Cheers to 2024, and happy New Year!

This is high on health. Every week, we dive into the real deal of healthcare 🌟. Simple truths, big impacts. Innovations that make you go 'wow' 🤩. In understanding, we find our power 💪. Stay cool, stay informed.

I just wrapped up a two-week break. It was solid. Time off, a chance to unplug or plug back into family life, brings pure joy, calm vibes, and a recharge. But let's be real 😅. Holidays are cool, sure. Did I mention my three kids, 10, 7, and 4? They've been banking questions and requests, waiting for that exact moment I'm about to take a chill nap 🙈. But hey, it was still awesome. Monday's coming, and easing back into work mode will be the game.

Did I ever say I'm a winter fan? Yep, I enjoy the cold outdoors, then cozying up by the fire to warm back up. That's my spot for reading, letting my mind roam, diving into those tempting rabbit holes. Morgan Housel's take on passive learning? Love it. That's mostly what I do; I never put a name to it. 🤔❄️

Finally, snow showed up. After buckets of rain and floods, it got chilly, and boom - snow this morning. Up north, this means beach time with a twist: snow on perfect sand. Mind-blowing, right? 🌨️🏖️ But heads up: the wind today was no joke. It felt way colder than the 0°C (32°F) my watch claimed.

In today’s newsletter, we're diving into wearables, like my smartwatch. Think electronic gadgets you wear on your body. I've been digging into CGM (continuous glucose monitoring) and the latest developments to share. Recently, twice, I met healthy folks (not diabetic) who showed me their app readings 📊. The insights they got? Let’s discuss it!

Keep reading if you're curious about the backstory, types, and uses of CGM. Got thoughts on clinical vs. wellness use? Into the latest trends and key players? Or maybe you just wanna sound smart at the next pool party. 🕶️ 🌊 Dive in with me.

Take care!

The Evolution and Future of Continuous Glucose Monitoring: CGM's Past, Present, and What's Next

Intro: The CGM Lowdown

A CGM today is a sleek medical gadget that keeps tabs on your glucose non-stop, updating roughly every 5 minutes. You stick a small sensor onto your belly or arm, secured by an adhesive patch. It reads glucose in the fluid around your cells, day and night. The sensor needs a swap every 7 to 14 days.

It's wire-free. A tiny transmitter on the sensor beams your glucose data to a monitor or your smartphone app – no extra gear is needed.

Beyond the steady flow of info, CGMs alert you if your sugar levels spike or drop. Customize these alerts to suit your needs.

CGMs have flipped diabetes care on its head. Unlike a single reading from a fingerstick, CGMs give a full picture with about 288 readings a day (every 5 minutes). 📊 📲 

The Backstory: CGM's Roots and the DIY Wave

CGM started in the late 20th century, born from the need for better blood sugar monitoring in diabetics than just finger pricks. Medtronic, Dexcom, and Abbott led the early development. First users, mainly Type 1 diabetics, dealt with bulky, often off-base devices needing constant checks.

The game changed with tech-savvy diabetics stepping in. Frustrated by limits, they hacked these devices, using open-source software to get real-time data, share it for safety, and sync with phones and smartwatches. This led to DIY artificial pancreas systems, combining CGM data with insulin pumps for a self-adjusting system.

Online communities like GitHub, forums, and social media have become innovation hubs. Projects like Nightscout and Loop came from this drive. This DIY spirit shaped today's CGM devices, making them more open, user-friendly, and precise.

Ultimately, CGM's evolution is a tale of patient-driven innovation meeting tech advances. From simple tools to complex systems, it's changed diabetes management, showing the power of community in healthcare tech. 📈🤖🤝

CGM Types: The Variety

Today, CGM systems are diverse and tailored to different needs and styles. I mentioned ways to categorize them to provide an overview. Each of those topics could be a deep dive of its own. Let's break it down:

1. Tech Talk:

   1. Traditional CGMs: Under-the-skin sensors need finger-prick checks for calibration.

   2. Flash Glucose Monitoring (FGM): Like traditional but needs a manual 'scan' for data.

   3. Non-Invasive CGMs: Cutting-edge tech, no skin pricking, using optical sensors.

   4. Long-term Implantable CGM: An implanted sensor that can last to 180 days.

2. Use and Application:

   1. Long-term CGMs: Stick with you for 7 to 14 days.

   2. Short-term CGMs: Quick checks or diagnostics, shorter lifespan.

3. Connectivity and Data Handling:

   1. Standalone CGMs: They have their own screen for data.

   2. Smart CGMs: Sync with phones or watches, with features like alerts and cloud storage.

   3. Closed-Loop/Artificial Pancreas: These are paired with insulin pumps for automatic insulin control.

4. Approval and Regs:

   1. FDA-Approved CGMs: The official way, tested and approved.

   2. Research CGMs: For studies and trials, not for the everyday user.

5. Who's It For?:

   1. Medical CGMs: The diabetes population usually needs a doctor's note.

   2. Wellness CGMs: For the health-conscious, tracking how lifestyle affects glucose.

The "who's it for" part of CGMs has shifted in recent years. It's not just diabetics anymore. Healthy folks are using them, too, tweaking lifestyles, not just managing medical needs. It's a leap from medical to wellness, from need to optimization. 🏃‍♂️💪

CGM's Dual Roles: Clinical and Wellness

CGM's stepping into the wellness world was big news. Then, Apple's "no-prick" CGM project made waves, a vision from Steve Jobs' days, showing how CGMs are more than a medical device.

