For people with diabetes, keeping an eye on blood sugar levels is a necessary and regular activity, and for those with type 1, continuous glucose monitoring means more peace of mind and lower risk of complications. This is why the news that the FDA just gave Dexcom the nod for its next glucose tracking device, the G6, is such a big deal; for the first time it will eliminate the need to take regular finger pricks, an ostensibly small change that should be a major lifestyle improvement for people with diabetes.
The wearable device itself is smaller than the G5, but no longer needs to calibrate with blood drawn from the finger. The factory-calibrated sensors work by sitting under the skin and reading the interstitial fluid, then sending that information to your smartphone or smartwatch.
This should make the lives of users more comfortable, but the implications are much further reaching. First of all, when the FDA approved Dexcom's new technology it reduced this type of device from a Class 3 to a Class 2 medical device, something that will apply going forward and accelerate the review process for all similar products.
Secondly, the G6 will provide the basis of wearable technology that Dexcom is working on with Alphabet's Verily Life Sciences division, Dexcom president Kevin Sayer told Wareable. "The G6 will serve as the glucose sensing technology in the first joint product we release, so this is the platform for our collaboration going forward".
This alliance with Verily could fortify Dexcom in the coming years, and has already given it access to technology it otherwise wouldn't have, along with the know-how in miniaturising sensors. Sayer won't yet say when we'll see the first wearable created by both, but it'll be smaller than the G6. "The first one we replace the electronics and the form factor, we make it smaller and do a couple of other things, and we've got to do some work with the FDA to determine what the regulatory path is going to be."
It's a very slim small profile that a patient will wear on the body... the next big step in CGM
The first-gen device will have different use cases: the non-intensive diabetes market; a professional product for physicians. But more exciting is what comes after that: an inexpensive band-aid style, disposable glucose sensor that could also track physical activity. "At that point in time the transmitter and all the electronics become disposable, and it's a very slim small profile that a patient will wear on the body. It's the next big step in continuous glucose monitoring."
This could also be targeted at type 2 users, and Sayer says we can expect to see that in 2020, a prediction that's been emboldened by the approval of the G6. "We've always said the launch of the first throwaway product was dependent upon how this G6 launch went and G6 approval went."
Apple: Friend or foe?
At last year's WWDC, Apple announced that Dexcom's sensors would take advantage of CoreBluetooth in watchOS 4, meaning users could transmit data directly from the G5 to the Apple Watch, bypassing the iPhone. Since then Dexcom has announced a partnership with Fitbit that will also pair its sensors with the Ionic smartwatch.
That direct connection to either still hasn't been opened up, but it's happening once Dexcom has made some modifications its end, says Sayer. He also sees a lot of potential in cellular. "We believe there will come a day with Apple Watch whereby we can have the transmitter go straight to the Apple Watch which has cell capability," he tells us. "One of the things that's so important with our patients is the ability to share information with others, and so with that connectivity to the cellular network, that Apple Watch could primarily replace the phone as the patient's primary receiver."
But with rumours that Apple has a biomed crack squad working on a diabetes tracking breakthrough of its own, Cupertino could eventually turn an ally into a competitor. Diabetes is a massive health concern in the US, one that's growing all the time, and a lucrative place for wearable tech companies to be. With Verily – and by extension, Alphabet – on its side, Dexcom has the right friends, and Apple's quest for a breakthrough might never even happen. Verily's first idea was a glucose-tracking contact lens, but that hit a wall when it just couldn't pull it off. However, its work with Dexcom on smaller wearable sensors elsewhere on the body promises to pave a better way forward for the organisation.
We can see a health and wellness use someday with the product
There's also the potential to push the current target demographic of primarily type 1 diabetics, says Sayer, first to focus more on type 2 diabetics and then, possibly one day, even non-diabetics. "We can see a health and wellness use someday with the product, and we had to get to this platform with this new sensor tech and algorithm and ease of use," says Sayer. "This is the first level of ease of use that we're introducing; we can see a path to these other uses going forward where we think glucose becomes a very huge measurement, literally another vital sign in health and wellness over time."
With respect to nutrition and diet, these wearables could play a more critical role in helping people evaluate what to eat, especially as Dexcom has an API for third-party fitness platforms to use, and Sayer says the company intends to keep pursuing these partnerships and integrations going forward. Closer integration with the healthcare system is another opportunity Sayer sees."I had my physical last week and now that I'm in this field I watch what my doctor does, and he spent the entire time on my medical record entering stuff. Our data doesn't go directly to the electronic medical record. Imagine if you were seeing an endocrinologist and our system downloaded it all to the medical record without the patient having to do anything. You'll see a lot of things like that happen over time."
2020 might be the next major milestone for Dexcom, but right now the future of diabetic tech looks more positive than it ever has. "I think we're right at the cusp of the next generation of these technologies."
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