by Jean-Louis Gassée

Courtesy: National University of Singapore

Apple appears to be working on blood glucose monitoring as a way to address Type 2 Diabetes.“Stick it in your ear”. Literally.

Not all Apple product rumors are equal. Speculation that the headphone jack will reappear with the iPhone 8 has been rightly ridiculed. But the evidence Apple will introduce a glucose monitoring device is worthy of our interest.

“Glucose monitoring” is a code word for fighting the growing scourge of Type 2 Diabetes. Unlike Type 1 Diabetes, which is unpreventable, the Type 2 variety is, to be polite, a “lifestyle” disease, meaning we eat too much and don’t exercise enough. (As usual, the French are more brutal: for them, Type 2 is Diabète gras, Fat Diabetes).

A 2016 Harvard School of Public Health study places the global cost of Type 2 Diabetes at $825B per year and growing [as always, edits and emphasis mine]:

“… in the last 35 years, global diabetes among men has more than doubled — from 4.3% in 1980 to 9% in 2014 — after adjusting for the effect of aging. Meanwhile diabetes among women has risen from 5% in 1980 to 7.9% in 2014. This rise translates as 422 million adults in the world with diabetes in 2014 — which has nearly quadrupled since 1980 (108 million).”

In theory, there is, of course, an “easy” remedy: Eat less and exercise more…for the rest of your life. A healthy lifestyle adds days to one’s life, and life to one’s days. Easier nagged than done. In reality, a growing percentage of the human population keeps growing.

Enter blood glucose monitoring. Devices that tell you your blood sugar concentration, once the province of the lab, have moved into the home. With just a minuscule drop of blood — as little as .3 microliter — you can get an answer in seconds:

Courtesy: Wikipedia

The subject is immediately alerted to an anomalous rise in blood sugar, a circumstance that could result in limb amputation, blindness, and kidney failure if left untreated. But drawing blood, even in minute quantities, is painful, and pain, or fear of it, limits acceptance.

This leads us back to the rumor that Apple is getting into the blood sugar monitoring business. Let’s return for a moment to Tim Cook at the Startup Fest Europe in May, 2016 (full video here).

“If you think about some of society’s biggest problems and challenges, one of the ones that we are really focused on is health…the health care system can be made much simpler, …that bring out the best in the medical professionals…I think the runway there is enormous.”

More recently (April 12th, 2017), we have a substantial CNBC article that discusses a “supersecret” team of biomedical engineers hiding out in Palo Alto:

“They are part of a super secret initiative, initially envisioned by the late Apple co-founder Steve Jobs, to develop sensors that can noninvasively and continuously monitor blood sugar levels to better treat diabetes, according to three people familiar with the matter. Such a breakthrough would be a “holy grail” for life sciences. Many life sciences companies have tried and failed, as it’s highly challenging to track glucose levels accurately without piercing the skin.”

When he accepted an honorary degree at the University of Glasgow, Apple CEO Tim Cook “admitted” that he wears a glucose monitoring device:

“I’ve been wearing a continuous glucose monitor for a few weeks,” he said. “I just took it off before coming on this trip.”

All of this is positive, “science forward” news…but what are the political and regulatory implications? In a November 2015 interview with the UK’s The Telegraph, Tim Cook explains that he doesn’t want Apple’s Watch to become a medical device that’s subjected to the uncertainties of regulations by government agencies around the world:

“Cook hints that Apple may have more plans for the health sphere […], but he doesn’t want the watch itself to become a regulated, government-licensed health product. “We don’t want to put the watch through the Food and Drug Administration (FDA) process. I wouldn’t mind putting something adjacent to the watch through it, but not the watch, because it would hold us back from innovating too much, the cycles are too long. But you can begin to envision other things that might be adjacent to it — maybe an app, maybe something else.”

Put the pieces together and this is what we have:

The Type 2 Diabetes epidemic has created a broad (pardon the heartless expression) “consumer base”.

Apple is serious about blood glucose monitoring.

The glucose monitor would be a separate device, an accessory to the Watch.

And it would be “bloodless”.

The last point is, in my view, the most important. I can’t see Apple Stores demoing blood drawing Watch accessories, and while bloodless monitoring systems exist, they’re laden with caveats. There’s this device from GlucoWise…promised for “next year”:

And one from GlucoTrack…approved in Italy and Spain, but not the UK, France, Germany or the US:

Search for “bloodless glucose monitors” and you’ll find many more, all of them in the “study” stage.

You can walk into the neighborhood CVS and buy a blood pressure monitor for less than $100 and a pulse oximeter (measuring blood oxygen) for less than $50, but you can’t buy a bloodless glucose monitoring device. This is such a “holy grail for life sciences”, as the CNBC article explains, that if any company were near to an actual breakthrough, the exciting news would leak and it would be all over the Web, TV news, and print media.

The bloodless breakthrough may still be in an indeterminate future, but that shouldn’t prevent us from indulging in a bit of hopeful speculation. For this, the GlucoTrack earlobe clip device is a particularly interesting model. Add Bluetooth connectivity, miniaturize the glucose sensor so it fits next to an AirPod-like transducer….we already have devices that measure body temperature, heart rate, and blood pressure via the tympanic canal.…

You see where this is going.

Back down on earth, let’s recall, yet again, Horace Dediu:

“Those who predict the future we call futurists.

Those who know when the future will happen we call billionaires”

Billions will be made, but we don’t know when or by whom.

— JLG@mondaynote.com