Glucose Monitoring: Still on the Frontier of Innovation

”…To a large degree, medical care depends on a transfer of information.”

There is almost no overnight success.  That is why Alphabet subsidiary Verily’s cancelation of work on a glucose-sensing contact lens last fall shouldn’t be a large surprise…nor should it be viewed as the last word on the concept.  The history of glucose monitoring is replete with fits and starts, and with some specular success.

In 2002, Cygnus, Inc., launched The GlucoWatch – the first approved commercial transdermal continuous glucose monitor. The GlucoWatch failed to gain traction, however, because:

  • There was no reimbursement for the device at the time;
  • It was expensive;
  • The technology was novel but not yet bullet-proof; and
  • The data was interesting, but difficult to transmit, store, access, share, analyze and act on.

More recently, advances in glucose monitoring by companies including Dexcom and Medtronic/MiniMed have been life-changing for diabetes patients and their caregivers.

Verily’s project cancellation does point to some relevant truths:

  • The management of complex diseases depends on timely and accurate information;
  • Collecting, transmitting, recording, analyzing and acting on clinical data is intolerant of failure;
  • Despite of the urgency for a better solution, all the links in the solution set must work in concert and “the fleet sails no faster than the slowest ship”; and perhaps most significantly,
  • It was an initiative by an information company.

Things to be considered in glucose monitoring go well beyond new detection technology. For the entire generation of new physiological wearables – including new glucose monitors – to be both useful and competitive, they will need to be information-driven and include:

  • Seamless and user-friendly data collection, transmission, aggregation and analysis methodologies;
  • Integration into existing and evolving medical information systems;
  • integration into the dominant next-gen smart phone and home-assistant tech;
  • Clinically relevant, actionable information presentation;
  • Relevance to the payers, other interested third parties and population health;
  • Data security and data access; and
  • Synergistic data-driven alliances with the relevant device and pharma companies.

Better, cheaper, faster glucose measurement technology will always be welcomed; but in the end it’s all about the data.

 

Charlie Grebenstein

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† Johns Hopkins’ Barbara Starfield, M.D. from Primary Care: Concept, Evaluation and Policy in 1992

Heritage Partners has published a “A History of Digital Healthcare” (http://bit.ly/2u9AIoI) that incorporates advances in glucose monitoring as an allegorical representation of the historical integration of technology and clinical medicine.

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