Move over smartwatch, there’s a new wearable in town
Are continuous glucose monitoring and metabolic fitness the next big thing for the wellness industry?
Welcome back to HealthTrends. This week we’re talking continuous glucose monitoring.
Lets dive in…
🤷♂️ Problem
Management of diabetes is crude. Monitoring blood glucose requires finger-pricks (painful), carried out regularly (inconvenient), that can miss problematic blood glucose spikes (inaccurate).
💡 Solution
Combine the latest sensor technology with smart phones to make blood glucose monitoring continuous, convenient and more detailed. In the process, make it accessible for those who may not have previously considered it (healthy people).
📖 Terms
Self monitoring blood glucose (SMBG). Patients perform a number of glucose tests each day or each week. Normally involves pricking the finger with a lancet to obtain a small blood sample that can be used on a reagent strip and placed into a reading device.
Continuous glucose monitoring (CGM). A device worn on the skin that measures glucose levels continuously throughout the day and night. Technically it’s not measuring ‘blood’ glucose, but rather the glucose in the fluid around the body’s cells (interstitial fluid). It sends data continuously to a display device.
Flash glucose monitoring (FGM). Very similar to CGMs aside from how data is received. FGM systems use the same approach as CGMs but only provide readings and glucose trends when the device is scanned. See Freestyle Libre below.
📚 History
CGM devices have been around for longer than you think. The first system was approved by the FDA way back in 1999.
Medtronic heralded the 1st generation of real-time CGM systems in 2004 with their ‘Real-Time Guardian’ device (3 day lifespan). This was followed by Dexcom’s ‘SEVEN Plus’ (7 day lifespan) and Abbot’s ‘Freestyle Navigator’ (5 day lifespan).
Unfortunately the low accuracy of these devices limited their widespread adoption by doctors who didn’t feel comfortable relying on their glucose measurements to guide treatment decisions.
A 2nd generation of devices, produced by the same manufacturers, started entering the market around 2011. Although accuracy was still sub-optimal compared to SMBG readings, the consumer features were improving with longer wear times, reduced sensor size and weight, ability to take more frequent readings and mobile phone connectivity.
Abbot’s ‘Freestyle Libre’ brought about the 3rd generation of CGM systems in 2016 with significant performance improvements. 14 day wear time, no finger-prick calibration required, water resistance, and, most importantly - comparable accuracy to SMBG. A medical grade, unobtrusive device made this an appealing product to both doctors and patients alike.
💼 Use cases
Established
Type 1 diabetes. Guiding insulin dosing, identifying problematic glucose patterns, much research supports CGM use in this patient group instead of SMBG.
Emerging
Type 2 diabetes. Aside from providing a more detailed view of blood sugar control that could guide and monitor treatment decisions, there is increasing interest in the behaviour change capabilities of CGM for type 2 diabetics.
Health and wellness. Several companies are exploring the use of CGM for promoting and optimising ‘metabolic fitness’. See below.
👥 Players
FDA-approved
Freestyle Libre is everyone’s favourite CGM system (made by Abbott). The Libre 3 is the latest iteration and is supposedly the thinnest and smallest continuous glucose monitor in the world. Abbott are also rumoured to be making an athlete focussed biosensor…
Dexcom is another popular brand. Small sensors, sleek app and smart watch integration.
Medtronic is a titan of the medical device industry. Their sensors integrate seamlessly with their insulin pumps to automatically adjust insulin dosing.
FDA-pending
Nemaura Medical has developed their ‘BEAT’ technology platform which includes a sensor that can do CGM, temperature, lactate and even alcohol monitoring (maybe don’t use it on a Friday night).
Consumer
Levels is pushing the concept of ‘metabolic health’, allowing users to monitor it in real time with their CGM sensor and app. Currently in early access, its sleek patch and app design is clearly geared towards fitness fanatics.
Sano received $6M from Fitbit back in 2018 to help develop its CGM sensor. More recently it’s been acquired by One Drop - a diabetes management platform. One Drop is yet to release any form of CGM sensor into its product lineup though.
Veri describe themselves as the ‘compass’ of metabolic health. They combine Freestyle Libres (because why make your own sensor) with their app to help people track nutrition, glucose, sleep and other metrics.
👊 Impact
Improved measures of diabetic control
Increased weight loss
Reduced calorie intake
Higher adherence to diet plans
Increased physical activity
🔮 Predictions
Wearable 2.0. CGM sensors will become the new smartwatch. Expect to see more people (without underlying health conditions) wearing these in order to provide another stream of data they can track and monitor.
Type 2 diabetes. As the cost of CGM sensors continues to fall, their authorised uses (by insurers and health systems) will be expanded to include type 2 diabetics where promising evidence for health outcomes continues to accumulate.
End-to-end experience. The companies that will succeed in the consumer space will be those that provide an excellent user experience from the application of the sensor application through to the actionable insights it provides.
The Quantified Self. Activity trackers, smart scales, sleep monitors, CGM sensors. More people will continue to monitor as much of their physiology as possible in order to gain insights into the effects of their nutrition and exercise routines.
🌅 Opportunities
Pre-diabetes. The behavioural impact of CGM could help those trending towards diabetes. Sensors are now unobtrusive, easy to use, and accurate. Their ability to facilitate self-care is huge.
Monitoring metrics. HbA1c (the proportion of red blood cells ‘changed’ by high glucose levels) has been the diabetic control measure of choice for years. CGM means a new measure - ‘time in range’ (amount of time spent in the optimal blood glucose range) - can be used more widely to provide a more representative view of blood sugar control.
Ambulatory blood glucose profile (AGM). Not everyone can understand their CGM data. The AGM profile was developed by the International Diabetes Center and is a standardised report of CGM data regardless of manufacturer. It’s user-friendly to help patients identify whether their sugar control is good or bad.
Evidence base. Naturally the current body of research for CGM mainly focusses on those with the greatest clinical need (diabetics). But with consumer focussed CGM companies throwing out terms like ‘metabolic health’ as a sales tactic, more primary longitudinal research is required to understand what benefits CGM can bring to a healthy adult population.
Plastic waste. Ever applied a CGM sensor? The process is plastic heavy. If the trend towards more widespread use (amongst both diabetic and non-diabetics) continues, the environmental impact and reusability of components needs to be considered. This is no easy feat for sterile medical devices…