Apple Watch vs diabetes: The glucose monitoring story so far

For as long as the Apple Watch has been rumoured, there have been murmurs that the company will one day build a wearable that is capable of offering continuous glucose monitoring. Suffice it to say, that would be a big deal for a lot of people – not just diabetics.

The Apple Watch isn't quite there yet in terms of offering this serious health tracking feature, but it seems as if it's working to try and make it happen.

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As Apple continues to make a bigger push into health, we explore how the smartwatch is already working with glucose monitoring devices, the challenges Tim Cook and company face to offer the monitoring from its its own wearable and how it could actually take shape.

Like a G5

If you're looking to check your glucose right now, there is a way to do this with the Apple Watch. All you need is a device from Dexcom, the biggest name in continuous glucose monitoring these days. Specifically, you'll need the Dexcom G5 CGM mobile system, which will pair with the Dexcom G5 Mobile app. You'll then be able to see your glucose levels right there on your Watch.

Eventually, Dexcom plans to upgrade its app for watchOS 4 support, which will take advantage of core Bluetooth to pair your Dexcom device directly with your Apple Watch. That way you won't need your iPhone to act as an intermediary.

Read this: How wearables are helping the lives of diabetics

It's been a couple months since watchOS 4 dropped, so it's easy to wonder whether Fitbit's deal with Dexcom has killed the Apple Watch update, but it's likely the watchOS 4 support has been held up by the FDA (we'll get back around to this in a bit).

There's also Cardiogram, which says it can detect signs of diabetes via your Apple Watch's heart rate sensor with its AI. It's not exactly tracking your blood sugar, or actually diagnosing you, but if it helps previously undiagnosed diabetics get help, that's something.

Still, Dexcom is the best way to turn your Apple Watch into a diabetes-tracking device right now. But is there a day on the horizon when your Apple Watch will be all you need?

Apple's drive for glucose monitoring

In May 2017, we learned that Tim Cook was walking around Cupertino test driving a prototype device that tracks blood sugar. The device was connected to his Apple Watch, and the CEO was trying to understand how his blood sugar responds to his diet.

We don't know whether this prototype was from within Apple or from another company, like the aforementioned Dexcom, but we know that Tim is fascinated by the technology.

We also know that Apple has a secret team of biomedical engineers working on sensors that can track blood sugar. A month after this report came out, the report about Cook testing out a blood sugar-tracking prototype emerged. One plus one equals two, as they say in grade school.

It's not a surprise that Apple wants to track your blood sugar. It's been an idea at the company since Steve Jobs was around, as Jobs – who was reportedly diabetic – hated having to prick his finger for testing.

Apple's engineers have been researching how to non-invasively track glucose, but that effort could take years, sources close to the project told The New York Times. Well, if it happens at all. We hate to ground your technological hopes, but Valencell, which licenses sensor technology to Samsung, Sony and the rest, says that noninvasive glucose tracking is impossible.

"There will literally be stem cell regenerated pancreas cells in the body before there is ever anything that can be a truly noninvasive glucose monitor for dosing insulin," Valencell CEO Steven LeBoeuf told Wareable.

Currently, invasive glucose tracking techniques – like those from Dexcom – measure blood and interstitial fluid. This either needs a device that pricks the skin for blood or is able to press into the skin enough to pick up the interstitial fluid just below. But the challenge, according to LaBoeuf, is the laws of physics themselves.

Getting the FDA thumbs up

Then there's the big elephant in the room: the FDA. FDA approval is a menacing maze of regulation that scares off even the biggest companies. Like Apple. Don't take it from me, take it from Cook himself.

"We don't want to put the watch through the Food and Drug Administration process," Cook told The Telegraph. "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."

While Apple is signed up for the FDA's new fast track pilot system, it's still likely that FDA approval will take a while as they go through stringent requirements to make sure devices actually do what they say they do. Apple is unlikely to want to put the best-selling wearable in the world through federal regulations that could slow down its rollouts and sales.

An Apple Watch band solution

The solution could lie with something Apple has patented before, and one that AliveCor has put into practice with the KardiaBand. It's the first Apple Watch accessory approved by the FDA, and it's capable of adding health functionality with electrocardiogram technology.

It's not a leap to see Apple one day releasing a smart band that continuously tracks glucose. That band could go through the FDA and be released on its own, independent of the Apple Watch. Thanks to core Bluetooth in watchOS 4, you wouldn't even need an iPhone. We've also seen how Apple ties together its products in a seamless way that's so simple it's silly (hi, AirPods).

Apple wants to get into glucose tracking for Apple Watch, and it's actively working on it, but what we're mostly likely to see is a glucose-tracking smart band augmenting existing Apple Watches, rather than a Watch with built-in sensors, which would negatively affect battery life and performance.