The Wearables I Want
Wearable buzz is hitting a frenzied pitch in the consumer marketplace. Here in the lab, we’re early adopters, and not just of over-the-top video options. Leslie’s in year six of walking 10,000 steps a day, for instance, starting with a Fitbit in 2008, and has walked several different fitness bands into the ground (including the recently sampled Polar Loop, returned within a week); I’ve been wearing sensors for longer than iPhones have been on the market.
A bit of disclosure: I’ve had Type 1 (autoimmune) diabetes since childhood, and back in 2007 I got my first CGM (Continuous Glucose Monitor) — a system that tracks the glucose levels under my skin. There are two companies making CGMs for the US market currently – Medtronic and Dexcom – and both systems work essentially the same way:
A disposable sensor, changed out every week, has a small wire that sits below the skin and measures glucose in the interstitial fluid. This sensor connects to a reusable transmitter, which sends raw data from the sensor to a receiver, which in turn uses an algorithm to generate a graph of estimated blood glucose levels.
CGMs don’t replace blood glucose testing — they require fingersticks for calibration, and there’s a bit of a lag between the sensor and actual blood glucose levels – but the trend information is incredibly useful.
Imagine you’re driving a car that has no windows or mirrors, only a sunroof – and you have to keep popping your head out to get a brief glimpse of the curves in the road and the hazards in your way. When I got my first CGM, I suddenly found myself in a car with windows for the first time in over 10 years, able to spot trends in my glucose levels and head off potentially dangerous lows and highs.
But all of this comes at a price – one sensor, good for about a week, runs about $75-100. Transmitters are reusable but need to be replaced every 6 to 12 months, to the tune of about $1400 per year. Then there’s the receiver, which is an insulin pump in the case of Medtronic (roughly $6,000) or a standalone device in the case of Dexcom (about $1,000). Fortunately more insurance companies are starting to see the value of covering this technology, but the out-of-pocket burden is still incredible.
And several expensive CGM systems later, I’m still using pretty much the same technology I had 7 years ago. Back then, I was using a Palm Treo. The word “app” was not a part of the mainstream vocabulary.
Medical technology moves at a snail’s pace because there’s a lot of red tape in place to ensure that things actually work before they’re put on the market. This is why the glucose sensors and insulin pump that I wear 24/7 are still pretty much unchanged – every little feature addition is something that needs to be tested and retested to ensure it doesn’t introduce some unforeseen risk for the end user. That’s understandable, but depressing, especially compared to the pace of wearable innovation.
That’s why it’s quite a jarring contrast to follow this new explosion of wearable health devices, because the production cycle moves much quicker without the whole FDA clearance bit – but there’s also a big risk that these new devices won’t actually work as advertised.
Leslie’s experience with several Fitbits, Nike Fuelbands, the Polar Loop and a gamut of digital pedometers confirms this, at least on a “steps” level. Most bracelet-styled pedometers, for example, don’t count correctly when the “wearable arm” is connected to ground in any way — pulling a suitcase (she does a lot of that), walking dogs on leashes (that too), or holding on when on a treadmill.
She reports that there’s invariably “sync issues,” which highlight another unanticipated ogre of tracking your active life: The botched streak. The Nike Fuelband design team brought this to the foreground with its quirky little app-side dude, named “Fuelie,” which bounces and squeals on every new accomplishment — like the number of consecutive days of hitting “goal.”
Then, the Fuelband breaks (usually within eight months, and always the same way: It shows as charged when plugged in, then displays the “charge me” icon immediately upon removing power.)
Suddenly, you’ve lost your “streak,” but not because you didn’t reach your steps goal. As Leslie puts it: “And at that moment, you realize that your life is freakishly controlled by a little dancing digital icon” — in her case, a 249-day streak — because the only way to correct the streak is to actually pick up the phone and call Nike. (Which has the best customer service of all of them, she adds. But still.)
On the consumer-grade medical wearable end, there’s the GoBe Wristband – a glorified pedometer that claims to be able to calculate calories consumed by unobtrusively tracking glucose levels under the skin.
I’m skeptical about this one for a number of reasons, but mainly this: If you don’t have diabetes, your blood glucose levels won’t fluctuate much at all, even if you have 5 gallons of ice cream and a barrel of root beer for lunch — so the whole premise of tracking calorie consumption this way doesn’t make a whole lot of sense. Yet, over 4,000 people signed up for a GoBe Wristband on Indiegogo, pouring about $200 each into technology that probably doesn’t work as advertised.
As someone who’s lived with diabetes for most of my life, my data is for the most part accurate, but I need it to be seamless. Right now, I have to connect all my devices (CGM, glucose meter, insulin pump) to my computer and download the data, then compare a bunch of different reports in order to make adjustments to my treatment regimen.
Instead, I want everything – my CGM, my insulin pump, my glucose meter, my bike computer, my pedometer, and my desk chair – to send data automatically and wirelessly to a single source, where it can be analyzed for larger trends without taking up my whole day and making my brain hurt.
These devices should all work together to keep track of the larger patterns and the smaller victories, to simplify living with a chronic illness and keep burnout at a minimum.
My phone could alert me to the fact that I’ve been running high in the evenings and may need to tweak my insulin dosage, and then congratulate me when I keep my glucose levels in range for a full 24 hours (known among CGM users as the elusive “no hitter”).
And when I start stepping up the intensity of my workouts, and my blood glucose levels are likely to end up in the trenches overnight, maybe my phone could offer to set an alarm?
With big players like Samsung and Apple now building frameworks to combine data from 3rd party apps, we’re hopeful that some of the major hurdles with respect to security can be cleared. Maybe then medical devices can start talking to our other gadgets, and we’ll finally be on the way to having wearables that simplify our lives, instead of just adding angst.