10 ms·

Automated glucose control will be the next frontier in so many areas of healthcare. I'm still skeptical that anyone will be able to noninvasively and accurately

Automated glucose control will be the next frontier in so many areas of healthcare. I'm still skeptical that anyone will be able to noninvasively and accurately sense blood sugar, but I'm glad people (especially kids with T1) will have one more tool to help them. I hope they can figure out the reimbursement side to get it into the most hands possible!

SV_BubbleTime 23d ago
I wonder if there are any legs in an internal sensor that pushes out its reading every x? That seems pretty plausible.
- copperx 23d ago
  Internal as in swimming in the bloodstream?
- zamadatix 23d ago
  Invasive CGMs (Continuous Glucose Monitor) and minimally invasive CGMs exist. It's the non-invasive CGMs which are being worked on because managing an implant or having something always poking through you is a big annoyance+risk compared to wearing a watch, ring, or patch. The problems for these non-invasive options so far is they either too easily fail to work, are bulky/expensive, give very ballpark accuracies, or some combination thereof.
  - flinner 23d ago
    A good read on this topic is The Pursuit of Noninvasive Glucose: 'Hunting the Deceitful Turkey'.
    - m463 23d ago
      seems to be: https://nolanhergert.github.io/notes_old/0media/physics/noninvasive_glucose.pdf https://nolanhergert.github.io/notes_old/0media/physics/noni...
      - flinner 23d ago
        That’s the one
  - aarstid 23d ago
    The biggest problem is that they are racist. Optical blood sugar sensing devices were developed a decade ago. They were pretty accurate for pale white people, ballpark for most skin tones and don’t work at all for Black people. Good luck bringing that to market. Apple threw out the whole product and restarted with infrared.
- ijustlovemath 23d ago
  There are 6 month implantable CGMs, they're just quite expensive.
- dormento 23d ago
  You got me thinking about possible hollow spots INSIDE my leg to put a sensor :P
loeg 23d ago
> Automated glucose control will be the next frontier in so many areas of healthcare. What areas do you have in mind outside of diabetes management?
- nemomarx 23d ago
  Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe
  - hungryhobbit 23d ago
    They are specifically relevant to trying to enter a fasted state. The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight). Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
    - cperciva 23d ago
      whether or not (say) that coffee you just drank took you out of the fasted state A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state. Now, if you're talking about a cup of flavoured milk, that's a different question...
      - RHSeeger 23d ago
        Adding any amount of milk to a coffee adds carbs. And a large number of people add _some_ amount of milk.
        dredmorbius 23d ago
        An 8oz serving of milk (236 ml) has 12 g of carbohydrate. People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g. That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.
jamesgill 23d ago
Automated glucose control is already available via wearable insulin pumps combined with CGMs in a 'closed loop' system.
- ijustlovemath 23d ago
  None have been approved for hospital use as of yet, which is the next frontier.
  - lokar 23d ago
    Why is hospital use so important?
    - ijustlovemath 23d ago
      If the large studies are to be believed, you could save hundreds of thousands of lives and many billions in excess expenditure, because stable blood glucose shortens length of stay. People with diabetes alone account for 60% of hospital expenditure, so improving their care improves the system in a big way.
      - disillusioned 23d ago
        >People with diabetes alone account for 60% of hospital expenditure That number seemed too large to be true, and I think you might be conflating some numbers... The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states: >For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself. Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications. Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related. Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here. [1] https://pubmed.ncbi.nlm.nih.gov/37909353/ https://pubmed.ncbi.nlm.nih.gov/37909353/ [2] https://www.diabetes.org.uk/about-us/news-and-views/cost-complications-highlights-urgent-need-transform-diabetes https://www.diabetes.org.uk/about-us/news-and-views/cost-com... [3] https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytics-medical-expenditures-of-diabetes-related-hospitalizations-in-the-united-states-august-4-2020/ https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytic...
Allower 23d ago
[dead]
BrtByte 23d ago
A device like this only really changes outcomes if people can actually afford to wear one continuously, not just during periods when they're already at higher risk
smolder 23d ago
Automated control of every major component of the circulatory system should be coming up in the future of medicine if society doesn't implode first. Stabbed through the heart and lung? Plumb in an artificial blood pump and gas exchange unit until they can be surgically treated. There's no reason we can't duplicate the functionality of the heart, lungs, liver, or kidneys. It could save tons of lives if we get there.
- adrianN 22d ago
  We have functional machines that replace heart and lungs (for a while). Unfortunately they also mess up your blood cells and there is of course a risk of sepsis.
momojo 22d ago
I'm in biotech and if I had a dollar for every engineer I've met who dreamed of or worked-at-a-place-that-tried or even tried-in-their-freetime to make a non-invasive glucometer, I'd have at least enough to buy a coffee, which is a lot. There is an ever-growing bodycount in the NIO-GM graveyard [0], but I too hope that one day, it'll get figured out. My old roommate and good friend was T1 and monitoring one's glucose and remembering not to eat too much/little is half your life. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC8655290/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8655290/
- Beijinger 22d ago
  That is a very bad article. Most, if not all non-invasive blood glucose projects had no peer reviewed publications. Anyway, this problem, to measure blood glucose non-invasive, is solved now. A product should be on the market very soon. And while I am not involved anymore, I once submitted an SBIR grant application to the NIH with this technology. A specific item that this technology used would be a few hundreds bucks if produced in quantities. I also wrote this in the grant application. The examiner googled this thing, and a top-notch single item for lab measurements was 50 grand. Obviously, too expensive. So the thing I learned: An idiot and Google are a very dangerous combination. Even at the NIH. PS: Neither the start-up, nor their technology is mentioned in the paper. All the mentioned technologies have been tried and are bound to fail in my opinion. At least the examiner gave me a very high score on "innovative".
  - momojo 21d ago
    Did you get the grant? Are you under NDA? What was the innovation?
    - Beijinger 18d ago
      No. I did not get the grant. And SBIR is a highly rigged system. I am not involved anymore in the project but in another project. But if it interests you, I can point you to the publications and company. Email: a50q40ju@anonaddy.me
- 22d ago

