Last Fall, my husband came home with an Apple Watch for me and said, “Just try it, I think you’ll like having your Dexcom CGM data on your wrist.”

I’d been resistant to smartwatches because they felt so large on my small wrist. But within a week, I was loving the data and didn’t look back.

That’s kind of how using the new Klue app worked out for me as well. Currently available to Apple Watch users, Klue tracks your fluid intake and food consumption via wrist movements, and provides reminders to nudge users into building healthy habits.

Klue comes from a San Mateo, CA, startup with close ties to Stanford University. The idea of building an app that offers "personalized consumption graphs" for users is a first step towards the company's ambitious goal to develop a "groundbreaking operating system for behavior change."

We wrote all about Klue after they presented their app at the Fall 2018 DiabetesMine University D-Data event. They're initially focused on the ability to detect when and how a user eats and drinks, but hope to create a platform that employs these consumption patterns to enable insights into health behaviors and a basis for positive change.

So while the Klue app will eventually be able to be used more widely, it is for the moment aimed at PWDs (people with diabetes) to help build positive diabetes management habits, specifically: taking insulin on time. People with type 1 diabetes, and those with type 2 who take mealtime insulin, can sign up for the free app here: http://goklue.com/t1d.

 

Bit of a Rocky Start

My own experience was positive overall, but it did have a bit of a rocky start to be perfectly honest. Sign up and set up were incredibly easy, but then I got to the part where you have to put your Apple Watch on your dominant wrist. As a right-hander, I’ve been wearing a watch on my left wrist since high school, so the switch felt unnatural. Even after three weeks, I found myself sometimes checking my left wrist. But I was able to eventually start feeling pretty normal wearing it on the right arm.

The other rough spot for me is that Klue replaces the watch face with its own. It’s a minimal, clean face that I like and it tracks my water consumption, but allowing Klue to take over means I can’t have my Dexcom data front-and-center to glance at with a simple flick of my wrist. While it is easy to jump to my normal watchface -- just press the crown and it takes you there -- this can sometimes be a challenge when your other hand isn’t free. Fortunately, Klue tells DiabetesMine that they'll soon be adding Dexcom data display to the Klue watchface, so that would add value for a lot of PWDs, I believe!

The final main contributor to my rocky start was that the Klue app was draining my Apple Watch battery super fast. I actually stopped using it after a few days and contacted the company about this. You see, I wear my Apple Watch approximately 23 hours per day, charging it when I’m showering and getting ready to go to work. Why? Because I track not only my movement and glucose on it, but also my sleep. I want ALL the data! The fantastic Scott Vogelgesang, director of partnerships at Klue, who I had the pleasure of meeting at DiabetesMine University (DMU), got back to me right away on the issue and gave me the recommendation to turn on "Workout Power Save" mode for my watch.

You see, Klue operates by essentially running a workout on your watch to actively track the movement of your arm. Apple Watch users are probably familiar with the Workout app that tracks their movements and provides their health data. Klue taps into this functionality, running a custom program throughout your day to collect data to build consumption graphs and provide reminders. Based on gesture recognition, it is able to detect when you drink and how much -- advancing the hydration wheel on the face of your watch, as well as when you’re taking bites of food. Running a workout will increase the frequency with which your watch checks your heart rate and that will drain a battery very fast.

Workout Power Save mode was a great fix for this problem I was having. It enabled me to wear my watch for the whole day, drop it on the charger while I prepared for bed (about 20-30 minutes) and then resume my regular hour or so of charging in the morning. Scott explained that the typical Klue user is wearing their watch just 13-18 hours per day, and seems to have success without needing to use the Workout Power Save mode.



Does Klue Deliver?

So the main question you want answered is: Does it work?

The short answer is YES! I found it very good at detecting food consumption.

Okay, it’s not perfect. It doesn’t catch 100% of all eating and drinking, especially when I’ve been drinking my water with my left hand at work so I can use my mouse. Also, it rarely catches me on my first bite, but by bites 4 or 5, I would get the alert: "Are you eating?" It was roughly the same for food that I was eating with my hands and food that I was eating with a fork or spoon. In Klue’s presentation at DMU, Founder Katelijn Vleugels (who’s lived with T1D herself for many years) cited that 1 in 4 boluses are late or missed.

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I’m generally good at remembering to bolus, and over the past seven years with type 1, I’ve rarely forgotten to bolus completely, but when I do, I'm also pretty good at the belated bolus. In the four-ish weeks I’ve been using Klue, it caught me in two instances when I had forgotten to bolus before eating.

A lot of us with type 1 pre-bolus for our food to give our insulin a 15, 20, 30 (or more!) minute head start to begin working. This can help us minimize the glucose spikes. Klue can’t predict that you’re going to eat in half an hour, so of course it isn’t helpful for the pre-bolus, BUT bolusing within the first few bites is still much better on your BG levels than bolusing after you’ve finished or when your CGM is alerting high because you forgot to take your insulin. So that's where Klue really can add value!

Clearly Klue is not solely for people with type 1, but for anyone with diabetes who takes mealtime insulin. Note that it does not yet integrate with CGM or insulin pump data.

 

Speculating Success

I’d like to speculate here for a moment: I see a lot of potential for this app that Klue has developed. As our technology moves forward with closed-loop systems and integration with our phones, an app like Klue that allows wearables to use tactile input could help improve the experiences and life overall for many users. It helps do away with the need to manually enter data, and at the same time, helps assure that important health behaviors like taking meds on time are not forgotten.

The closed-loop systems currently available and in the works still require users to "announce" that they are eating and enter the estimated carbs, which is just as easy to forget to do as delivering an actual bolus. Imagine that an app like Klue could automatically feed this critical information into the closed loop algorithm, prompting the system to release a meal bolus or even correct blood glucose spikes caused by eating.

In short, Klue seems to have great potential for the future, and we'd love to see more PWDs trying it out now.

If you have trouble remembering to bolus or need a reminder to drink more water, this app could be very helpful for you!

Has anyone else out there used Klue? How has it work for you?