Do Diabetics Really Get the Care They Need, or Do Companies Like Apple Just Want More Users?

In recent years, Apple has made significant strides in healthcare, particularly through its Apple Health ecosystem and Apple Watch innovations. The company is reportedly working on a secretive initiative called Project Mulberry, which aims to redesign healthcare using AI and consumer data. But does this mean diabetics are getting the care they need, or is Apple simply looking to expand its user base?

Diabetes Management

Apple has long been rumoured to be developing non-invasive blood glucose monitoring for the Apple Watch, which could be a game-changer for diabetes management. While a working feature has not yet been released, Apple continues to enhance its health tracking capabilities, including heart rate monitoring, ECG functionality, and activity tracking, which are all beneficial for individuals managing diabetes. Even if there is a huge desire from Apple, Samsung, and other smartwatch manufacturers to come up with a non-invasive blood sugar tracker via simply a watch on the wrist, it seems to be quite difficult to create a reliable blood pressure tracking solution that can be attached to the surface of the body. The measurements are incorrect and the smartwatch requires continuous calibration. Would it be realistic to expect that a non-invasive blood glucose monitoring accurate and reliable enough for clinical use in a form of a smartwatch is around the corner? Not at the moment, and here is why:

1. The Challenge of Measuring Through the Skin

Low Glucose Concentration in Interstitial Fluid

Smartwatches typically aim to measure glucose in the interstitial fluid (the fluid surrounding cells) rather than directly in the blood. The concentration of glucose in this fluid lags behind blood glucose levels and is much lower, making it difficult to detect accurately through the skin.

Interference from Other Substances

The skin and underlying tissues contain many other substances (like water, hemoglobin, and other biomolecules) that can interfere with the signals used to detect glucose. Isolating the specific signal from glucose is a significant technological hurdle.

Individual Variability

Skin thickness, hydration levels, temperature, and other individual physiological factors can vary significantly and affect the accuracy of non-invasive measurements.

Signal Attenuation

Biological tissues, especially water, absorb light and other forms of energy used in many non-invasive techniques, weakening the signal that reaches the sensors and the signal that returns.

2. Limitations of Current Non-Invasive Technologies

Many different technologies have been explored for non-invasive glucose monitoring, including:

Near-Infrared (NIR) Spectroscopy

While promising, NIR struggles with interference from water and hemoglobin, limiting accuracy.

Raman Spectroscopy

This method can directly identify glucose molecules, but often suffers from weak signals and requires sophisticated equipment.

Radio Frequency (RF) and Microwave Sensing

These approaches are still in early stages and face challenges in specifically targeting glucose and achieving sufficient accuracy.

Photoplethysmography (PPG)

Primarily used for heart rate and oxygen saturation, its correlation with glucose levels is indirect and not yet reliable for accurate monitoring.

Other methods

Bioimpedance, ultrasound, and fluorescence have also been investigated but face their own technical limitations regarding accuracy and reliability.

3. Accuracy Requirements for Medical Devices

Blood glucose monitors are medical devices that require a high degree of accuracy to ensure patient safety. Inaccurate readings can lead to incorrect insulin dosages or treatment decisions, potentially causing dangerous health consequences (hypoglycemia or hyperglycemia). Current non-invasive smartwatch technologies haven't yet consistently met these stringent accuracy standards. Regulatory bodies like the FDA have even issued warnings against using smartwatches or smart rings that claim to measure blood glucose non-invasively due to a lack of proven accuracy.

4. Calibration Issues

Some non-invasive devices require frequent calibration against traditional finger-prick tests or continuous glucose monitors (CGMs). This defeats the purpose of being truly non-invasive and highlights the underlying limitations in their measurement accuracy.

In summary, while the concept of a non-invasive blood glucose monitoring smartwatch is highly desirable, the current technological limitations in accurately and reliably measuring glucose levels through the skin, amidst various biological interferences and individual variations, prevent them from being a viable alternative to existing invasive or minimally invasive methods.

Market Disruption and User Loyalty

Apple has a long history of disrupting existing markets. They also have very loyal users and ridiculously high brand recognition. In 2023, Apple sold 38 million watches, and in 2024, they sold 54 million. It is unlikely they could introduce glucose monitoring into an existing watch, but Apple users are accustomed to upgrading to the latest and greatest.

Leading Providers of Glucose Monitors

The leading provider worldwide for wearable glucose monitors is Dexcom, followed closely by Abbott with its FreeStyle Libre system. These companies dominate the Continuous Glucose Monitoring (CGM) market, which is projected to reach USD 20.2 billion by 2032. Estimates suggest that millions of people globally rely on CGM devices, with Abbott reporting over 4 million users of its FreeStyle Libre system. Dexcom also has a significant user base, though exact figures vary.

Market Penetration and Growth Potential

The relatively small penetration of wearables among diabetics indicates it is still a growth market. It also means that the industry could be consolidated or dominated by a major consumer brand, such as Apple, Samsung or Garmin. What role would an AI-powered health management application for diabetics play in it?

Competitive Landscape of Health Management Apps for Diabetics

MySugr was established in 2012 and has 5 million registered users at the moment; Diabetes:M was established in 2013 and has 2 million users. The space is crowded with many "diabetes apps" or rather general health management apps that are offering AI-powered features analytics, diet tracking, meal prep; unfortunately, there isn't a single to go app that would have everything that diabetics need. It's becoming more and more obvious that there are plenty of half-baked solutions out there, but none of them puts the diabetics in the centre and truly considers their needs or what would be truly beneficial for them, not to mention the end goal of improving the quality of life and longevity. It's sad. Almost 600 million diabetics in 2025, with so many possibilities, gadgets and apps out there, still not a single, reliable solution that is fully focused on their needs.

Conclusion

While Apple's advancements in healthcare and diabetes management are promising, it remains to be seen whether these efforts are genuinely aimed at improving care for diabetics or simply expanding their user base. The crowded market and high expectations for user adoption present significant challenges. Ultimately, the success of Apple's healthcare initiatives will depend on their ability to deliver meaningful and differentiated solutions that truly benefit those managing diabetes.