SV_BubbleTime 23d ago

I wonder if there are any legs in an internal sensor that pushes out its reading every x? That seems pretty plausible.

copperx 23d ago
Internal as in swimming in the bloodstream?
zamadatix 23d ago
Invasive CGMs (Continuous Glucose Monitor) and minimally invasive CGMs exist. It's the non-invasive CGMs which are being worked on because managing an implant or having something always poking through you is a big annoyance+risk compared to wearing a watch, ring, or patch. The problems for these non-invasive options so far is they either too easily fail to work, are bulky/expensive, give very ballpark accuracies, or some combination thereof.
- flinner 23d ago
  A good read on this topic is The Pursuit of Noninvasive Glucose: 'Hunting the Deceitful Turkey'.
  - m463 23d ago
    seems to be: https://nolanhergert.github.io/notes_old/0media/physics/noninvasive_glucose.pdf https://nolanhergert.github.io/notes_old/0media/physics/noni...
    - flinner 23d ago
      That’s the one
- aarstid 23d ago
  The biggest problem is that they are racist. Optical blood sugar sensing devices were developed a decade ago. They were pretty accurate for pale white people, ballpark for most skin tones and don’t work at all for Black people. Good luck bringing that to market. Apple threw out the whole product and restarted with infrared.
ijustlovemath 23d ago
There are 6 month implantable CGMs, they're just quite expensive.
dormento 23d ago
You got me thinking about possible hollow spots INSIDE my leg to put a sensor :P

loeg 23d ago

> Automated glucose control will be the next frontier in so many areas of healthcare. What areas do you have in mind outside of diabetes management?

