Not having to pay $50-100/mo for CGM patches would also be nice.

Oh there will be a subscription, don’t worry about that.

But if they want to capture (or create, commercially) the market they’ll probably price it closer to $20 or under.

More likely is a dollar per day for T2 and higher for T1. The differentiator will be non-invasiveness, not price.

Then they will get their lunch eaten when smartwatch / ring / etc companies ship it for free. Probably smarter to go for market share with affordable one-time costs and build revenue from conplementsry goods and services.

It's a university research, not in-company. The tech is published.

CGMs are probably going to still be more accurate, so the watch may not be ideal for Type 1, but could be nice for people with pre-diabetes who are trying to optimize their health. I'm also curious how accurate they will be.

CGMs themselves are still inaccurate compared to needles. And even needle based meters have a lot of different levels of accuracy. A CGM, even once calibrated, may be off by as much as 10%.

My understanding is that CGMs shine at having a large volume of good data. You can see how your biometrics are trending over time much better than the <10/day readings someone with manual testing will receive.

It's both. The volume of data is helpful in making adjustments to insulin basal rates or dosing ratio. The instantaneous data is useful for making immediate decisions, either manually or automated, about insulin or sugar intake. Seeing a trend line can be much more useful than a single reading from finger stick too.

The value is in clinical application though. For closed loop systems, making a clinical decision for insulin dosing every 5 minutes is life-changing, even if the dosage is 10% off. I’d say even with compression lows, most systems are self-balancing enough to produce better results than a self-monitoring person could.

Besides, 10% off doesn’t often matter:

At 0-70 mg/dl the pump should suspend insulin either way. At 110-600 mg/dl the pump should ensure enough IoB by bolus, increase basal, and monitor either way. In that 70-110mg/dl the 10% MARD kind of matters for clinical decision-making, but not much. 90mg/dl is about as healthy as 81 and 99.

Patients are sometimes fussy by this inaccuracy but forget the tremendous benefit of trend indicators, let alone closed loop systems. Both of these have a much much larger positive impact to health than blood glucose being 10% above or below target impacts health negatively.

CGM with <=10% MARD, whether in wrist form factor or sensor form, is good enough for treatment. Of course, same as most readers, I have my doubts about this article.

So maybe it gets paired with the self-attenuating insulin and the experience gets even better despite some inaccuracy!

Agreed, cool and certainly some improvement but Freestyle is good enough already. Next step for me is more towards the new insulin research which activates only on glucose in the bloodstream (don’t recall how it was called but was here more recently also shared). This sounded more self controlling where it’s hopefully just making sure you have enough of it in your body and don’t need to take care of the rest.

Until then, Freestyle with Omnipod Dash in a close loop with iAPS was a game changer for me: Almost no peaks anymore, HBA1c on the level of a non diabetic person…

Nevertheless, good luck in productising it and I’ll be certainly trying it once it’s available…

I believe this is a reference to the tech you are talking about. I have a similar take as you: current cgm tech plus closed loop is pretty good. Self activating insulin is the first promising tech I’ve seen in the 40+ years of following the research.

https://youtu.be/lVTS_J7Xmxs?si=vemMfo3IbfMlYrUi

> Freestyle is good enough already

In my experience, the quality control isn't very good (some patches will read much more accurately than others) and accuracy isn't that good when you get out of normal ranges.

I don't think the "invasive" nature of the Freestyle is a problem at all, but it would be nice to see some innovation on either the cost or the accuracy or both.

OP lacks imagination for sure. This would reduce infections, prevent compression lows, be more discrete and potentially increase accuracy.

In no way would I describe CGM as solved, and this would go a long way towards filling many of the gaps, especially in younger / older / less compliant patient populations.

For closed loop better cgms will help.

Main points are (fsl2 based):

- latency, currently 10min.

- accuracy, fine in normal range, but when you have a low blood sugar suddenly the latency spikes a lot.

- values when being under the shower too high.

- start up time of 60min could be lower.

-open up the hardware for any app to read

For me the worst part of current CGMs isn't the needle or the very thin piece of plastic it leaves behind with the probe. Rather, it's the effect on the skin under the patch and the residual adhesive. So from that perspective a watch would be cool.

Indeed though, advancements in (affordable) closed loop tech matter more than where the CGM is worn.

Can you say more about the plastic left behind? Polyurethane coating on the cannula?

Been using a dexcom g7 for a few weeks as a test. Pulling the sensor off can be painful, and leaves behind adhesive residue when I do it. And there's also a bit of inflammation in the area since it sticks a small probe into you, which sits there for 10 days.

Lookup beach tar remover

Oil slick is a skin safe tar remover and searching for that using a pummice stone was reccomended on reddit.

