinsic 10y ago
We already have automated continuous insulin injection pumps that work well. It's a big improvement over shots every few hours. But they still need manual setting of pump rate, based on manual periodic measurements. A noninvasive sensor that measures blood glucose accurately, even just once a minute, would give you the ability to close the feedback loop and remove all human input from the system. No "oh shit I forgot to measure and adjust". Especially for kids it would be a big breakthrough. In essence, you'd have an almost-perfect artificial pancreas.
- jcims 10y ago
  Medtronic released the first closed loop pump this year.
  - zaroth 10y ago
    I'd say closed loop ish system. It uses the CGM data to make temp-basal adjustments. It's not like a full autopilot or anything. Since modern fast acting insulin still takes time to kick in, you need to dose to cover carbs about 15 minutes before eating. So there will always be some level of involvement of you want to avoid actually going high and then coming back down (proactive vs reactive). Don't get me wrong, it's great to know you're going to wake up at your target even if you screwed up your dinner-time bolus a bit. That is, assuming the CGM is functioning properly. My experience with the Dexcom G4 with my kids was much less than stellar. Lots of '???' readings or having it off by over 50 points, extremely painful insertions and being mostly useless the first 24 hours and then sensors failing long before 7 days was the norm and ultimately we abandoned it. Anxiously waiting for the auto-inserting CGM to come out of trials.
    - coldpie 10y ago
      That's too bad. I got my Dexcom about 18 months ago and while it's not perfect and very expensive, I really do miss it if I have to go a week without it. I can imagine having to use it on children would be pretty nasty, though. Putting the sensor in is not a fun time for a grown adult. You have multiple kids with T1D? That's a stroke of bad luck :(
llccbb 10y ago
I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of __treating__ diabetes is technology that helps maintain excellent blood glucose control. Diabetes Mellitus (T1) is not a curable disease right now except through pancreas transplants. Diabetes is therefore a disease that has to be treated. The treatment for diabetes is personal, non-uniform, active, and adaptive. Every ingestion of food or liquid affects your body and needs to be considered. Diabetes is a disease that needs its symptoms to be monitored and managed at a high granularity. Both monitoring and managing blood glucose can be really invasive though, with needles and finger-sticks causing extensive scar tissue development. Minimally invasive glucose monitoring technology that generates high-resolution time series data (such as Dexcom systems) literally transforms the way that people can manage their disease. Going from glucose reading every 6 hours (test strips) to every 5 minutes (CGM) is life changing. Monitoring that is non-invasive is the next technological step. The holy grail for treating diabetes should actually be stabilized monomeric human insulin. Afrezza[0] is exactly that, and inhalable no less. The company that makes it just can't break through the insulin cartels and insurance-pharma exclusivity, so they are having a hard time. They did what was unachievable for 100 years though, and they are amazing chemists. [0] https://www.afrezza.com/hcp/afrezza-action-profile/ https://www.afrezza.com/hcp/afrezza-action-profile/
- zaroth 10y ago
  I'm not sure inhalable is a feature. Insulin pumps/pods micro-dose fast acting insulin throughout the day to cover your basal dose, you can't do that with fast-acting insulin via inhaler. You can't close loop your inhaler with a CGM to adjust your basal based on your current BG and automatically control for overnight highs/lows. You can't dose your kid from across the room from your smartphone. Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...
  - llccbb 10y ago
    I think alternative delivery mechanisms to injection are a feature. Ask any diabetic if they would like less needles in their bodies. There is work and patents on adjustable dose inhaler systems, but its never going to be a basal insulin that is being delivered. It's prandial. The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers. I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.
jk2323 10y ago
It is not about "ubiquitous sensors", it is about non-invasive. A good starting point would be: http://www.mendosa.com/The%20Pursuit%20of%20Noninvsive%20Glucose,%20Fourth%20Edition.pdf http://www.mendosa.com/The%20Pursuit%20of%20Noninvsive%20Glu... Would be very interested in the email of Johny Srouji.
vfuse 10y ago
Research by doctors such as Bart Roep at the City of Hope is the holy grail. Sensors like this already exists like the Freestyle Libre by Abbott.
abarringer 10y ago
Clearly you don't have diabetes. Everyone responds differently to the same inputs. My BG spikes hundreds of points if I eat a banana. It drops 50pts an hour when sitting in intense sun. Make sense? No.. is it repeatable, for me, yes. Would ubiquitous sensors help me identify more of these patterns? Absolutely.

