As a wearables reviewer, I roll over every morning, pull out my phone, and check my sleep stats. But that has changed in the past 14 days. Instead, I’ve been checking my blood sugar levels. This is because I have a Dexcom Stelo continuous glucose monitor (CGM) on the underside of my left arm. Sometimes I feel relieved by what I see. Other days, I wonder if I should call my doctor.
Stelo is unique in that it is one of three FDA-approved over-the-counter CGMs. (The other two are from Abbott.) Typically, people with type 1 diabetes, who produce little to no insulin, a hormone that regulates blood sugar, use CGM to monitor their condition. However, Stelo is aimed at patients with type 2 diabetes, specifically those who are not insulin-dependent. Unlike type 1 diabetes, type 2 diabetes develops over time as the body becomes more insulin resistant. Although some people with type 2 diabetes rely on insulin, the vast majority control their blood sugar through lifestyle changes and oral medications.
The pitch for over-the-counter CGMs like Stelo is that they can theoretically help people with type 2 achieve manageable levels without the need for medication. For people with prediabetes, it can even help them reverse their condition. In these use cases, CGM can be a good tool to understand how certain foods or exercise affect blood sugar levels.
The problem is, if you don’t take insulin, continuous glucose monitoring is typically not covered by health insurance, making them too expensive for the average person. When I met with Dexcom in January, its chief operating officer Jake Leach stressed that Stelo would be easier to use. It is, although some will still find it expensive. With Stelo, you have two options. You can purchase a pack of two sensors (30-day supply) for $99. Alternatively, you can pay a monthly subscription fee of $89 and get two sensors per month. These devices are also HSA and FSA eligible.
Stelo works similarly to Nutrisense, a CGM-based platform I tested last year on non-diabetic patients looking to optimize metabolic health. There is an app that guides you through inserting CGM. (It’s easy and surprisingly painless.) Depending on whether you have Type 2 diabetes, prediabetes, or nondiabetes, you’ll be given a recommended target blood sugar range. After a calibration period of approximately 30 minutes, you can view real-time blood glucose values in the app. Stelo also integrates with iOS and Android health APIs so you can sync your workout and sleep data. You can also log your meals manually. If your blood sugar spikes, you’ll get an alert on your phone.
Overall, I found Stelo to be easy to use. The data is kept relatively streamlined without too much visual clutter. However, it does require a certain level of vigilance. I’ve had a few blood sugar spikes in the past two weeks, but the alert didn’t go off on my phone until 20-60 minutes later. (However, if you continuously monitor your application, you can watch the spikes occur closer to real time. This is not always practical.)
This isn’t necessarily shocking, since it’s not designed for people with type 1 diabetes, but it’s not great either. I also want it to be easier to log my meals. I’ve been tracking my macros in another app these days, so it would be a good idea to import that information into the Stelo app. Instead, I have to cross-reference and manually log everything twice.
But the most helpful thing was the extra insight into interpreting my blood sugar data. (Quick note: I’ve been testing a pre-release version of the app, so not everything will be the same as it is in the final product.) Long-term viewing of daily historical data is not possible. If I want to show my doctor my blood sugar spike pattern after certain exercises, I have to take screenshots that day. I’m not sure my numbers are good either. Although I spent about 95% of the time within the recommended range, my average blood sugar levels were higher than when I tested Nutrisense last year. I’m also a little worried about how many times I have blood sugar spikes with no obvious explanation, such as high-intensity exercise or a high-carb diet.
I have since made an appointment with the doctor to test my blood sugar. This is personal to me. My father has type 2 diabetes and I have polycystic ovary syndrome, a hormonal disease that increases insulin resistance. On the surface, this is how Stelo works. I am someone who is at higher risk for diabetes and have seen worrying trends in my data and am now proactively consulting with a medical professional.
I have some quibbles with the Stelo app, but it’s still early days and this is an emerging category. Slowing down is to be expected. I plan to test Stelo further and am curious to see how my conversation with my doctor will go. Even so, from my time to this day, I can see how using Stelo in conjunction with a doctor could help people with prediabetes and type 2 diabetes. Less clear is how other parts of the market will attract wider use of CGM. Sometimes, I see health influencers touting CGM for weight loss and “fixing” metabolic health. Although we have yet to prove whether CGM is worth using, there are several startups based on this premise. We’ll have to see where this goes, but at the very least, I appreciate Dexcom’s focus on the people who can most benefit from this technology — and at a cheaper price.
