Headline aside, it sounds like the real news is just how difficult this problem is - even for Apple. Back in 2020-2021, the rumor was that a Watch might include Rockley glucose monitoring[1], possibly in 2022-2024. If this article is correct, Apple is nowhere near that:
> Apple’s system — more than 12 years in the making — is now considered to be at a proof-of-concept stage, said the people, who asked not to be identified because the project is confidential. The company believes the technology is viable but needs to be shrunk down to a more practical size.
> Engineers are working to develop a prototype device about the size of an iPhone that can be strapped to a person’s bicep. That would be a significant reduction from an early version of the system that sat atop a table.
…
> Before shifting to TSMC, Apple had worked with Rockley Photonics Holdings Ltd. to develop the sensors and chip for the technology. In 2021, Rockley publicly disclosed its work with Apple, stoking interest in the supplier. Apple later ended the partnership, and Rockley filed for bankruptcy last month.
> it sounds like the real news is just how difficult this problem is - even for Apple
I've worked in this space for 5 years now, and this is not news to any of us. Today, a tiny, noninvasive device, that is accurate enough to make insulin dosing decisions, is pure science fiction. It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
What is interesting about this though is the possibility of using this device for non-diabetics who don't need extremely accurate glucose readings. A rough approximation of someone's blood glucose levels is enough to learn how your body reacts to different types of foods and exercise, and would be helpful for amateur athletes who can't afford to purchase real continuous glucose monitors, as well as pre-diabetics for whom CGMs aren't covered by insurance.
I'm fascinated by the fact that this seems incredibly hard, yet not so impossible that Apple is trying.
Is there an ELI5 of the basic principle of how it would work (or at least the direction being pursued), and what the main obstacle is, and why we think we'll be able to overcome it to some degree?
Besides athletes, I can't help but think it could be a huge step forwards for weight loss as well. I'm aware of the concept (for non-diabetics) of only eating once your blood sugar is below a certain level, and never eating so much that it goes over a certain higher level.
> I've worked in this space for 5 years now, and this is not news to any of us.
The reason it's your comment I'm replying to is because you indicate you actually worked in this field.
Whenever these discussions surrounding noninvasive monitoring of blood solute concentrations come up I keep wondering why anyone is surprised taking a hard route is hard, and why there seems little attention to seeking easier routes of noninvasive optical sensing.
Please do shoot my comment if it is nonsensical, so that I can stop caring next time I read such a discussion, but I would like a mechanistic explanation why the lips wouldn't be easier.
From an a priori perspective, it would certainly be desirable to have any type of noninvasive monitoring in the form factor of a watch. There is nothing wrong with dreams or hope. Yet to me it sounds like a dream was interpreted too literally: starting from some hypothetical dreamer exclaiming "imagine testing concentration X or Y, but noninvasively! sure wearing a device would may come with some inconveniences, but if the advantages outweigh the inconveniences, it would find a niche" and "after all people have been wearing watches too".
An idea that started as an analogy: just like a personal wearable watch had advantages compared to an immobile pendulum clock, perhaps we can devise the analogous personal wearable device that performs the duties of some large inconvenient measuring setup, workflow, discipline,....
I can't shake the feeling that the analogy has been taken too literally, as if the original dream insists the blood glucose meter has to be integrated into the watch and located on the same or similar place on the body...
Blood is red.
Lips are red.
The color of the lips is the color of the blood.
Acknowledging the inconvenience of mounting a device or perhaps an optical fiber to your lips, it may constitute a more tractable milestone.
What is the reason all the 'failed' startups avoid the lips and make life hard on themselves by choosing to do spectroscopy (in the widest sense: plain, Raman, ...) through the highly variable noisy medium of skin (different pigmentations by genetics, different pigmentations by varying exposure to sun within an identical individual, different states of skin like sweating, the intinsic noise incurred by imaging through a robustly thick layer of skin, scattering like mist, ...).
It almost looks like attempting an artificially troubling tour de fource, akin to painting a masterpiece... with your toes. I think its possible eventually, fundamentally speaking, but it doesn't sound like a wise choice to make, at least not initially.
(I wrote failed in quotes, because in reality after bankruptcy IP is transferred, experience was gained by employees, some of which end up at different companies in the same space, others end up in new disciplines where they gain a new applicable insight that nobody previously connected to blood glucose monitoring, etc...)
Then there's the social issue of the first iterations of the tools potentially working better for less pigmented skin...
> It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases ...
I have some serious question marks surrounding the near-term viability of stem cell regrown organs.