I don't understand how having ubiquitous sensors is the "holy grail for treating diabetes."

by leoh 10y ago

I don't understand how having ubiquitous sensors is the "holy grail for treating diabetes."

Seriously. You'd think genetic therapy, or even just a sensor-injector automatic combo (which to my knowledge already exist) might be more worthy of the title. But then, it's evident that the article is giving Apple too much credit already - even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying.

MBCook 10y ago
You don't think an Apple Watch (which starts at about $350) which could monitor your glucose more or less continuously would be far more preferable to a huge chunk of people then occasionally sticking themes with a lance and then trying to record the reading of a portable meter they have to carry around? Don't forget you have to buy the little strips. Let's ignore the idea of insurance paying for this or any other kind of help. I imagine the Apple Watch would end up paying for itself for a type one diabetic within what, a year or two? I know those little testing strips aren't cheap. But the Apple Watch would give you much better monitoring, no pain, no testing, far more data… Oh yeah and every feature that the people who already have an Apple Watch like. As others have mentioned in this thread, I'm sure it's INCREDIBLY easy to get small children to test their blood glucose when necessary. I imagine this would easily be worth it to a lot of parents as well.
- ivanbakel 10y ago
  I think the technology would be better put to use on something other than the Apple Watch, unless an equivalent sensor minus Apple's other contributions also somehow starts at $350. You're conflating the sensor with an overpriced and rather useless piece of technology, which I say as the owner of one. I'm in full support of a non-invasive sensor for diabetics, but if we manage to come up with one, I would be against giving it an Apple price tag.
  - MBCook 10y ago
    Apple could invent this an then license the sensor to other people. They gave away health kit. And they could choose not to license it to their competitors, only medical companies. But surely they'd put it on their own devices as well. Seems like a weird attitude though: If company X can afford to (possibly waste) billions of dollars to make a medical breakthrough in Y, I don't want them to because then they'd use it themselves and charge money.
    - ivanbakel 10y ago
      Where did I say that I don't want Apple to pursue this research? I just said that I don't want it to be solely available on Apple devices, and I certainly wouldn't support a company being congratulated for providing a medical service at an incredible cost.
jpttsn 10y ago
> even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying What a curious set of priorities.
tracker1 10y ago
Not a gimmick at all... if I could track my blood sugar in even 5 minute intervals, it would be nice to know, and help a lot. As it is, I'm LADA, which has aspects of type 1 and 2, and my body is also very adept with gluconeogenesis... even if I have nearly no carbs (no refined sugars, no bread/pasta, minimal overall intake) for a few days, my blood sugar can start spinning out. It's about keeping things as level as possible. Also, genetic therapy could be amazing... but it's still, afaik a very long way off.
- ivanbakel 10y ago
  I was referring to the Watch itself as a gimmick, which I think it currently is.

semi-extrinsic 10y ago

We already have automated continuous insulin injection pumps that work well. It's a big improvement over shots every few hours. But they still need manual setting of pump rate, based on manual periodic measurements. A noninvasive sensor that measures blood glucose accurately, even just once a minute, would give you the ability to close the feedback loop and remove all human input from the system. No "oh shit I forgot to measure and adjust". Especially for kids it would be a big breakthrough. In essence, you'd have an almost-perfect artificial pancreas.

