Apple Makes Significant Progress Towards No-Prick Blood Glucose Monitoring for the Watch

Bloomberg (Bloomberg) — Apple Inc. is working on a moonshot-style project that dates back to Steve Jobs’ time: noninvasive and continuous blood glucose monitoring.

The purpose of this covert project, called E5, is to determine how much glucose is in someone’s body without having to prick their skin for blood. According to those familiar with the endeavor, the company now believes it can eventually bring glucose monitoring to market after passing critical milestones recently.

If developed, such a breakthrough would be a godsend to diabetics and help Apple solidify its position as a healthcare superpower. The ultimate goal of incorporating the monitoring system into the Apple Watch would also make the device a must-have item for millions of diabetics worldwide.

There is still much work to be done, but the move has the potential to upend a multibillion-dollar business. Diabetes affects roughly one in every ten Americans, and blood samples are commonly collected using a device that pokes the skin. Dexcom Inc. and Abbott Laboratories also make patches that are put into the skin and must be updated every two weeks.

Apple is adopting a different approach, employing silicon photonics chip technology and an optical absorption spectroscopy measurement technique. The technology employs lasers to direct certain wavelengths of light into a location beneath the skin containing interstitial fluid — chemicals that leak from capillaries and can be absorbed by glucose. The light is subsequently reflected back to the sensor in such a way that the concentration of glucose is indicated. The blood glucose level of a person is then determined using an algorithm.

Hundreds of engineers are working on the project as part of Apple’s Experimental Design Group, or XDG, a previously unknown endeavor similar to Google Inc.’s X division. It’s one of the most closely guarded projects at Apple, which is notorious for keeping things under wraps. It involves even fewer employees than the company’s self-driving car project, which is handled by the Special Projects Group, or the mixed-reality headgear, which is being developed by the Technological Development Group.

Shares of diabetic technology companies fell more than 3% on Wednesday as a result of the announcement, with both Dexcom and Abbott plunging more than 3% before recovering. Apple rose 0.3% to $148.91 at the New York closing.

Apple’s Cupertino, California-based representative declined to comment. Meanwhile, an Abbott official stated that the company is working on new glucose monitoring products. “Continuous innovation in health technology is vital,” said Abbott spokesman Scott Stoffel. “It’s also sophisticated and must be accurate, easy, and economical. Because our FreeStyle Libre solutions meet those needs, Abbott is the world leader in continuous glucose monitoring.”

During the last decade, Apple has tested its glucose technology on hundreds of people. It has employed the technology in human trials with patients who don’t know if they are diabetic, as well as persons with prediabetes and Type 2 diabetes. It has compared its own technique to routine testing on blood extracted from veins and capillary blood samples acquired from a puncture in the skin.

Apple’s technology, which has been in development for more than 12 years, is currently believed to be in the proof-of-concept stage, according to the people, who asked not to be identified since the project is confidential. The company feels the technology is workable, but it needs to be scaled down to a more manageable size.

Engineers are working on a prototype device that is roughly the size of an iPhone and can be strapped to a person’s bicep. That would be a huge improvement over an earlier version of the system that rested on top of a table.

One of Apple’s technical aims is to develop a prophylactic tool that alerts people if they are prediabetic. They could then undertake lifestyle changes to try to avoid acquiring Type 2 diabetes, which happens when the body’s insulin is not used effectively. Apple’s regulatory team has already begun negotiations with the government about obtaining government permission for the system.

But, there is a reason why it is called a moonshot goal. Several startups, as well as some of the world’s largest corporations, have attempted and failed to develop a noninvasive monitoring system. Google unveiled intentions in 2014 to develop smart contact lenses that could assess blood glucose levels through teardrops. It put the complicated project on hold in 2018.

Apple’s top executives feel the company is well positioned to solve this problem, owing to its experience in hardware and software integration, as well as its large coffers. According to those familiar with the matter, Chief Executive Officer Tim Cook, Chief Operating Officer Jeff Williams, and Apple Watch hardware director Eugene Kim are all involved in the initiative, which has already cost hundreds of millions of dollars.

The Apple Watch has progressively evolved into a health-monitoring device. The initial model, released in 2015, had a heart-rate sensor but was focused more on fitness tracking. In 2018, the gadget received the capacity to capture electrocardiograms (ECGs) from the wrist. It can also detect body temperature and measure blood oxygen levels, which is useful for tracking women’s health.

The glucose system will rely on a set of silicon photonics devices and sensors built by Apple. The key chip that powers the function was built by Taiwan Semiconductor Manufacturing Co. TSMC, an Apple partner, that already manufactures the major CPUs found in iPhones, iPads, and Macs.

Before to switching to TSMC, Apple collaborated with Rockley Photonics Holdings Ltd. to develop the technology’s sensors and chips. Rockley formally acknowledged its work with Apple in 2021, sparking interest in the supplier. Apple later terminated the collaboration, and Rockley declared bankruptcy this month.

While Apple has achieved significant technological advances in the glucose project, it has recently suffered a setback: the group’s chief, longtime scientist and engineering executive Bill Athas, died abruptly at the end of 2022. A couple of Athas’ top subordinates, including managers Dave Simon and Jeff Koller, are now in charge of the project. They report to Apple’s chip chief, Johny Srouji.

Before joining the XDG team, the project was even more well-guarded: it operated as its own firm called Avolonte Health LLC, which was unaffiliated with Apple to any outside observer.

The company was headquartered in Palo Alto, around 12 miles from Apple’s headquarters. Team members wore Avolonte employee badges rather than Apple credentials. This technique kept Apple’s work, as well as its efforts to get patents and find partners, under wraps during human testing.

The research began in 2010 when Apple acquired RareLight, a business that promoted an early approach to noninvasive blood glucose monitoring.

Due to his personal health issues, Apple co-founder Steve Jobs instructed the iPhone maker to purchase the company. Apple hired RareLight’s founder, Bob Messerschmidt, to begin work on its own glucose monitor, which was initially designated E68. Messerschmidt is presently the CEO of Cor Health, a healthcare company.

The arrangement came about as a result of “Jobs’ vision of health care mixed with technology,” he explained in an interview. Former Apple hardware execs Bob Mansfield and Michael Culbert, according to many involved, were also significant factors behind the initiative.

Messerschmidt was succeeded as a project manager in 2011 by Apple veteran Michael Hillman, who retired in 2015. Avolonte Health was closed down when he left, and the venture became part of Athas’ XDG. The crew is now based near Apple Park’s offices.

—With thanks to Madison Muller.