As an unethical thought experiment consider freshly born twins, and removing their pancreas and putting each in a chamber where you would otherwise grow the artificial pancreas. How fast would you notice harmful levels of sugar purely from observation of the kept-alive pancreas? (without cheating and using knowledge of healthy blood sugar levels). If it would take many many experiments or very long durations to detect these problems (for glucose or otherwise), then one doesn't really have the engineering confidence of how long it would last, what the side effects are, ... i.e. blanket statements that stem cell derived organs will arrive earlier than affordable democratized noninvasive sensing could be true, could be false, but isn't proven by a blanket statement. The burden of proof doesn't lay with the reader.
> ... and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
Which type of diabetes?
Type 1:
The root of the problem is an unsuitable autoimmune response, during V(D)J the immune system rolls the dice to construct a generator of randomly chosen but from then on specific antibody. Due to natural selection library of segments for V(D)J recombination has a strong bias for resulting in antibodies that match foreign pathogens and potentially endogenous cancers while simultaneously also having a strong bias for not matching normal endogenous or symbiotic features. So usually nothing goes wrong.
We all carry a different but similar library of segments for V(D)J, so our immune systems display slightly different statistics for expressing antibodies.
Imagine an individual has the flu and its immune system ramps up the production rate of new generators of antibodies, each generator corresponding with a randomly chosen but from then on fixed type of antibody, usually safe but not guaranteed. Perhaps this individual has bad luck and besides generating suitable antibodes for the flu, it has also generated a low probability antibody that happens to attack the pancreas. Over time the pancreas starts to degrade and fail. The person now has type 1 diabetes. The pancreas damage is a symptom, not the cause.
Even if you grow a new pancreas, and replace the damaged one with the freshly grown one, the immune system cells generating the regrettably bad antibodies are not filtered out of the body, so after a while the type 1 diabetes will recur! Your proposal does not straight-up cure diabetes type 1
(how hard or easy does it sound to locate and filter the specific immune system cells that result in the autoimmune disease without also removing those that represent your acquired immunity of diseases the individual was exposed to throughout life? if such a thing were easy, curing HIV would be easy by simple filtration of every last HIV genome from a human body, so it does not sound that easy at all)
I don't think anyone who is in the know would be surprised about that. Noninvasive blood glucose monitoring is a multi billion dollar product, should anyone be able to figure it out at all. It's fiendishly difficult, and quite possibly impossible to do it sufficiently accurately, even more so over long periods of time. C8 MediSensors was trying to do it 10 years ago, but ultimately went under. Even with Apple's budget, it's a herculean task.
You’re underselling it. Measuring blood at millimoles per liter precision through skin on a watch sized device is Theranos-esque physically impossible product-market fit. Tricoder level of science fiction.
Movano plans to ship an Oura-style smart ring this year, but it won’t have the glucose monitor. (One might suspect the “moonshot” glucose RF chip story is meant to keep investors excited through the zero-revenue stage until hopefully the more ordinary smart ring takes off.)
on the contrary, I wouldn't be too surprised to find that this burst of innovation is happening to coincide with a bunch of patents held and buried by big pharma coming near their expiration period.
up until now there has been zero financial incentive for stakeholders to promote a method of blood glucose measurement which bypasses the need for consumables, and every incentive to prevent such a solution.
You can’t bury patents, a patent is a public record. That’s the whole point of patents: an incentive to disclose your invention.
If we knew how to do this, but valid patents blocked the broader commercialization of it, then we would not be reading stories about breakthroughs in basic implementations. We’d be reading stories about how companies have products ready to go once the countdown timer hits zero.
This isn't a 3d-printing type problem where the problem was basically solved twenty years ago but locked behind patent protection. It's really an incredibly hard problem. C8 sold a battery-powered miniaturized Raman spectrometer that strapped to your belly about a decade ago. It was a technological tour de force, but it went under. Battery tech is better, but we're just waiting for some particularly clever team to figure out a different optical stack that is small enough to wear comfortably, delivers enough power to be effective, and is robust enough to wear 24 hours a day.
It's interesting you mention that because Abbott (maker of the Freestyle sensor) is trying to hire like crazy for a project named Lingo. It's pretty much the same technology that will be offered to non-diabetics to offer health monitoring via blood chemistry.
Granted, at least they make progress and have actually health products. I had a colleague who left UCSF to work for Verily....we were all quite impressed at the time. But now, I realize I haven't heard heads or tails from him for 4-5 years now...
I'm sure if it were easy the medical world would have done it ages ago. There's a huge market for this kind of device and medical markups are even more royal than Apple's.
