Following the success of sleep-tracking rings and activity-analyzing watches, it looks like the next big thing in wearable health tech might be here.
A small crop of startups are promising to let you in on all the secrets hidden in your blood sugar – from what’s causing those fog-inducing highs and hangry lows, to how your body responds to both exercise and periods of rest.
And they’re betting that customers won’t mind sticking a sensor in their arms to find out.
The evolution of continuous glucose monitoring
Supersapiens, Levels in the U.S., and MyLevels in the U.K., are pairing continuous glucose monitors (CGMs) with slick app interfaces to provide insights aimed at helping us better understand our metabolic makeup.
While this technology might sound like science fiction, these devices are already commonly used around the world by people with diabetes. CGMs were introduced in the late 90s and changed the game for diabetes management. For up to two weeks, users wear them on the arms or belly, where a thin filament inserts into the skin. Now brands (and the device manufacturers) want to take them to a wider market.
In September 2020, medical devices maker Abbott confirmed that it had struck a deal with Supersapiens to launch a new CGM designed specifically for non-diabetic athletes, the Libre Sense. The platform went live three months later and now has 2,800 customers, including 12 English Premier League football teams and a number of Tour de France cyclists.
Meanwhile, Levels, a metabolism-tracking startup that uses Abbott’s Freestyle Libre model (a device commonly prescribed to people with diabetes) announced a $12 million funding round led by venture capital firm Andreessen Horowitz in November 2020. The company is currently beta testing its platform, and says it has a 100,000-strong waitlist for its 2021 launch.
In the U.K., MyLevels has been running beta tests with small cohorts since 2018, originally with the Libre Freestyle, and now with the Dexcom G6 sensor. Following one more round of beta testing in April, its plan is to launch publicly this summer.
Why track blood sugar?
Phil Southerland, the founder of Supersapiens, is a living testament to the power of glucose tracking.
At seven months old, he was diagnosed with diabetes and given a grim outlook by doctors, who weren’t sure if he’d make it past age 25. But the introduction of glucose testing, first with finger prick devices and later with CGMs, turned everything around. Ever since, Southerland – a professional cyclist – has been “hyper obsessed” with tracking his glucose levels alongside his sports performance. “Everyone knows donuts are bad for you,” he says. “But until you see that spike in your glucose after eating one, you can’t really quantify just how bad it is.”
For people not diagnosed with diabetes – and therefore not as informed on what affects their blood sugar levels – it may not seem like something to worry about. But an estimated 88 million American adults have blood sugar levels in the pre-diabetic range. The CDC reckons 84% aren’t aware of their condition. There are a number of health concerns, ranging from Alzheimer's to weight loss and gain, associated with out-of-range blood sugar fluctuations.
Southerland points out that it’s not just the food you eat that influences your glucose levels. There are 42 different factors, including stress and sleep, that can trigger a blood sugar response.
From medical device to consumer product
While CGMs aren't new, two hurdles have stood in the way of bringing them into the mainstream.
First, access to the devices themselves, which can be tricky depending on where you live. When Josh Clemente became interested in this tech back in 2017, while still an engineer at SpaceX, his U.S. doctors refused to write a prescription for the device for the purposes of, essentially, curiosity. As a workaround, Clemente imported them from Australia. CGM devices in the U.K., like MyLevels, don't have this problem. They can be purchased over the counter without a prescription.
When he finally got hold of it, Clemente said the CGM data changed his perception of his health. “With one device, I was able to see the impact of different meals on blood sugar control, but also corresponding quality of life,” he explains. Clemente, who went on to found Levels, thought he was suffering burn out, but it turned out to be blood sugar spikes.
Levels now works with a telehealth provider to prescribe the devices. Doctors are paid a flat fee regardless of whether they decide to prescribe or not. Broadly speaking, Clemente says the criteria is to be in generally good health, and not managing any kind of chronic illness (the CGM startups are all clear that their services are not to be used for monitoring diabetes).
The second challenge is around software, and how it can answer the question consumers so often have when it comes to their health data: what do I do with this information?
Southerland says Supersapiens spent 18 months developing its app, which not only shows users how their blood sugar levels change throughout the day, but can also identify and help manage optimal eating patterns for sport performance and analyze how exercise affects glucose levels.
The Levels app, meanwhile, provides helpful prompts based on the data flowing in, such as the best time to have a final snack before bed, and scores foods based on how they affect blood sugar. MyLevels, which has a similar food scoring system, also sends out boxes containing 14 different food products with which users can experiment and see how their blood sugar reacts.
MyLevel’s cofounder Laura Douglas says the app also prompts users to take "daily challenges." "These are things that might reduce your blood sugar levels,” she explains. “Things like having a cold shower in the morning can actually reduce [your] levels on that day.”
Taking existing tech and improving the UX experience is a tried-and-tested strategy among wearable health tracking firms. “Most rest-based heart rate devices have a little optical sensor that costs a few pennies – that’s the core technology,” Clemente points out. “But what turns that into an Oura ring, a Whoop strap or an Apple Watch is entirely the software and the user experience, and how that data is turned into insights about your sleep quality and exercise.”
The cost of good health
This crop of health tech companies say their mission is to democratize access to personal health data – but at their current price points, it’s hard to see how they can achieve that goal. A Levels subscription costs $399 for the first month (which includes a consultation with a doctor), then $199 per month after that to continue receiving data. Supersapiens, meanwhile, charges $140 per month for a subscription, which includes two 14-day sensors.
A subscription to the MyLevels app costs £35 a month, and a pack of three 10-day Dexcom G6 sensors (purchased separately) comes in at £190.
The companies are aware of the apparent contradiction and say that prices should come down once economies of scale are achieved and there is more competition in the market. The biggest cost of providing these services is the CGMs themselves.
"We expect a race in the hardware space that will make this more available and more affordable with time,” Clemente says, adding that Levels is aiming to get its monthly subscription cost down to below $100 per month (including the doctor consultation) within the next two years.
Meanwhile, Apple and Samsung – both reportedly working on watches featuring non-invasive glucose monitors using optical sensors – are likely to raise awareness of the benefits of glucose monitoring among people without diabetes.
Getting insurers and healthcare providers onboard could also drive demand and further reduce prices. Levels says that once it has spent time in the direct-to-consumer market, it will have the proof points it needs to approach these types of customers (although Clemente says access to personal data will be strictly off limits).
“We believe [our platform] will help people make better choices, and that should show up in the data long-term,” Clemente explains. “Combine that with the user experience, and that’s the data the insurers and self-insured employers need to see to know that this is worth purchasing for their employees.”
Supersapiens, meanwhile, says it has already had discussions with medical chiefs in the U.K.’s NHS and insurers in the U.S. “If we could make this paid for by the government or co-pay, I think a lot more people would use it and the outcomes would be much better from a preventative standpoint,” Southerland says.
“Long-term, we want to make this accessible to anyone who wants it,” Clemente says. “We see a future where this technology is in the background, and you are refining and iterating a lifestyle that works for you. The reality is that people want to know how their bodies function. They want better information about themselves right now, and they’re willing to wear a device to achieve that.”
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