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.