nemomarx 23d ago
Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe
- hungryhobbit 23d ago
  They are specifically relevant to trying to enter a fasted state. The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight). Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
  - cperciva 23d ago
    whether or not (say) that coffee you just drank took you out of the fasted state A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state. Now, if you're talking about a cup of flavoured milk, that's a different question...
    - RHSeeger 23d ago
      Adding any amount of milk to a coffee adds carbs. And a large number of people add _some_ amount of milk.
      - dredmorbius 23d ago
        An 8oz serving of milk (236 ml) has 12 g of carbohydrate. People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g. That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.

jamesgill 23d ago

Automated glucose control is already available via wearable insulin pumps combined with CGMs in a 'closed loop' system.

ijustlovemath 23d ago
None have been approved for hospital use as of yet, which is the next frontier.
- lokar 23d ago
  Why is hospital use so important?
  - ijustlovemath 23d ago
    If the large studies are to be believed, you could save hundreds of thousands of lives and many billions in excess expenditure, because stable blood glucose shortens length of stay. People with diabetes alone account for 60% of hospital expenditure, so improving their care improves the system in a big way.
    - disillusioned 23d ago
      >People with diabetes alone account for 60% of hospital expenditure That number seemed too large to be true, and I think you might be conflating some numbers... The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states: >For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself. Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications. Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related. Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here. [1] https://pubmed.ncbi.nlm.nih.gov/37909353/ https://pubmed.ncbi.nlm.nih.gov/37909353/ [2] https://www.diabetes.org.uk/about-us/news-and-views/cost-complications-highlights-urgent-need-transform-diabetes https://www.diabetes.org.uk/about-us/news-and-views/cost-com... [3] https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytics-medical-expenditures-of-diabetes-related-hospitalizations-in-the-united-states-august-4-2020/ https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytic...

Allower 23d ago

[dead]

BrtByte 23d ago

A device like this only really changes outcomes if people can actually afford to wear one continuously, not just during periods when they're already at higher risk

smolder 23d ago

Automated control of every major component of the circulatory system should be coming up in the future of medicine if society doesn't implode first. Stabbed through the heart and lung? Plumb in an artificial blood pump and gas exchange unit until they can be surgically treated. There's no reason we can't duplicate the functionality of the heart, lungs, liver, or kidneys. It could save tons of lives if we get there.

adrianN 22d ago
We have functional machines that replace heart and lungs (for a while). Unfortunately they also mess up your blood cells and there is of course a risk of sepsis.

momojo 22d ago

I'm in biotech and if I had a dollar for every engineer I've met who dreamed of or worked-at-a-place-that-tried or even tried-in-their-freetime to make a non-invasive glucometer, I'd have at least enough to buy a coffee, which is a lot. There is an ever-growing bodycount in the NIO-GM graveyard [0], but I too hope that one day, it'll get figured out. My old roommate and good friend was T1 and monitoring one's glucose and remembering not to eat too much/little is half your life. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC8655290/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8655290/

Beijinger 22d ago
That is a very bad article. Most, if not all non-invasive blood glucose projects had no peer reviewed publications. Anyway, this problem, to measure blood glucose non-invasive, is solved now. A product should be on the market very soon. And while I am not involved anymore, I once submitted an SBIR grant application to the NIH with this technology. A specific item that this technology used would be a few hundreds bucks if produced in quantities. I also wrote this in the grant application. The examiner googled this thing, and a top-notch single item for lab measurements was 50 grand. Obviously, too expensive. So the thing I learned: An idiot and Google are a very dangerous combination. Even at the NIH. PS: Neither the start-up, nor their technology is mentioned in the paper. All the mentioned technologies have been tried and are bound to fail in my opinion. At least the examiner gave me a very high score on "innovative".
- momojo 21d ago
  Did you get the grant? Are you under NDA? What was the innovation?
  - Beijinger 18d ago
    No. I did not get the grant. And SBIR is a highly rigged system. I am not involved anymore in the project but in another project. But if it interests you, I can point you to the publications and company. Email: a50q40ju@anonaddy.me
22d ago