"The whole sensor field is going to explode. It’s already exploding. It’s a little all over the place right now, but with the arc of time, it will become clearer I think," said Apple CEO, Tim Cook, way back in 2013.
The arc has shifted quite a bit since then. Regular readers will know I’ve been explaining how deeply committed the company is to digital health. So, why the focus on diabetes?
Diabetes is a major problem worldwide.
Over 29 million people suffer from diabetes (types 1 and 2) in the U.S. alone, and the global incidence of the problem is over 422 million, according to the WHO. That's about one in every eleven people, according to this infographic.
It will reach over 700 million by 2025, the WHO warns.
There is a difference between type 1 diabetes, which is an autoimmune disease, and type 2 diabetes, which may emerge over time. Type 1 diabetes is a condition, but type 2 diabetes can sometimes (though not always) be prevented or controlled through changes in physical habits.
Here is a good account of the complexity of both conditions.
"Global estimates of diabetes prevalence for type 1 and type 2 do not exist," the WHO wrote in its 2016-published Global Report on Diabetes, which you can download in PDF format here. The organization also warns that type 2 diabetes comprises the majority of those affected.
One major non-WHO study concluded that around 85-90 percent of diabetes conditions are of type 2 diabetes.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
Apple is reported to be developing a non-invasive sensor to accurately determine glucose levels through the skin, rather than using invasive blood tests. I speculate that such a technology could work in conjunction with Apple's other physical monitoring systems.
The potential life-changing and life-ending consequences of diabetes are incredibly serious.
One of those consequences is cost.
The global cost of diabetes is now a staggering $825 billion per year, according to the largest ever study of diabetes levels across the world.
The biggest share of this huge cost impacts economies in China, the U.S. and India -- all three regions are key Apple markets.
The impact on lives and national economies is bad enough, but what compounds the challenge of diabetes is that -- when it comes to some cases of type 2 (though not type 1) diabetes -- the problem can often be managed – and (in the case of some type 2 conditions) sometimes prevented – with simple lifestyle changes.
There's no doubt that making lifestyle changes can be hard to achieve without education, and information. Condition causes can range from genetic predispositions to inaccuracy in food labelling -- and that’s where switched on digital health devices may make a difference.
You see, it’s not just about measuring your blood sugar levels when you are suffering from the problem, it’s also about intelligent analysis of habits, exercise and diet before you encounter the disease. And that's where a diabetes sensor that works in conjunction with Apple's other physical sensors may make a difference.
Healthy habits aren’t everything, of course, but they help. Obesity is frequently cited as an important risk factor when it comes to diabetes type 2 prevention, which is the condition that accounts for around 90 percent of 422 million diagnosed diabetes sufferers,
Professor Majid Ezzati from the School of Public Health at Imperial College London was senior researcher on the study mentioned above.
He’s quite clear about the need to combat the problem:
“We need financially accessible and effective health systems that can highlight those at high risk of diabetes or at pre-diabetes stage,” he said.
“Healthcare staff can then deliver medication and lifestyle advice to delay or even prevent the onset of the condition, as has been done in some countries in western Europe."
Knowledge really is power when fighting this problem.
Health, Care Kit and Research Kit are enabling major studies in public health and treatment.
These tools are providing valuable data that may enable healthcare professionals to identify, treat, and (perhaps) cure health problems -- though diabetes is certainly a problem for which prevention beats cure.
Apple last year hired a top doctor who specialized in treating child diabetes, Rajiv Kumar. Kumar rose to prominence when he developed a HealthKit pilot app that helped patients monitor important data, such as their blood sugar levels, and then share it with healthcare professionals.
At least one other ResearchKit study, GlucoSuccess from the Massachusetts General Hospital has already led to increased understanding of the relationship between some type 2 diabetes subtypes and exercise.
The digital impact is not limited to diabetes, but given the number of people who suffer from the illness and the societal and personal costs of that suffering, it perhaps makes sense for Apple to focus on this problem. If only in marketing terms.
I believe Apple wants to extend the range of information its sensors can gather about health.
The need to achieve regulatory clearance for some health solutions (likely including any form of non-invasive diabetes sensor) remains a big challenge for Apple. Not only must it prove its solutions can deliver on their promises, but doing so may also mean some sensors need to be put on a different product release road map.
What I mean by this: When Steve Jobs announced the original iPhone in 2007, he did so in January for release later in the year because the company had had to achieve regulatory clearance for the device. That clearance meant some details pertaining to it would be published, so Apple came clean.
I speculate that the need to achieve clearance for new health-focused features may also require the company undergo more public scrutiny, making it possible some could be introduced as additional accessories in order to enable the main product to remain under wraps.
Despite that challenge there’s very little wrong with Apple providing additional, regulated sensors as add-on items for use beside other products in its ecosystem.
Ultimately the first dream of connected health is the creation of products that can warn you before you become unwell; the next step will be accurate diagnosis, treatment, and intervention, but that, as they say, is another story.
Update note: Story updated to make more differentiation between type 1 and type 2 diabetes, which had not been clearly explained in the original story. To learn more about diabetes please visit the American Diabetes Association website.
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