Advances in Diabetes Care Apple-style
I think we all understand Apple-style at this point. The company drops a product, the buzz explodes, and after the dust cloud settles we often realize that, yes, our lives and the computing landscape around us have indeed been irrevocably changed.
But what about Apple and type 1 diabetes (T1D)?
Let’s start with the deep past. Ten years ago, Amy Tenderich, diabetes advocate and founder of DiabetesMine, wrote an essay called “An Open Letter to Steve Jobs.” IPod sales had recently reached the 100 million mark, and the essay, which went viral, called on Jobs to apply the same technological innovation and brilliance to the design of cutting edge diabetes-care devices. Her thrust: let’s save lives and have convenient access to our music libraries at the same time.
Evidence is emerging that Jobs, who died in 2011, listened.
Last spring Apple CEO Tim Cook was seen wearing a mysterious Apple Watch tied to a prototype glucose tracker. Rumors about Apple cracking the “holy grail” of diabetes management: a noninvasive continuous glucose monitor (CGM) system that did not require breaking the skin with a needle sensor or wire began to stir. Around the same time, news reports confirmed that Apple had hired a secret team of scientists and was indeed working on such a project.
The here and now
This summer Apple announced a fall update to its Health app incorporating the ability to track insulin delivery doses. The update, which is available in the recently released iOS 11 software, includes both basal and bolus insulin delivery tracking. Simply open Health, go to Health Data, click on results, and then insulin to enter data.
In the past, Apple Health allowed users to collect diabetes-related information ranging from blood glucose levels, to carb intake, to general activity data. Data was often gathered by secondary health apps and then coded over to Apple Health. Once the data was centralized in Apple Health, diabetes care apps could then scan the compiled information, tying together a complete diabetes-related health profile.
Apple Health essentially acts as a catch all for your tracked and entered health data, providing a central source database. Without it, tech companies and app developers would have to navigate the difficult web of data sharing, which is loaded with contractual hassles. For instance, your food-tracking app would have to agree to share with your exercise-tracking app, which may be designed and owned by a potential competitor. See the risk and the headaches here? The solution has become sharing to Apple Health, which all apps functioning on the Apple operating system essentially have to consent to.
Insulin data, however, a critical element of the diabetes care equation, was the missing component in the Apple Health picture. But app-to-app sharing of insulin data is now possible and easy with Apple Health support.
But what’s the next step?
A CGM system without a wire or a needle. Think about that for a moment. Imagine not having to break your skin in any way. Imagine not having to replace a sensor every few days. Imagine having continuous and uninterrupted blood glucose readings through a wearable device that sits entirely on top of the skin. Imagine an optical sensor that sends light down through your skin and reads blood sugar levels (this is the model Apple is purportedly working on). For years, life science companies have been trying to make that dream a reality. It appears that Steve Jobs had the same vision years ago, and ultimately it appears that Apple is the tech giant closest to making the impossible possible and cashing in. After all, in addition to being a life-changing piece of diabetes tech, such a CGM system stands to make a fortune and dominate the market.
Apple currently partners with the Dexcom G5 CGM system via a mobile app that shares CGM data to a users phone or tablet. Furthermore, the next iteration of Dexcom’s CLARITY app is slated to be capable of transmitting CGM data directly to a user’s Apple Watch via Bluetooth even when one’s iPhone is out of range, freeing a user from having to be tethered to their phone to get their blood glucose levels (BGLs).
That’s a solid technological development in CGM land, but back to this “holy grail.” In 2010, Apple acquired the company Cor, honing in on the development of sensor technologies. Since then they have been quietly working for more than five years on an Apple-based non-invasive CGM system linked to a wearable device.
In April it was reported that Apple had hired a small team of biomedical engineers. The scientists were working at a fairly ordinary office in Palo Alto, California, a few miles from Apple headquarters. Their mission was secret, crucial and directly in line with what Steve Jobs had envisioned years before. They had been charged with developing the elusive non-invasive sensor system to continuously monitor blood sugar levels on a wearable Apple device.
The company’s CGM initiative is far enough along that feasibility trials are being conducted at clinical sites across the Bay Area. Consultants have been hired to navigate regulatory pathways. And then there’s Tim Cook, who has been showing up here and there wearing his mysterious prototype blood glucose tracker.
In 2001 Apple released the iPod and changed how we listen to music. In 2003 the iTunes store opened and changed how we purchase that music and other media. In 2007 Apple released the iPhone, and the landscape of mobile phones and mobile computing was forever changed. It remains to be seen if, when and how the company changes the landscape of diabetes care and patient convenience, but they appear to be close.