What can Apple Health really do for people with diabetes? It’s a question we’ve had on our minds for a while now as the notion of a “seamless connection” between various diabetes devices and the ever-evolving and improving Apple HealthKit and Apple Health app become an increasing reality.
By this point most of us know what Apple Health is. The app consolidates health data from a person’s iPhone, iPad, Apple Watch, and various third-party apps, allowing people to view all of their health and lifestyle data, goals, and progress in one convenient place.
Decoding the Apple HealthKit
Let’s start with terminology. According to DIY tech guru and diabetes advocate Kathryn DiSimone, who is currently working with Tidepool to release Loop, the open-source, DIY insulin delivery app, as an Apple-supported, FDA-regulated app, people trip over the terms.
HealthKit refers to the database and integration point for a user’s health data. While the Apple Health app is the mobile app itself that’s used to manage HealthKit.
Apple apps ask iOS users permission to read and write specific data types to HealthKit, DiSimone tells us. The apps that write to HealthKit are called “sources” in the Apple Health app. DiSimone added that users can always change a source's permissions through the Health app interface, as well as interface with the stored data for each source.
As more and more devices and apps interface with HealthKit, more and more data is stored. That data can then be accessed, tracked, and used in real-time by users via the Apple Health app.
It’s not as confusing as it may sound. When third-party apps properly communicate and work with HealthKit, users can manage their health data from one single app, Apple Health, versus opening one app to check your glucose, another to see your last insulin dose details, another to correlate your nutritional intake with your glucose trends, and yet another separate app to see how your activity or sleep patterns may be affecting your care.
DiSimone, for example, says she uses the Apple Health app to retrieve data about her T1 daughter’s carbohydrate, blood glucose, and insulin history. “When we are at an endocrinology appointment and the question comes up ‘How many carbs per day is she eating?’, we can simply open the phone and see the data waiting for us in Health app,” she says.
Since last fall’s Apple Health overhaul, where insulin delivery tracking and several other new features were introduced, diabetes devices and apps have made a push to better operate with HealthKit, shedding proprietary controls over health data to a certain level and recognizing that Apple Health’s versatility and catch-all nature are hugely convenient. Users we’ve heard from in our community are pleased with the results and finding more and more ways to make Apple Health work with their diabetes tech setups.
For instance, with the right set up, a quick look at the Apple Health app can show one’s last-measured BG result, last insulin dosage details, detailed nutritional data, and detailed activity breakdowns, including steps taken, hours standing, active energy, and resting energy measurements.
Consider these images, which DiSimone shared with us:
Data can be sorted by day, week, or month. And detailed information about particular date ranges can be isolated and viewed. Fore example, you can see your average basal and bolus amounts for a two-week period.
All of that brings us to the question of whose tech currently works with Apple Health, how exactly, and how well?
Dexcom and Apple Health
Dexcom has long been a leader in integrating with the Apple Health app. Dexcom G5 and G6 mobile apps share data with Apple HealthKit. By linking the two apps, PWDs (people with diabetes) can see critical information about their glucose levels integrated with information about their activity, sleep, mindfulness, and nutrition.
One interesting thing to note: by connecting the Dexcom app with the Apple Health app, PWDs can also share retrospective glucose data with other third-party apps, making it easier to draw a correlation between glucose levels relative to meal times and choices, workouts, or sleep patterns. In effect, Dexcom doesn’t stop at communicating with just Apple Health.
Which Dexcom products are integrated fully with what Apple platforms at this point? The Dexcom G5 and G6 systems are compatible with all of the latest iPhones and every generation of the Apple Watch. Dexcom has a helpful compatibility chart here.
Direct communication to Apple Watch is still in development, the company notes. The system currently requires a compatible iPhone to serve as an intermediary between Dexcom’s CGM transmitter and the Apple Watch. Basically you can’t run your data via an app on the Apple Watch itself. Instead, you have to use the Apple Watch app on your phone.
Another thing to note: Dexcom shares glucose data with Apple Health passively rather than in real-time. The Apple Health app receives a patient’s glucose information on a three-hour delay. That means you’ll still have to open the Dexcom app to see real-time readings.
The company tells us that compatibility with the Health app is designed for patients to look at glucose trends over time, relative to activities or events, rather than to monitor glucose levels in real-time. So while seamless integration is more or less a thing, Dexcom holds back real-time monitoring in order to continue patient use of its own app.