CGMs are a hit not only with diabetics but fitness buffs too, all after that blood sugar insight. Companies like Dexcom and Abbott are leading this shift with new tech for both health and lifestyle.

CGMs have evolved: from cassette player-sized devices to tiny, penny-sized sensors. They help dodge sugar highs and lows, sending alerts to keep things in check. This shines a light on how food choices impact our bodies. Yet, some of these user-shared insights? They're pretty much what you'd expect. Simple, clear-cut stuff.

Social media's buzzing with CGM stories, though science hasn't fully caught up. Still, startups like Levels and Signos are pushing boundaries, blending CGM data with lifestyle choices, aiming for better health outcomes.

Doctors are cautious, though. CGMs can inform, but they need context. Misreading data can lead to skewed lifestyle choices. Yet, they're potential tools for deeper body understanding under the right guidance.

As the wellness market grows, CGMs are finding their place. From health tech companies to startups, they're shaping a new narrative in health monitoring. It's a mix of tech innovation and consumer education, with a dash of skepticism from nutrition experts. But one thing's clear: CGMs are more than just a diabetic's tool; they're a window into personal health for many. 📈💡🏃‍♂️

Looking Ahead: CGM's Tomorrow

Two recent innovations tackle glucose monitoring from opposite ends: highly invasive to completely non-invasive.

Eversense E3: A 180-day CGM with FDA and CE Mark approval, made by Senseonics and Ascencia Diabetes Care. It's straightforward: a six-month, under-skin sensor. A transmitter sends data to your phone. The app tracks and alerts. Main advantage? Only two sensor changes per year.

Afon's working on a breakthrough: Glucowear, a non-invasive, wrist-worn RF sensor. It promises instant, real-time data. Set for a 2024 launch, it faces regulatory hurdles. Glucowear means no pain, constant monitoring, smart device connection, no extra costs, and a two-week battery life. Fits under a smartwatch.

Movano's in the race, too, with a similar tech for a smart ring. They start with blood pressure, and then shift to glucose.

Then we have weight loss, which is always a big market, booming thanks to GLP-1 drugs like Ozempic and Wegovy. Their sales skyrocketed in 2023. These drugs, mimicking gut hormones, curb appetite and have become a key player in the obesity fight.

Signos, a five-year-old startup mentioned above, partners with Dexcom for CGMs and has secured $20 million in funding to advance its research. Their model includes various plans, the longest being a six-month commitment, including CGMs in the cost. Signos aims not for quick fixes but sustainable weight loss journeys. Fouladgar-Mercer, Signos' co-founder, driven by personal struggles with weight, sees CGMs as a key to unlocking individual metabolism mysteries. For a tailored approach, Signos combines glucose data with sleep, heart rate, and exercise data from devices like the Apple Watch.

Fouladgar-Mercer views GLP-1 drugs as a jump-start for weight loss but emphasizes the role of platforms like Signos in maintaining long-term health. His vision for Signos is to use data-driven technology for sustainable lifestyle changes.

And Dexcom and Abbott? Both are busy downplaying the risk of the GLP-1 revolution and its impact on the Type-2 diabetes CGM market:

• Abbott analysis finds FreeStyle Libre CGM and GLP-1 drug adherence rise when used together

• Dexcom: Glucose monitoring doubles when diabetics take weight loss drugs

Wrap-Up

CGMs: crucial for some, intriguing for others. This tech is getting sleeker and more user-friendly. There's a market brewing. I haven't tried one, mainly due to cost vs. benefit for just wellness. But if it syncs with smartwatches? Count me in for some data play. 📟⌚

I would love to get your thoughts and comments!

Gardner's Theory of Multiple Intelligences

I tuned into Lex Friedman's podcast with Jeff Bezos recently. I highly recommend it. Bezos dropped a quote that stayed with me, like many of his insights from that chat:

That sparked my interest, and I found Howard Gardner, a Harvard psychologist, who flipped the script on intelligence. Forget just IQ tests. Intelligence isn't just inborn potential, a score, or fixed.

Gardner suggests a broader view: multiple intelligences. He lists eight types:

• Visual-spatial

• Linguistic-verbal

• Logical-mathematical

• Body-kinesthetic

• Musical

• Interpersonal

• Intrapersonal

• Naturalistic

It's a whole new way to see smarts. I feel where I’m playing and where I need training wheels..

From the same podcast with Bezos and Friedman, a point ties in well with our CGM data chat.

I believe in data but admit most big life choices were gut-driven. I value anecdotes and love good storytelling. Part of this might stem from the skepticism of the McNamara Fallacy: the idea that rational decisions come purely from numbers, ignoring the immeasurable yet crucial stuff. It's named after Defense Secretary McNamara's approach to the Vietnam War, trying to quantify everything.

See you out there! ✌️

DISCLAIMER: None of this (such as text, graphics, images, and other materials) is medical or health advice. This newsletter is strictly for informational, educational, and entertaining purposes only. While I’m a medical doctor and a dentist by training, I’m not your doctor. The content is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on high on health! Please be careful and do your research.