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Glucose Sensing Likely Too Challenging to Include in First-Generation iWatch

Apple's iWatch has been rumored to include a glucose monitoring feature, but how that feature would be implemented is still unknown. One report from earlier this month indicated that a "Healthbook" app under development for iOS 8 will be able "to read glucose-related data," while another report has warned not to expect glucose sensing built directly into the initial iWatch. The two reports are not necessarily conflicting given the possibility of Healthbook interfacing somehow with third-party glucose-monitoring devices, but a new report from Network World argues that the technology is indeed too early in its development to be incorporated into a mainstream consumer device such as the iWatch.

Heisler points to C8 Mediasensors and its non-invasive continuous glucose monitoring (CGM) device, the HG1-c, as an example of how this technology is still in its infancy. It's a relevant example as Apple has hired several research scientists and engineers from the now defunct company and is presumably using their knowledge to explore bringing CGM to the iWatch.

The HG1-c device relied on Raman spectroscopy to indirectly measure a person's blood glucose level. This technique shines light through the skin in order to excite blood glucose molecules and cause them to vibrate. An optic sensor then analyzes the amount of light reflected off these vibrating molecules and returns a reading that is used to calculate an approximate glucose level.

hg1-c
Though innovative, the technology has flaws that make it impractical for a wrist-worn device. The sensor unit was attached to a belt that was worn around the waist and required a large battery pack to operate. It also needed a gel to accurately measure light levels, which were influenced by ambient sunlight. This sunlight sensitivity was highlighted by former C8 employee Charles Martin, who spoke to Network World.
Yes, the camera sensor had to be shrouded in darkness to function. You have to understand that Raman Spectroscopy is looking for a very faint signal emitted by the glucose molecules. A rough analogy: try to pick out someone's voice in a noisy room. The sunlight was this kind of noise that the camera sensor was not calibrated against. They did try to implement algorithms to discount measurements against sunlight anomalies, but some of the anomaly criteria these algorithms were supposed to detect, overlapped. This made things hard to verify and test on the device.
Apple likely can overcome many of these limitations, but it will take time to transform the technology to the point where it is reliable enough to be used as a diagnostic or monitoring device. Once Apple improves the technology, it will need to receive FDA approval, which is a painstaking process with extensive clinical trials and documentation.

If Apple goes down this route, it could take up to 18 months just to receive approval necessary to sell the device. Given this lengthy approval process and the fact that evidence of Apple earnestly assembling its iWatch biometric research team only started surfacing around early 2013, Heisler believes "the notion that this feature will appear in the first iteration of the device is highly improbable."

Instead of measuring glucose levels, the iWatch may allow users to monitor glucose levels by importing them from a glucose monitoring device or by manually entering them into the accompanying Healthbook app for iOS. Apple is rumored to be working on the health and fitness app, which uses a card-based interface to track vital health statistics such as heart rate, weight and step count.

Related roundup: iWatch

Top Rated Comments

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21 weeks ago
This thing is beginning to sound more and more like the Galaxy S 4. All I'm reading about are a bunch of functions that maybe 5% of the population will actually care to use on a regular basis.

This whole iWatch thing is BS. Just make a wider iPhone and put out an iOS version that doesn't crash my iPad and let's move on.
Rating: 10 Votes
21 weeks ago
They should just invent some kind of implantable iDevice and be done with it.
Rating: 4 Votes
21 weeks ago
Interesting territory as it would potentially open them up to medical liability. Tread lightly.
Rating: 4 Votes
21 weeks ago
The more I read about this thing, the less I want one. The endless messages my iPhone pops up are bad enough. Can you imagine getting this sort of thing each day?

Hello. It appears you are in or near a restaurant. You should stop eating, you are obese.
Hello. I predict you are about to have heart attack.
Hello. You have entered 60 minutes of swimming exercise this afternoon but my location records show you have been to a pub 4.7 miles from the nearest swimming pool. This message has been sent to all your iOS devices, including your wife's.
Hello Barman. It appears Tom has just asked you for an alcoholic beverage. I do not think you should serve this man. He is 3 alcohol units above his weekly total.
Hello. It appears you need an insulin injection. I think.
Hello. You have been in the pub and movements of your body suggest you may be driving. As you did not tick the "do not grass me up box" this information and your location have been sent to the police.
Hello. It appears you are running. Here are three sports shops near you now.
Hello. Are you in a restaurant? Computing your requirements... You should order lettuce soup, half a cucumber, a cup of lavender tea and, as a treat, 0.0435 g of dark chocolate. Enjoy your meal.
Hello. During your meal you have moved your hand towards your mouth four times. You have either left some food or are putting too much on your fork. Did you know this can lead to an average lifespan reduction of 0.000000687676 days?

No thank you. Not for me.
Rating: 4 Votes
21 weeks ago
If only Apple had experience shrinking down bulky technology...



;)
Rating: 4 Votes
21 weeks ago
Any device that measured glucose levels would have to get government approvals in any country that it was sold in. There are also different units of measurement used, depending on the country you're in. Think metric vs. non-metric. Recent law changes required that glucometers must be hard coded to the units used in the selling country. This would mean different SKU's.

You're in an entirely new world when you've got a device that could make a person take potentially fatal actions - taking insulin or not. Potentially a huge, huge liability for Apple should somebody die.

Non-invasive glucose monitoring has a lot of hurdles to get through before it'd be reliable.