In order to enable data communication between your G5 or G6 app and the Apple HealthKit, go to the menu in the Dexcom app. Choose Settings. Then choose Health. Tap the “Enable” button to enable CGM data sharing with Apple Health. Tap the slider for “Blood Glucose” on the health access screen. Press the “Done” button.
One Drop and Apple Health
Earlier this fall One Drop became the first blood glucose monitoring platform to directly interface with Apple Watch, effectively cutting out the middleperson tech-wise, and allowing users direct access to diabetes data via a One Drop companion Apple Watch app.
The pairing eliminates the iPhone as an intermediary and makes One Drop the only wireless blood glucose monitoring system to connect directly to Apple Watch. Once paired, blood glucose data is transmitted from the Bluetooth-driven One Drop glucose meter directly to the watch. Users can simply open the One Drop app on their Apple Watch to access health information.
In the Apple Watch app, users can see real-time blood glucose information, manually log blood glucose, food, medication, and exercise. They can also view various daily statistics and diabetes management goals they set.
Instructions to pair your One Drop glucose meter with your Apple Watch can be found here. In order to allow the One Drop app and Apple Health to share data, you then have to enable sharing settings via the One Drop mobile app on your phone too. To do that, open the app. Go into settings. Click “Health Data Sync," then “enable” data to be sent to the Apple HealthKit. All health data compiled by Apple Health is then automatically added to your Apple Watch via the cloud.
Ascensia and Apple Health
In November, Ascensia Diabetes Care announced it would be updating its Contour Diabetes app to integrate and work with Apple Health. Contour has a popular diabetes care app that monitors trends in in blood glucose levels via the connected Contour Next One glucose meter. Users can now transfer their BG and carbohydrate data from the Contour app into Apple Health for more in-depth examination against other measured and gathered nutritional, activity, health, and lifestyle data reported to HealthKit.
The updated app is currently available in the Apple app store. After a user opts in, data collected by the Contour app will automatically show up within the “Blood Glucose” area of the Apple Health app.
While users can see the Contour data in the Apple Health app, the flow doesn’t work in the reverse direction. Information captured through Apple software can be stored in the Contour Cloud service, but the Ascensia app does not display these data.
In a press release, Ascensia acknowledged that many people with diabetes were already using Apple Health as their primary health tracking application. Their app update and decision to more fully integrate with Apple Health was the result of user feedback pushing for an elimination of the barriers between apps.
Loop and Apple Health
Maybe you’ve shed the proprietary nature of apps and gone open-source already or thinking of going that way.
Looping, or building a Loop, is the process of users creating their own closed-loop, artificial pancreas-like, glucose monitoring and insulin delivery system. It’s becoming increasingly popular and easier all the time as tech and open-source data trends advance. The system generally consists of an insulin pump, an iPhone, a CGM, and a RileyLink device.
Loop is a DIY, automated insulin delivery app that operates the homemade system. It contains the communication algorithms and the user interface to control insulin-dosing and AP functionality. (See this video for an Intro to Loop.)
Like other diabetes apps, Loop now stores its carbohydrate, blood glucose, and insulin data in HealthKit as well. That means people using a home-built loop system get long-term, secure storage of their insulin, carbohydrate, and blood glucose data on their phone. They also get secure backup in the cloud. DiSimone, who created the user guides for Loop, points out that having that Loop data in HealthKit also allows other apps to provide additional analysis beyond what the Loop app does.
Recently, Tidepool, the open-source data nonprofit, began an official project to support Loop and create an officially supported, FDA-regulated, Loop app that communicates with Aple HealthKit and is available via the Apple app store. An exciting announcement came just last week that Tidepool has received $6 million in funding from JDRF and the Helmsley Trust to complete this project.
Beta testing just recently started on the app, according to DiSimone, who joined Tidepool this Fall to help handle development. The Tidepool Mobile app is being updated to import Looper’s diabetes-related HealthKit data into their Tidepool account.
"This opens up a fantastic opportunity to do more detailed retrospective analysis on your own diabetes data," she says. "Future uses of HealthKit could include leveraging exercise and lifestyle data (for example, sleep cycles and heart rate) to improve Loop’s algorithm. HealthKit integrations with other apps and devices produce an amazing amount of available data that could all affect blood glucose-insulin interactions. Loop could potentially access and use that HealthKit data as part of algorithm development.”
While it remains to be seen exactly how the Tidepool Loop app and Apple Health work together, the trend is pretty clear at this point: Apple Health is increasingly being embraced by diabetes patients and diabetes device and tech companies as a catch-all health data compendium with crazy power to make both one’s access to information and day-to-day lives better. You can't argue with that.