As a wearables reviewer, every morning I roll over, pull out my phone, and check my sleep stats. But that’s changed over the past 14 days. Instead, I’ve been monitoring my glucose levels. That’s because on the underside of my left arm I have a Dexcom Stelo continuous glucose monitor (CGM). Some days, I’m relieved by what I see. Other days, I wonder if I should call my doctor.
The Stelo is unique in that it is one of three FDA-approved over-the-counter CGMs (the other two are from Abbott). Typically, CGMs have been used by type 1 diabetics (those who produce little to no insulin, a hormone that regulates blood sugar) to manage their condition. The Stelo, however, is aimed at type 2 diabetics, specifically those who are not insulin-dependent. Unlike type 1, type 2 diabetes develops over time as the body becomes more resistant to insulin. While some type 2 diabetics are insulin-dependent, the vast majority manage their blood sugar with lifestyle changes and oral medication.
The over-the-counter pitch for CGMs like Stelo is that they could, in theory, help people with type 2 diabetes get to manageable levels where they don’t have to take medications. In the case of prediabetics, it could even help them reverse their condition. In these use cases, a CGM could be a useful tool to learn how certain foods or exercise affect glucose levels.
The problem is that CGMs are generally not covered by health insurance if you don’t take insulin, making them too expensive for the average person. When I met with Dexcom in January, its COO, Jake Leach, stressed that Stelo would be more accessible. And it is, though some people will still find it pricey. With Stelo, you have two options. You can pay $99 for a single pack of two sensors (30-day supply). Or you can pay an $89 monthly subscription and receive two sensors each month. The devices are also HSA and FSA eligible.
Stelo works similarly to Nutrisense, a CGM-based platform I tried last year for non-diabetics looking to optimize their metabolic health. There’s an app that walks you through inserting the CGM. (It’s easy and surprisingly painless.) Depending on whether you identify as a Type 2 diabetic, someone with prediabetes, or a non-diabetic, you’ll be given a recommended glucose target range. After a calibration period of about 30 minutes, you can see your glucose levels in real time in the app. Stelo also integrates with iOS and Android health APIs, so you can sync your exercise and sleep data. You can also manually log your meals. If your glucose spikes, you’ll get an alert sent to your phone.
Overall, I found Stelo easy to use. The data is kept relatively tidy, without too much visual clutter. It does require a certain degree of vigilance, though. I've had a few glucose spikes over the past couple of weeks, but alerts don't hit my phone until 20-60 minutes later. (You can, however, see spikes in near real time if you monitor the app continuously. It's just not always practical.)
It’s not necessarily outrageous, as it’s not designed for type 1 diabetics, but it’s not great. I also wish it were easier to log my meals. I’ve been tracking my macros on another app these days, so it would have been nice to import that information into the Stelo app. Instead, I had to cross-reference and log everything manually twice.
But what would have been most helpful is additional insight to interpret my glucose data. (Quick note: I’ve been testing a pre-release version of the app, so not everything was as it will be in the final product.) There’s no way to see long-term, daily historical data. If I want to show my doctor a pattern of how my glucose spikes after certain exercises, I have to take a screenshot from that day. I’m also not sure if my numbers are any good. While I managed to spend about 95 percent of the time in my recommended range, my average glucose level is higher than what it was while testing Nutrisense last year. I’ve also been a little concerned about the number of glucose spikes I’ve had that don’t have an obvious explanation, such as high-intensity exercise or a high-carb meal.
I have since scheduled an appointment with my doctor to have my blood sugar tested. For me, it's personal. My father had type 2 diabetes, and I have polycystic ovary syndrome, a hormonal condition that can increase insulin resistance. On the surface, this is because the Stelo is working as it should. As someone at higher risk for developing diabetes, I saw a concerning trend in my data and am now going to proactively consult with a medical professional about it.
I have my complaints about the Stelo app, but it's still very early days and this is an emerging category. Hurdles are to be expected. I plan to test Stelo further and am curious to see how my conversation with my doctor will go. Still, from what I have had experience with so far, I can see how using Stelo, in conjunction with a doctor, could be helpful for people with prediabetes and type 2 diabetes. What’s less clear is how the rest of the market will latch on to more affordable CGMs. Occasionally, I see influencers in the wellness space promoting the use of CGMs for weight loss and “fixing” metabolic health. There are several startups based on that premise, though we have yet to prove whether this is a worthy use for CGMs. We’ll have to see where this goes, but at the very least, I appreciate that Dexcom has kept its focus on the people who could most benefit from this technology, and at a more accessible price point.
