I don't understand how having ubiquitous sensors is the "holy grail for treating diabetes."
Diabetes is a disease that needs its symptoms to be monitored and managed at a high granularity. Both monitoring and managing blood glucose can be really invasive though, with needles and finger-sticks causing extensive scar tissue development. Minimally invasive glucose monitoring technology that generates high-resolution time series data (such as Dexcom systems) literally transforms the way that people can manage their disease. Going from glucose reading every 6 hours (test strips) to every 5 minutes (CGM) is life changing. Monitoring that is non-invasive is the next technological step.
The holy grail for treating diabetes should actually be stabilized monomeric human insulin. Afrezza[0] is exactly that, and inhalable no less. The company that makes it just can't break through the insulin cartels and insurance-pharma exclusivity, so they are having a hard time. They did what was unachievable for 100 years though, and they are amazing chemists.
My father was involved in some of the early long-term diabetes control trials which began at the University of Washington in the '80s. One group was randomly selected and told to keep doing what they were doing. The other group was to keep as tight of control over their blood sugar and insulin administration as humanly possible, and was continually given state of the art tools to do so. He was in the later group.
Despite having excellent leading-edge advice, and being one of the most disciplined people I've ever known - marathon runner / Mormon* / literal boy scout (master) - it was a constant battle to keep things under control. It's a myth that diabetics can't have sugar; rather, it's easier avoid it because it ends up being such a pain in the ass.
I wasn't really paying attention, but still knew what a basal rate was as a kid.
* I never realized how much more difficult Diabetes could be until college, when a roommate was relieved to hear I knew what a glucagon shot was, and how to administer it. Alcohol & everything else was something my dad never had to deal with.
You know, it's funny. I've had Type 1 Diabetes since I was 13, more than 15 years ago. I just can't imagine what it's like to not think about everything you eat. I have to do several math equations every time I eat just to survive. At this point it's just a part of eating, there is no alternative. The idea of eating a donut and not worrying about feeling like shit for the next two hours is totally foreign to me.
I always say, if you want to monitor your food intake, just become a Type 1 Diabetic. You will consider everything you eat :)
¯\_(ツ)_/¯
Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...
The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers.
I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.
Insurance company A needs to help with a wide variety of prescription needs -- cholesterol management, heart disease, kidney disease, cancers, MS, diabetes. Insurance company A negotiates with pharmaceutical companies B, C, and D for how much A will pay for any drug and what copay A will charge to the insured patient.
Pharma B makes a deal to ensure that their diabetes drugs are on tier 1 or preferred status (most likely to be approved/used/paid) in exchange for a very good deal to the insurance companies on the price for each prescription and a lower tier for their cholesterol drug. The agreement also states that all other diabetes drugs (insulin, let's say) will be tier 3 or need prior authorization. This is a contract that might last a year or 5 and is not public.
Company C makes a deal to get their MS drug as the only reasonably priced option in exchange for basically giving away their foot fungus drug. The insurance company is happy because every foot fungus prescription is pure profit. Company C is happy because they are they only game in town for MS treatments on that insurance provider.
Pharma D wants to get their insulin at a higher tier so that patients can afford it and not buy out of pocket. But Pharma B already has an agreement that all other insulins will be tier 3 or lower, so Pharma D is locked out of that insurance company.
The current health insurance and prescription system in the US __heavily__ favors large pharma companies that can negotiate on multiple grounds and leverage competing health interests. Small pharmas that offer a singular stellar product have a tremendous fight to even get past prior authorization.
A noninvasive sensor that measures blood glucose accurately, even just once a minute, would give you the ability to close the feedback loop and remove all human input from the system. No "oh shit I forgot to measure and adjust". Especially for kids it would be a big breakthrough. In essence, you'd have an almost-perfect artificial pancreas.
Since modern fast acting insulin still takes time to kick in, you need to dose to cover carbs about 15 minutes before eating. So there will always be some level of involvement of you want to avoid actually going high and then coming back down (proactive vs reactive).
Don't get me wrong, it's great to know you're going to wake up at your target even if you screwed up your dinner-time bolus a bit.
That is, assuming the CGM is functioning properly. My experience with the Dexcom G4 with my kids was much less than stellar. Lots of '???' readings or having it off by over 50 points, extremely painful insertions and being mostly useless the first 24 hours and then sensors failing long before 7 days was the norm and ultimately we abandoned it.
Anxiously waiting for the auto-inserting CGM to come out of trials.
You have multiple kids with T1D? That's a stroke of bad luck :(
Everyone responds differently to the same inputs. My BG spikes hundreds of points if I eat a banana. It drops 50pts an hour when sitting in intense sun. Make sense? No.. is it repeatable, for me, yes.
Would ubiquitous sensors help me identify more of these patterns? Absolutely.
A good starting point would be: http://www.mendosa.com/The%20Pursuit%20of%20Noninvsive%20Glu...
Would be very interested in the email of Johny Srouji.
But then, it's evident that the article is giving Apple too much credit already - even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying.
Let's ignore the idea of insurance paying for this or any other kind of help. I imagine the Apple Watch would end up paying for itself for a type one diabetic within what, a year or two? I know those little testing strips aren't cheap.
But the Apple Watch would give you much better monitoring, no pain, no testing, far more data… Oh yeah and every feature that the people who already have an Apple Watch like.
As others have mentioned in this thread, I'm sure it's INCREDIBLY easy to get small children to test their blood glucose when necessary. I imagine this would easily be worth it to a lot of parents as well.
Seems like a weird attitude though: If company X can afford to (possibly waste) billions of dollars to make a medical breakthrough in Y, I don't want them to because then they'd use it themselves and charge money.
It's about keeping things as level as possible. Also, genetic therapy could be amazing... but it's still, afaik a very long way off.
What a curious set of priorities.