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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

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.

gabrielgoh 9y ago
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)?
emdowling 9y ago
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.
- cperciva 9y ago
  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.
  - emdowling 9y ago
    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.
ollysb 9y ago
> 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.
- cperciva 9y ago
  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.
  - ollysb 9y ago
    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).
zurn 9y ago
An effective population-level way to address type 2 diabetes could be dietary feedback from glucose levels, for pre-diabetic people.
cpwright 9y ago
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.
super_mario 9y ago
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.
lj3 9y ago
> 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.

gabrielgoh 9y ago

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)?

emdowling 9y ago

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.

cperciva 9y ago
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.
- emdowling 9y ago
  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.

ollysb 9y ago

> 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.

cperciva 9y ago
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.
- ollysb 9y ago
  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).

zurn 9y ago

An effective population-level way to address type 2 diabetes could be dietary feedback from glucose levels, for pre-diabetic people.

cpwright 9y ago

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.

super_mario 9y ago

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.

lj3 9y ago

> 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.