A breakthrough would be well welcome, but I would stress for everyone who reads any potential news about non invasive blood glucose monitoring from a small wearable to be very skeptical. It is an extremely difficult task, one which numerous startups have attempted and failed using Apple's approach of optical absorption spectroscopy. I'd wish anyone working on the project the best of luck, as it would be truly ground breaking if it could work, but I fear that it will take many, many, more years if it's even possible to do so with any real reliability.
Are you familiar with Loop? I believe they are currently just intercepting the Dexcom notifications rather than connecting directly over BLE by default for the G6/G7. However the xDrip + xDrip4iOS projects have gotten the G5/G6 BLE protocol to a state of being fairly well understood.
Out of curiosity, why do that? The Dexcom app already has the ability to generate detailed logs that you can just email to yourself. It’s actually a very handy feature.
There is an entire open-source ecosystem around having direct access to your diabetes data, which predates the commercial availability of things like sharing glucose data live with others. The Nightscout Foundation (https://en.wikipedia.org/wiki/Nightscout) and Tidepool (https://www.tidepool.org/about) are two nonprofit organizations who lead development on open-source products (Nightscout and Tidepool, respectively) which help with this.
While the manufacturer-provided ecosystems function okay, they give you limited data mobility in case you switched to a different diabetes-related product like a CGM or insulin pump. They also introduce a dependency on on a cloud SaaS platform managed by said manufacturer, which can impose limitations, such as not allowing for real-time access to your data (Dexcom requires an approval process to get real-time data from their API: https://www.dexcom.com/webapi) and can have uncertain reliability (Dexcom had a notable outage in 2019, for instance: https://www.wsj.com/articles/diabetes-blood-sugar-data-outag...).
Conversely, you can run a Nightscout server on a Raspberry Pi in your home, or on a cloud server, for yourself and have full access to your data.
Considering that, despite knowing for decades that pulse oximetry gives inaccurate results for people with darker skin, Covid showed us that we still can't/don't properly account for skin pigmentation during treatment[1]... I am not hopeful that they will be able to solve the challenge of measuring something MUCH more difficult and in a consumer format. Then again, Apple Maps shows us they might just release it anyways...
Things like Apple Maps are a special case, where improvement is driven by public exposure. Yes, Apple’s maps were full of errors upon initial release, but improvement was fairly rapid (albeit entirely opaque, unlike a typical open source project).
Today, I find that while Waze does the best driving navigation and Google Maps is unbeatable as a modern yellow pages, Apple Maps is equal to or superior in nearly every other way. It’s walking and public transport modes are, in my experience, consistently superior to anything else.
Especially over the last few years around most of the east coast, for me Apple Maps has become far better than google maps for everything, except reviews. Especially for biking and public transport as you said.
If Apple Maps gives you bad information, you usually can correct the wrong turn you take without too much difficulty.
If glucose monitoring gives you bad information, you could easily lose body parts, die, or other bad outcomes (In the last 10 years, one of my friends died, after apparently having lost several toes in an earlier episode. Another friend was rescued by the police after driving on the highway for several hours in a disoriented state. Both of them were medical professionals and presumably using best practices in their monitoring).
Others have demonstrated optical sensors for blood pressure and blood alcohol content. 24/7 monitoring of HR, Resp., glucose, BP, & alcohol will be interesting.
I worked in this field, or very close to it, for a few years. The issue is that demonstrations are relatively easy, but validation and achieving acceptable performance over the entire range of the human population and entire range of operating conditions is very hard.
Yes, you can build a wearable device that mostly gets your blood pressure right, most of the time. What are you supposed to do with that? It's not a useful product (and the FDA won't let you sell it, for that reason).
If you can't depend on the results, you can't quantify in exactly what way the results are erroneous, and you don't have an enormous volume of clinical data and outcome studies, etc. with your device that allows you to draw clinical conclusions about your results regardless of their errors, you have nothing actually useful.
Readit News
> Apple’s system — more than 12 years in the making — is now considered to be at a proof-of-concept stage, said the people, who asked not to be identified because the project is confidential. The company believes the technology is viable but needs to be shrunk down to a more practical size.
> Engineers are working to develop a prototype device about the size of an iPhone that can be strapped to a person’s bicep. That would be a significant reduction from an early version of the system that sat atop a table.
…
> Before shifting to TSMC, Apple had worked with Rockley Photonics Holdings Ltd. to develop the sensors and chip for the technology. In 2021, Rockley publicly disclosed its work with Apple, stoking interest in the supplier. Apple later ended the partnership, and Rockley filed for bankruptcy last month.
