I Hated, but Now Support Continuous Glucose Monitors

Healthcare consumerism places individuals in the driver’s seat in their healthcare decisions. With the advent of wearable tech, consumers have more data then ever at their fingertips. One principle question comes up, though, for consumers:

1. Is this data meaningful?

In this article, I’ll touch on healthcare consumerism, highlight the continuous glucose monitors (CGMs) space, and then dive into what I feel is the efficacy of CGMs.

Healthcare Consumerism

Healthcare consumerism and, specifically, wearable tech, represent a transformative shift in the healthcare industry, emphasizing patient empowerment and access to personal health data. This approach encourages patients to become active participants in their healthcare decisions, similar to their engagement in retail or major purchase choices.

At the forefront of this movement is the integration of wearable health technology, which gives patients direct access to their health metrics, thereby placing them in command of their health and wellness.

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 reveal that a significant portion of 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.

The Deets: Continuous Glucose Monitors

CGMs are wearables the provide real-time feedback on consumers’ blood glucose levels.

Originally, CGMs were medical-grade technology geared for patients with type 1 diabetes, allowing them to control their sugars during fasting and post-prandial periods.

Over the past couple of years, CGMs have moved into the type 2 diabetes management kit, allowing these patients who use insulin to monitor their blood sugar trends. Personally, I’ve prescribed CGMs for these types of patients, and the 24/7 blood sugar trends help me better manage their diabetes. It also helps that Medicare covers CGMs for these patients with type 2 diabetes, making such technology accessible to those who need it.

Around the pandemic, when digital health funding was exploding, digital health startups offering consumer-grade CGMs began to take off.

While medical-grade CGMs were made to monitor blood sugar trends in patients with type 1 or uncontrolled type 2 diabetes to better titrate insulin and other anti-diabetic regimens, consumer-grade CGMs were made for behavior modification in consumers not on insulin or a hefty anti-diabetic regimen. Consumers with these CGMs could see how their sugars respond to food and activity and tweak their behavior to better keep their sugars within a healthy range. The advantage of these consumer-grade CGMs is that they’re optimized for the user-experience and allow seamless integration with mobile apps that display the data nicely.

The direct-to-consumer CGM space is relatively nascent, with only a handful of companies offering programs that integrate CGMs into their platforms. I group these companies into the Metabolic Health space.

• Levels: provides a program that combines the use of a CGMs and a mobile app to help users understand their blood glucose levels and improve their metabolic health through diet and lifestyle changes.

• Signos: offers a personalized weight loss program using CGM and AI technology to provide real-time blood sugar data and tailored nutritional advice.

• Veri: combines a CGM with a mobile app to offer personalized insights and guidance for improving metabolic health through diet and lifestyle adjustments

• Nutrisense: offers a program that leverages CGMs and personal nutritionist support to provide insights into your body's unique responses to food, aiming to optimize metabolic health and support wellness goals.

• 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

• 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 aimed at enhancing metabolic efficiency, designed to optimize energy, exercise, and recovery through real-time glucose insights.

• Dexcom: the OG CGM device maker that will be launching a consumer-grade CGM over the summer called Stelo.

The above companies are aimed to improve metabolic health, which is great. However, the major barrier right now is the cost prohibitiveness of the CGMs, since they’re not covered by insurance. Just browse any of the above companies’ website to see how joining costs $100+ per month.

Dashevsky’s Dissection

I love the use of CGMs in my patients with uncontrolled type two diabetes. With CGMs, there’s no need for quarterly hemoglobin a1cs, since I can see a patient’s fasting glucose from the morning of the visit. This accurate, real-time data makes it worlds easier (and safer) to titrate a patient’s diabetes regimen. It’s truly remarkable, and I’m sure other folks in the primary care setting feel the same way.

Now, I’ve previously held strong views on the use of CGMs in consumers without diabetes, especially those not on insulin:

The physiology has not changed, but my views have—only slightly.

First, as the Metabolic Health space expands, there’s a growing focus on treatment vs prevention:

• Treatment: treating metabolic health conditions such as overweight/obesity with GLP-1s.

• Prevention: preventing the onset or exacerbation of metabolic health conditions such as overweight/obesity/diabetes.

I now feel there’s significant potential for CGMs to prevent the progression from prediabetes to type 2 diabetes in the 90 million Americans at risk. One study estimated that 70% of those with prediabetes will have type 2 diabetes within their lifetime. The current issue is that “lifestyle modifications,” are often first prescribed for prediabetes. But such modifications can be challenging due to varying social determinants of health like access to fresh food and green spaces. Additionally, these lifestyle modifications are vague and the only objective metric for progress is weight loss, which may take weeks to realize.

This is where CGMs can play a huge role.

CGMs offer tangible insights into how diet directly impacts glucose levels, providing a clearer path towards managing prediabetes with real-time feedback on dietary effects and fasting glucose trends. Those with prediabetes can see how tweaking different aspects of their daily meals affect their sugars, allowing for more robust management of their sugars, potentially preventing progression to type 2 diabetes.

Of course, the issue right now with CGMs is costs. The subscriptions are unaffordable for the general population, and I doubt insurers would cover CGMs anytime soon. Currently, companies like Levels are capitalizing on the demand among health-conscious individuals willing to pay a premium for detailed health monitoring, even if they may not strictly need it.

We’ll see how my opinion changes throughout my medical training.

In summary, healthcare consumerism and CGMs are empowering patients with data-driven insights to improve their health. The evolution of CGMs from a clinical tool for diabetes management to a consumer-grade device for broader metabolic health monitoring has the potential to prevent the progression from prediabetes to type 2 diabetes. But current challenges posed by the cost and accessibility of these devices may prevent widespread use and benefits.