jcims 10y ago
Medtronic released the first closed loop pump this year.
- zaroth 10y ago
  I'd say closed loop ish system. It uses the CGM data to make temp-basal adjustments. It's not like a full autopilot or anything. Since modern fast acting insulin still takes time to kick in, you need to dose to cover carbs about 15 minutes before eating. So there will always be some level of involvement of you want to avoid actually going high and then coming back down (proactive vs reactive). Don't get me wrong, it's great to know you're going to wake up at your target even if you screwed up your dinner-time bolus a bit. That is, assuming the CGM is functioning properly. My experience with the Dexcom G4 with my kids was much less than stellar. Lots of '???' readings or having it off by over 50 points, extremely painful insertions and being mostly useless the first 24 hours and then sensors failing long before 7 days was the norm and ultimately we abandoned it. Anxiously waiting for the auto-inserting CGM to come out of trials.
  - coldpie 10y ago
    That's too bad. I got my Dexcom about 18 months ago and while it's not perfect and very expensive, I really do miss it if I have to go a week without it. I can imagine having to use it on children would be pretty nasty, though. Putting the sensor in is not a fun time for a grown adult. You have multiple kids with T1D? That's a stroke of bad luck :(

llccbb 10y ago

I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of __treating__ diabetes is technology that helps maintain excellent blood glucose control. Diabetes Mellitus (T1) is not a curable disease right now except through pancreas transplants. Diabetes is therefore a disease that has to be treated. The treatment for diabetes is personal, non-uniform, active, and adaptive. Every ingestion of food or liquid affects your body and needs to be considered. Diabetes is a disease that needs its symptoms to be monitored and managed at a high granularity. Both monitoring and managing blood glucose can be really invasive though, with needles and finger-sticks causing extensive scar tissue development. Minimally invasive glucose monitoring technology that generates high-resolution time series data (such as Dexcom systems) literally transforms the way that people can manage their disease. Going from glucose reading every 6 hours (test strips) to every 5 minutes (CGM) is life changing. Monitoring that is non-invasive is the next technological step. The holy grail for treating diabetes should actually be stabilized monomeric human insulin. Afrezza[0] is exactly that, and inhalable no less. The company that makes it just can't break through the insulin cartels and insurance-pharma exclusivity, so they are having a hard time. They did what was unachievable for 100 years though, and they are amazing chemists. [0] https://www.afrezza.com/hcp/afrezza-action-profile/ https://www.afrezza.com/hcp/afrezza-action-profile/

zaroth 10y ago
I'm not sure inhalable is a feature. Insulin pumps/pods micro-dose fast acting insulin throughout the day to cover your basal dose, you can't do that with fast-acting insulin via inhaler. You can't close loop your inhaler with a CGM to adjust your basal based on your current BG and automatically control for overnight highs/lows. You can't dose your kid from across the room from your smartphone. Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...
- llccbb 10y ago
  I think alternative delivery mechanisms to injection are a feature. Ask any diabetic if they would like less needles in their bodies. There is work and patents on adjustable dose inhaler systems, but its never going to be a basal insulin that is being delivered. It's prandial. The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers. I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.

jk2323 10y ago

It is not about "ubiquitous sensors", it is about non-invasive. A good starting point would be: http://www.mendosa.com/The%20Pursuit%20of%20Noninvsive%20Glucose,%20Fourth%20Edition.pdf http://www.mendosa.com/The%20Pursuit%20of%20Noninvsive%20Glu... Would be very interested in the email of Johny Srouji.

vfuse 10y ago

Research by doctors such as Bart Roep at the City of Hope is the holy grail. Sensors like this already exists like the Freestyle Libre by Abbott.

abarringer 10y ago

Clearly you don't have diabetes. Everyone responds differently to the same inputs. My BG spikes hundreds of points if I eat a banana. It drops 50pts an hour when sitting in intense sun. Make sense? No.. is it repeatable, for me, yes. Would ubiquitous sensors help me identify more of these patterns? Absolutely.