[1]: Related conversations: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
I've worked in this space for 5 years now, and this is not news to any of us. Today, a tiny, noninvasive device, that is accurate enough to make insulin dosing decisions, is pure science fiction. It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
What is interesting about this though is the possibility of using this device for non-diabetics who don't need extremely accurate glucose readings. A rough approximation of someone's blood glucose levels is enough to learn how your body reacts to different types of foods and exercise, and would be helpful for amateur athletes who can't afford to purchase real continuous glucose monitors, as well as pre-diabetics for whom CGMs aren't covered by insurance.
Is there an ELI5 of the basic principle of how it would work (or at least the direction being pursued), and what the main obstacle is, and why we think we'll be able to overcome it to some degree?
Besides athletes, I can't help but think it could be a huge step forwards for weight loss as well. I'm aware of the concept (for non-diabetics) of only eating once your blood sugar is below a certain level, and never eating so much that it goes over a certain higher level.
One potential solve is watch-only for non-diabetics and a more invasive watch + patch solution for those that need high accuracy.
Deleted Comment
The reason it's your comment I'm replying to is because you indicate you actually worked in this field.
Whenever these discussions surrounding noninvasive monitoring of blood solute concentrations come up I keep wondering why anyone is surprised taking a hard route is hard, and why there seems little attention to seeking easier routes of noninvasive optical sensing.
Please do shoot my comment if it is nonsensical, so that I can stop caring next time I read such a discussion, but I would like a mechanistic explanation why the lips wouldn't be easier.
From an a priori perspective, it would certainly be desirable to have any type of noninvasive monitoring in the form factor of a watch. There is nothing wrong with dreams or hope. Yet to me it sounds like a dream was interpreted too literally: starting from some hypothetical dreamer exclaiming "imagine testing concentration X or Y, but noninvasively! sure wearing a device would may come with some inconveniences, but if the advantages outweigh the inconveniences, it would find a niche" and "after all people have been wearing watches too".
An idea that started as an analogy: just like a personal wearable watch had advantages compared to an immobile pendulum clock, perhaps we can devise the analogous personal wearable device that performs the duties of some large inconvenient measuring setup, workflow, discipline,....
I can't shake the feeling that the analogy has been taken too literally, as if the original dream insists the blood glucose meter has to be integrated into the watch and located on the same or similar place on the body...
Blood is red.
Lips are red.
The color of the lips is the color of the blood.
Acknowledging the inconvenience of mounting a device or perhaps an optical fiber to your lips, it may constitute a more tractable milestone.
What is the reason all the 'failed' startups avoid the lips and make life hard on themselves by choosing to do spectroscopy (in the widest sense: plain, Raman, ...) through the highly variable noisy medium of skin (different pigmentations by genetics, different pigmentations by varying exposure to sun within an identical individual, different states of skin like sweating, the intinsic noise incurred by imaging through a robustly thick layer of skin, scattering like mist, ...).
It almost looks like attempting an artificially troubling tour de fource, akin to painting a masterpiece... with your toes. I think its possible eventually, fundamentally speaking, but it doesn't sound like a wise choice to make, at least not initially.
(I wrote failed in quotes, because in reality after bankruptcy IP is transferred, experience was gained by employees, some of which end up at different companies in the same space, others end up in new disciplines where they gain a new applicable insight that nobody previously connected to blood glucose monitoring, etc...)
Then there's the social issue of the first iterations of the tools potentially working better for less pigmented skin...
> It's probably not impossible, but we'll literally be able to use stem cells to regrow human pancreases ...
I have some serious question marks surrounding the near-term viability of stem cell regrown organs.
As an unethical thought experiment consider freshly born twins, and removing their pancreas and putting each in a chamber where you would otherwise grow the artificial pancreas. How fast would you notice harmful levels of sugar purely from observation of the kept-alive pancreas? (without cheating and using knowledge of healthy blood sugar levels). If it would take many many experiments or very long durations to detect these problems (for glucose or otherwise), then one doesn't really have the engineering confidence of how long it would last, what the side effects are, ... i.e. blanket statements that stem cell derived organs will arrive earlier than affordable democratized noninvasive sensing could be true, could be false, but isn't proven by a blanket statement. The burden of proof doesn't lay with the reader.
> ... and straight-up cure people of diabetes before this tech becomes a reality. (We're much further along that path.)
Which type of diabetes?
