The Secrecy Squad

The Secrecy Squad

We just love it when a report comes out that talks a about some company “secretly” working on a some whiz bang way cool technology. This happens a lot in diabetes given how much the toy makers just love playing with their way cool whiz bang toys. But now that Apple and Amazon have made the deep dive into diabetes these super secret projects have gone to new heights. These two companies have much in common and not just that they have gobs of money, both are borderline paranoid when it comes to keeping secrets.

Yes once again we are hearing reports that Apple is working on a super secret non-invasive continuous glucose sensor which will become part of a future version of the Apple Watch. Something we have reported on in the past and something that has an ice cubes chance in hell of happening. Listen Diabetic Investor has talked with every expert we know of in CGM all of whom are familiar with what Apple is working on. And guess what? None of these people think this thing will work no matter how much money Apple throws at it.

Listen we hate to break the news to Apple worshipers but there are only so many ways you can do CGM. Additionally most of the people who work on these super secret projects are known in the community and most have a background in CGM, unfortunately most have never succeeded at bringing anything to market. Not that these people aren’t super smart, they are. The problem isn’t how smart they are or how much money Apple throws their way. No the problem is their chosen path to CGM just doesn’t work, it looks very promising but there are just some issues they cannot and will not get past.

Now this fact won’t stop them from trying and who knows maybe they will find a solution that has eluded them. But what then? Ok let’s say they solve the problem, will this vault Apple to the lead in CGM? Think about this just for a moment and take away the fact that yes Apple is the maker of all things way cool and whiz bang, what problem are they solving? So CGM becomes non-invasive is the fact that current CGM sensors are inserted into a patient’s body hurting CGM sales? Maybe but there is little hard evidence to suggest that a non-invasive CGM will sell more than or be used more than current versions.

But again lets say they can get the damn thing to work, can they then make it in scale, get it covered by payors and support it. Not to mention by the time this damn thing gets here Dexcom (NASDAQ: DXCM) and Google will have their slap it on turn it in disposable sensor on the market. Although they haven’t said much on future versions of the Libre we suspect Abbott (NYSE: ABT) will have an updated version on the market as well. And let’s not forget about Medtronic (NYSE: MDT) as they too play in this sandbox as does countless others who are much further along than Apple and have products that do work.

Would it not make more sense for Apple to work with or buy a company like Dexcom. Or perhaps go to Abbott and do something with the Libre. Just as we never believed in non-invasive BGM we could care less about non-invasive CGM. This is has nothing to do with invasive vs. non-invasive. This isn’t about data collection. This is and always has been about turning all this damn data into patient relevant patient actionable information, information the patient can use to more effectively management their diabetes.

Now we know what everyone says that patients want non-invasive which is a bunch of bull. Sure in a focus group maybe but in a real word setting they want access at the cheapest price possible. They want someone to make sense of this damn data. See the low hanging fruit in CGM has already been picked intensively managed patients were and are using this technology in greater numbers. But the real growth in CGM will come from less intensively managed patients, patients who are not proactive or majorly engaged with their diabetes management. Patients who want their device to gather the data and an app that transforms this data into something that is meaningful to them. Given the choice between non-invasive or the minimally invasive sensors we have today non-invasive would be nice but not a game changer.

We suppose if ALL things were equal, which they won’t be, non-invasive might trump minimally invasive. But we do know this PRICE and ACCESS matter more. Just look at why all the analysts have fallen in love with the Libre, a sensor which by all accounts is not as good as the Dexcom sensor but it’s a lot cheaper and doesn’t require calibration. The calibration advantage will soon go away but given how aggressive Abbott has been the price disparity won’t. The fact is Abbott is willing to lose money to build share and they have the deep pockets to fund a price war.

So again we ask just what problem does non-invasive solve?

What gets lost in the non-invasive excitement is a strong argument can be made that having a sensor on a Apple Watch makes life a little tougher for the patient simply because they must wear the watch all the time. What happens when the watch is charging or when the patient doesn’t want to wear it, what happens to the readings? CGM stands for continuous glucose monitoring and when the watch isn’t worn or is charging means no readings are gathered.

Right now the Libre does not require a finger stick calibration, the Dexcom system requires two finger sticks upon start up and one every 24 hours thereafter, so over a week a Dexcom patient would have a total of 9 finger sticks. So again we ask what problem is being solved here? Is it really that much of an inconvenience for a Dexcom patient to perform 9 finger sticks over a week and what happens when the FDA clears Dexcom for no finger stick calibration, something that will definitely happen.

Listen we know that non-invasive sounds so damn cool but the fact is when it comes to CGM it’s a non-factor. Even if Apple can solve the technical issues with non-invasive, we don’t think they can, but even if they did they would not have that much of an advantage over Libre and Dexcom. So will someone please explain to us what all the fuss is all about and why all the secrecy?