I mean the probe itself, which appears to be wire encased in plastic. When I said "left behind" I just meant that the probe is placed below the skin as intended, not that anything remains after the sensor is removed. This is the part that would be considered "invasive."

Those might be really great for T2 though. I don’t need to know the exact number just a ballpark number to know how I’m doing. Having always had a bad relationship with food, I fall off way too easily without a CGM so for me, those things would be perfect.

But also in times where we have the Libre 3 which is so tiny that you legit don’t even notice it, a CGM on your wrist is not worth the loss of accuracy for T1 I guess (assuming your insurance pays for it).

> but for me, the biggest quality of life improvements for me will be continued improvements with closed loop CGM + insulin pump systems

You might find this interesting: "A bi-hormonal fully closed loop system"

https://www.inredadiabetic.nl/en/home-english/

Having talked with T1 diabetics about such systems, the issue is that you don’t want to deplete glycogen stores just for basal management. Because your life might depend on their levels in case of a severe hypo.

What exactly do you mean by "you don’t want to deplete glycogen stores" ?

It sounds like the system would release a hormone known as glucagon when blood sugar levels are too low. Glucagon triggers cellular pathways that break down glycogen stores into glucose molecules, and releases the glucose into the bloodstream. This is opposed to how diabetics handle it normally, by merely eating a sugary snack- however that takes longer to impact blood sugar levels. Depleting these stores could be catastrophic when they actually need a large amount of sugar to be dumped into the bloodstream

Disclaimer: not a doctor or biologist

Yes T1 here, those body glucose reserves shouldn't be used for regular control. They are reserves for exertion and emergencies. 42 years in, I'm fortunate with a high metabolism and I've always consumed fat as somewhat free extra calories. I use olive oil as a condiment I feel it gives me a standing energy reserve.

I don't use one or have diabetes but my understanding is that current CGMs measure interstitial glucose levels, which lag blood levels by up to 15 minutes. As a result, I believe those who require accurate spot measurements rather than just overall trends are still recommended to use finger stick tests.

In the article, the researcher claims "No other technology can provide this level of precision without direct contact with the bloodstream", so it sounds like they're claiming it's better than existing CGMs in a way that might be clinically relevant. Not sure if that's plausible or whether they are directly measuring blood glucose rather than interstitial.

Type 1 here, a 15 min lag is fine. The constant sampling especially overnight and the multiday graphs are what I love about CGM. I've always been in decent but loose control 6.7 to 7.1 A1C (longer term measurement). After a year w CGM I got to 6.5. Now last checkup I'm at 5.9, this ties my record from my first month on Lantus insulin, never repeated in 19 years until now. Also getting numbers on phone and checking number every 15 min while driving are amazing. The stock software for Dexcom and Freestyle are both abysmal. Both refuse to allow silent mode, Dexcom has a hard 6 hours left on sensor uninteruptable alarm, woke me up at 4 am, coustomer service had nothing to say, so Goodbye. I went back to Freestyle their handheld reader is silencable and I use a third party app called Juggluco for my Android phone. Sorry I've survived 42 years on human insulin I don't want software taking over my life w unsilencable alerts. Anyone w less than 10 or 20 years OK, but my brain has extra backup pathways and I'm still functionable down to 50 (very rare), and I can recognize dimished coordination and the emotional shifts that accompany dips. Plus I have life experience to know my low time of day and to watch w exertion.

Not diabetic myself but managing my little kids T1. If we could go from one poke every 10 days to 0 pokes, I am all in. Skeptical of the accuracy as well though especially for someone who is too young to fully participate and not fully hypoglycemic aware.

Low sugar awareness is a learned and developed skill. As blood sugar drops, systems shut down. The issue is that the Frontal Lobe turns off at some point. Thankfully the energy conservation reduces that impact, but once severely low I can answer a myriad of questions wrongly. I reccomend cake-mate frosting tubes used to write on cakes as an emergency prep. That can be squeezed carefully into mouth between teeth and gums and begins a bootstrap process. Another suggestion make the low fun emotionally so please try and hide anger and fear. With the sensor and fairly tight control we haven't needed the cakemate in years now but it's good to have. A Glucagon shot is another thing to keep around too. I use olive oil on my food to have unsaturated fat as a backup nonglycemic energy source. Just be mindful virgin olive oil isn't to be used for cooking, only refined non-virgin is for cooking. Also fyi Walmart has always had affordable diabetic supplies. I use their meter and strips as an extra spare. Their Relion glucose pills are very good too, I keep them everywhere and carry them with me. To equate blood sugar to body mass divide weight in pounds by 4.4 (kilograms by 2), that gives a number for what 100 equals in grams of carbohydrates to better fine tune sliding scale insulin dosages and not overcorrecting lows. Best wishes as it is very stressful for loved ones.