Can Apple handle the heat?

Apple has reached the proof-of-concept stage for a non-invasive, continuous blood glucose monitor which has excited the digital health world and also reignited the clinical debate about the benefits and challenges of managing the steady stream of data from a CGM. 

Citing anonymous sources within Apple, Bloomberg said the company’s system is more than 12 years in the making. It centers on an iPhone-sized device, worn on the bicep, which emits specific wavelengths of light that, when reflected back, indicate glucose concentration. From there, an algorithm determines blood glucose level.  

The long-term goal, according to the article, is to integrate the system with Apple Watch. 

All of Apple’s potential forays into healthcare make waves, and the possibility of an Apple CGM is no exception. The day the story broke, shares of Abbott and Dexcom – who respectively make the FreeStyle Libre and G7 systems – both fell 3%, Bloomberg noted. Other CGM makers include Insulet, Medtronic, and Senseonics, which makes an implantable sensor. 

Three factors drove the hype. One is the potential, even if it’s years away, for the Apple Watch to serve as a CGM. This eliminates the need to wear a monitor, which much be attached to the skin and replaced at least once every two weeks.  

A wearable could potentially lower the cost of continuous monitoring, too. GoodRx points out that the average CGM starts at $1,000, with sensors costing about $65 per month, compared to a starting price of $399 for the Apple Watch Series 8. Insurance coverage is possible for CGMs – and has recently been approved for a broader patient population – but the American Academy of Family Physicians indicates it can be complicated and may require prior authorization. To that end, one Dutch researcher has argued that the high cost of CGM is an issue of health inequity and injustice. 

The third factor is the end of skin pricks. Though patients wearing a CGM face far fewer finger pricks than those using a standard blood glucose monitor, they still need to do it, whether to recalibrate their device or get a second measurement if the CGM numbers seems amiss. The National Institute of Diabetes and Digestive and Kidney Diseases also notes that a finger-prick glucose test is necessary before changing an insulin dose. 

While there could be benefits to Apple’s foray into the CGM market, it also raises a commonly cited concern about continuous monitoring: Since CGMs collect readings every five minutes, there’s an influx of data that poses challenges to providers and patients alike. 

In a 2018 paper, patients using CGM reported that device data “provided a more nuanced picture of blood glucose control” and improved confidence in decision making. However, most patients not only needed but expected healthcare professionals to help them interpret data and change insulin doses. Additional research has shown that improving health outcomes and quality of life for patients with CGM requires collaboration among patients, their families, and their clinical care team. 

Security also poses a concern. “Data overload” from CGM is all too common, and the American Diabetes Association notes that some practices download CGM to a standalone computer and printer outside the office’s firewall. This keeps data away from critical clinical applications and makes analysis easier – but it also leaves CGM data susceptible to privacy and security risks both at rest and in transit, and it puts the onus on patients to secure their CGMs, their home networks, and their personal devices. 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.