As a diabetic myself, this could be useful but I'm not holding my breath.
Rating: 3 Votes
21 weeks ago
That dude looks comfortable.
Rating: 3 Votes
21 weeks ago
If I recall, a few months ago Apple applied for a patent for a wrist glucose monitoring device. The market is not people with diabetes who need very accurate glucose levels, but people who want to avoid becoming diabetic. For the later, simple glucose range indicators is enough. One would primarily eat less sugar containing foods to change it.
Rating: 2 Votes
21 weeks ago

Any device that measured glucose levels would have to get government approvals in any country that it was sold in. There are also different units of measurement used, depending on the country you're in. Think metric vs. non-metric. Recent law changes required that glucometers must be hard coded to the units used in the selling country. This would mean different SKU's.

You're in an entirely new world when you've got a device that could make a person take potentially fatal actions - taking insulin or not. Potentially a huge, huge liability for Apple should somebody die.

Non-invasive glucose monitoring has a lot of hurdles to get through before it'd be reliable.

As a diabetic myself, this could be useful but I'm not holding my breath.


Even if not diagnostically accurate, if the 'false negatives' are within clinical norms (It may overreact, but rarely under react), it may be a good first step for early warning.... (read: all use procedures will read "prior to action, confirm your BGL with your FDA approved and MD prescribed device").

But in general, it will take at least one generation of 'wearable' BGM (noninvasive) with FDA approval to drive this down into the 'general computing platform' (which the iWatch is).

Until then, if Apple can deliver an App platform for analysis/communications (reliable BT and notifications, and alerting), then I see them building the framework for that, and inviting 3rd Party Med device makers build the device and the app for the iOS platform. And stay out of the FDA fray, and just design the iWatch for 'non-diagnostic, advisory' purposes.'

Why is that? Because if insurance pays for the monitoring, and the payment of the monitoring is through your AppleID, That's like printing money without the risk (a $19.99 app and then say $5/month to remotely monitor equals 25 bucks the first year, and 18 bucks a year after that... multiply by... a couple billion people who either have chronic HyT, Cardiac, or endocrine issues that would reduce net costs if monitored properly continually).

That's why the device is less important ,and the transport (which from an FDA/HIPAA perspective is a lot simpler to standardize,even across regulatory geographies), is easier to build out.

This all goes to the end game model of Apple building the appliance that you have, and building the infrastructure for others to ride on (AppleID, App Store, TouchID/security, Passbook (think HSA cards or Insurance accounts as payment for this)).

Whether it be a picture of a skin lesion on your leg you want to send to your Derm MD (saving a 1/2 day drive and part of $130 office visit to be told it's a benign keratosi), or an upload of your sleep pattern to your sleep apnea tech to verify adjustments to your CPAP, or your week's history of BP to your Cardiologist for checking the dosing of a new med, all of this will require a secure data transport.

Apple is in the lead on this, as they control the hardware and the encryption/transport (hence the TLS bug being so bad)... few others have that, and none at the scale. And Apple's model of 1 to 4 new devices a year, makes FDA validation of applications a lot easier (Validated systems are a pain. validating on 300 android devices would be impossible... 2 iPad and 2 iPhone devices and 1 new major OS, Not so much), makes them an early leader in 'consumer grade' diagnostic apps.

And Apple, like BioTechs and Pharma, are comfortable with the long view. Let the technology mature... and any promising great tech can be acquired-bought-into early (BioTech is almost all based on M&A cashouts), and implemented when the medical world is ready. Remember, your MD has to accept both the technology, and the new diagnostic paradigm of continuous outpatient monitoring - most MDs can't handle 'big data' - it will take a generation of research, follow-up, and then med school curriculum upgrades adopting these as 'promising new technologies' before MDs (and more imporantly in the US, Insurance companies) start modifying their practice to encorporate them into their diagnostic/pricing model.
Rating: 2 Votes
21 weeks ago

Do you own a bathroom scale? Or do you believe that scales are some sort of weird fancy item only of interest to a few specialized people?
How about a toothbrush? You're willing to brush your teeth everyday, or you think that's too much effort, and the cost of those brushes and toothpaste really adds up.

Look, I know there's a certain type of (rather despicable) human that loves to look down on their fellow countrymen as no better than animals (basically the Nazi view of the world) but try to have a grain of intelligence here. The number of people who truly don't give a damn about their health is a very small percentage of the population.

So the issue is not "Do I care?" (as compared to selling a device that gives you immediate updates of the price of cocoa in Cameroon, something that truly IS a specialized market). The issue is --- is the benefit worth the cost?

Wow...just wow.
You manged to change my observation that most people don't pay much attention about their health into my being an obese Nazi that never brushes his teeth. That's just...wow.

The point that you seem to have missed is that most people DON'T care. Oh they might get on the scale once in a while. They likely do brush their teeth and wipe their own @$$, but just look at the number of smokers, the obesity epidemic, the number of people hurt in stupid preventible accidents, there's a hundred metrics out there that show that in fact most people don't think that far down the road. They give little more than lip service to the state of their health. They may say they care but if they did salad cafe's would outnumber burger joints.

And on your last point I know of far more people that are interested in the value of, maybe not Cocoa, but gold, oil, and the spot price of the US$ vs the Yen and Euro, than those that stand on a scale every single day. I know of far more that monitor the situation in Ukraine than wonder regularly about their cholesterol or blood pressure.

I might be wrong, but I just don't think there's a huge mass market for a health monitor. Unless the "iWatch" does a lot more than nag you about your vital statistics, I don't see it having much appeal. And Apple is all about mass appeal. They want to sell millions of whatever personal device they make.
Rating: 1 Votes

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