Type 1:
The root of the problem is an unsuitable autoimmune response, during V(D)J the immune system rolls the dice to construct a generator of randomly chosen but from then on specific antibody. Due to natural selection library of segments for V(D)J recombination has a strong bias for resulting in antibodies that match foreign pathogens and potentially endogenous cancers while simultaneously also having a strong bias for not matching normal endogenous or symbiotic features. So usually nothing goes wrong.
We all carry a different but similar library of segments for V(D)J, so our immune systems display slightly different statistics for expressing antibodies.
Imagine an individual has the flu and its immune system ramps up the production rate of new generators of antibodies, each generator corresponding with a randomly chosen but from then on fixed type of antibody, usually safe but not guaranteed. Perhaps this individual has bad luck and besides generating suitable antibodes for the flu, it has also generated a low probability antibody that happens to attack the pancreas. Over time the pancreas starts to degrade and fail. The person now has type 1 diabetes. The pancreas damage is a symptom, not the cause.
Even if you grow a new pancreas, and replace the damaged one with the freshly grown one, the immune system cells generating the regrettably bad antibodies are not filtered out of the body, so after a while the type 1 diabetes will recur! Your proposal does not straight-up cure diabetes type 1
(how hard or easy does it sound to locate and filter the specific immune system cells that result in the autoimmune disease without also removing those that represent your acquired immunity of diseases the individual was exposed to throughout life? if such a thing were easy, curing HIV would be easy by simple filtration of every last HIV genome from a human body, so it does not sound that easy at all)
https://www.wareable.com/wearable-tech/movano-ceo-on-its-rf-...
Movano plans to ship an Oura-style smart ring this year, but it won’t have the glucose monitor. (One might suspect the “moonshot” glucose RF chip story is meant to keep investors excited through the zero-revenue stage until hopefully the more ordinary smart ring takes off.)
up until now there has been zero financial incentive for stakeholders to promote a method of blood glucose measurement which bypasses the need for consumables, and every incentive to prevent such a solution.
If we knew how to do this, but valid patents blocked the broader commercialization of it, then we would not be reading stories about breakthroughs in basic implementations. We’d be reading stories about how companies have products ready to go once the countdown timer hits zero.
https://www.fiercebiotech.com/medtech/abbott-ceo-ford-unveil...
I did a proof of concept with a Bluetooth scales so this should work. I'll add a README after work:
https://github.com/BrianHenryIE/tweakdexcomg6
While the manufacturer-provided ecosystems function okay, they give you limited data mobility in case you switched to a different diabetes-related product like a CGM or insulin pump. They also introduce a dependency on on a cloud SaaS platform managed by said manufacturer, which can impose limitations, such as not allowing for real-time access to your data (Dexcom requires an approval process to get real-time data from their API: https://www.dexcom.com/webapi) and can have uncertain reliability (Dexcom had a notable outage in 2019, for instance: https://www.wsj.com/articles/diabetes-blood-sugar-data-outag...).
Conversely, you can run a Nightscout server on a Raspberry Pi in your home, or on a cloud server, for yourself and have full access to your data.
[1] - https://hms.harvard.edu/news/skin-tone-pulse-oximetry
Today, I find that while Waze does the best driving navigation and Google Maps is unbeatable as a modern yellow pages, Apple Maps is equal to or superior in nearly every other way. It’s walking and public transport modes are, in my experience, consistently superior to anything else.
Apple Maps has been working entirely fine for me.
For this glucose monitoring the early product that Apple ships will almost certainly be grossly inferior to the product 10-20 years later.
I don't understand why this is a problem.
If glucose monitoring gives you bad information, you could easily lose body parts, die, or other bad outcomes (In the last 10 years, one of my friends died, after apparently having lost several toes in an earlier episode. Another friend was rescued by the police after driving on the highway for several hours in a disoriented state. Both of them were medical professionals and presumably using best practices in their monitoring).
https://www.mdpi.com/1424-8220/21/12/4076
https://www.nature.com/articles/s41598-021-99294-w
Yes, you can build a wearable device that mostly gets your blood pressure right, most of the time. What are you supposed to do with that? It's not a useful product (and the FDA won't let you sell it, for that reason).
If you can't depend on the results, you can't quantify in exactly what way the results are erroneous, and you don't have an enormous volume of clinical data and outcome studies, etc. with your device that allows you to draw clinical conclusions about your results regardless of their errors, you have nothing actually useful.
At the moment every 10days we have to pay $100 for a Dexcom sensor. That is like buying a couple new iPhones a year and just throwing them away.
A non disposable glucose sensor would change the world for all diabetics.
https://aktiia.com/blood-pressure-monitoring-app