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CGM Wars: Who Will Lead the Future of Metabolic Health Monitoring?
Jared Dashevsky, MD
September 15, 2024 • Estimated Reading Time: 11 minutes
GRAND ROUNDS
CGM Wars: Who Will Lead the Future of Metabolic Health Monitoring?
The direct-to-consumer continuous glucose monitoring (CGM) market is heating up fast. Major players like Abbott and Dexcom have entered the D2C arena, while wearable tech company Oura just made waves by acquiring metabolic health company Veri.
In this article, I’ll dive into what I’m calling the CGM wars, explore the growing consumer focus on metabolic health, and share what we can expect over the next year or two.
CGM Wars
CGMs are wearable technology that provides real-time feedback on patients’ blood glucose levels. Originally, they were medical-grade technology geared for patients with insulin-dependent diabetes. After all, insulin is a deadly drug, and it’s critical to have real-time feedback on blood glucose levels.
Over the past couple of years, however, CGMs have moved more into the consumer space. And it’s not just digital health companies leading the charge into consumer health. Incumbent CGM device makers Dexcom and Abbott have now both officially launched consumer-grade CGMs.
Have we officially entered the CGM wars?
Below, I provide a breakdown of the current CGM landscape and business moves.
Digital Health
Levels: provides a program that combines CGMs and a mobile app to help users understand their blood glucose levels and improve their metabolic health through diet and lifestyle changes. Price: over $200 per month.
Signos: offers a personalized weight loss program using CGM and AI technology to provide real-time blood sugar data and tailored nutritional advice. Price: over $200 per month.
Veri: combines a CGM with a mobile app to offer personalized insights and guidance for improving metabolic health through diet and lifestyle adjustments. More on them below.
Nutrisense offers a program that leverages CGMs and personal nutritionist support to provide insights into your body's unique responses to food. The goal is to optimize metabolic health and support wellness goals. I’m using this right now and have so far enjoyed their CGM solution. Price is $225 per month.
January.ai utilizes AI-powered glucose tracking and insights to help users improve their eating habits and overall metabolic health by predicting the impact of foods on blood sugar levels. It does not have a CGM, though.
Zoe: offers a program that uses CGM and personalized nutritional insights to optimize metabolism, energy, and mood based on individual glucose level responses.
Supersapiens offers a CGM designed to enhance metabolic efficiency and optimize energy, exercise, and recovery through real-time glucose insights.
Device makers
Dexcom: launched their consumer-grade CGM, Stelo. Dexcom already dominates the medical-grade CGM market, capturing 40% of it. Analysts expect Stelo to add $31 million in sales this year, reaching $200 million by 2025. The price is $89 per month.
Abbott: launched their consumer-grade CGM, Lingo. Unlike Stelo, Lingo is marketed to the general wellness consumer. Their website targets the wellness-focused demographic and resembles a startup despite Abbott being an incumbent. Currently, Abbott captures around 35% of the market. Their pricing model is a bit different than everyone else’s:
Business Moves
Oura, maker of Oura Ring, acquired metabolic health company Veri—just in time for the launch of Dexcom and Abbott’s consumer-grade CGM. This is a strategic move. Oura can essentially do everything but monitor blood sugar. It gathers heart rate, respiratory rate, and sleep data, compiling it all into an algorithm to output a recovery score. Now, Oura will integrate CGM data to further provide insights on how blood sugar affects overall well-being.
Why Focus on the Consumer Market?
There are three reasons for these digital health companies and device makers to double down on the consumer market:
Consumers want to track their health: Recent findings from a Deloitte consumer survey highlight the growing adoption of smartwatches and fitness trackers, with a notable increase in ownership and usage for health monitoring purposes. The data show that many users not only track their fitness and health metrics through these devices but also share this data with their medical providers, further bridging the gap between consumer technology and healthcare.
Total Addressable Market is large: there are around ~100 million Americans with prediabetes, and 70% of those may progress to type 2 diabetes. Additionally, around 38.4 million Americans, or ~12% of the population, have diabetes. It’s unclear, though how many are non-insulin dependent. You also have the worried-well wealthy market. These are the folks who are already purchasing/subscribing wearable tech like WHOOP, Garmin, Oura Ring, etc.
D2C Headwinds: Initially, I thought companies in metabolic health (CGMs, diabetes management, weight management) needed a business-to-business model to succeed. Considering the costs of CGMs (and GLP-1s, for example), it seemed the market could quickly become saturated, with only the wealthy affording high fees and medications. However, major device makers and drug makers are entering the consumer market, showing significant economic potential, likely backed by research.
Dashevsky’s Dissection
I’ve been following the continuous glucose monitoring (CGM) space for a while now, and my perspective has evolved. Initially, I dismissed CGMs as an unnecessary gadget catering to the worried wealthy—those who are healthy but hyper-focused on monitoring. But now, I see CGMs as a valuable tool for individuals at risk of developing type II diabetes. That said, I still don’t think they’re necessary for everyone.
Affordability is also improving, which changes the game. We could see a shake-up with Dexcom and Abbott entering the consumer market. Their pricing models are significantly lower than many digital health companies selling CGMs. Why pay $200/month for Levels when Dexcom offers theirs for $89/month? Of course, the features and insights differ between companies, but Dexcom and Abbott’s presence might drive down subscription costs for other CGM providers.
Their lower pricing could help them quickly capture market share, especially as more people focus on improving their metabolic health.
The metabolic health market itself is maturing, moving beyond just lifestyle changes like exercise and diet. We’re in the medication era now, with GLP-1s, and CGMs are poised to be the next big step. Consumers will be regularly tracking blood sugar while using GLP-1s and participating in weight management programs. We might as well call this the era of “GLP-1-as-a-service + CGM.”
Don’t be surprised if CGM acquisitions follow. Oura’s recent acquisition of Veri is likely just the start. My prediction? WHOOP could acquire Signos, or Found might acquire Zoe. I wouldn’t be shocked if these dominoes start falling soon.
In summary, the CGM wars are intensifying as major players like Dexcom and Abbott disrupt the market with more affordable pricing. This shift is pushing CGMs beyond the “worried wealthy” into mainstream metabolic health, especially for those at risk of type II diabetes. With further market maturation and potential acquisitions, CGMs may soon become a vital tool in weight management and GLP-1 programs.
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