Glucose-monitoring specialist Dexcom made several announcements this year, including receiving FDA clearance for its over-the-counter continuous glucose monitoring (CGM) solution Stelo, G7's expanded capabilities to connect directly to the Apple Watch and, most recently, its $75 million investment in and strategic partnership with health-tracking ring maker Oura.

Jake Leach, Dexcom executive vice president and chief operating officer, recently spoke with MobiHealthNews about the evolution of its products for use cases beyond diabetes monitoring. 

MobiHealthNews: What types of partnerships are you looking to form, and how is your technology progressing?

Jake Leach: Dexcom just celebrated 25 years as a company. We were founded in 1989, and over those more than two decades, the goal has always been to develop a better way to help people manage glucose. 

Obviously, diabetes was the first place we were focused on, Type 1 diabetes and insulin, dependent on multiple daily injections of insulin. That was hard to do with just finger sticks; that was the standard of care. No one liked that.  

As we have moved down this continuum, one of the most interesting things that have occurred is that as the performance of our sensors has gotten better, starting with our G6 in 2018, it was indicated as an ICGM [integrated continuous glucose monitor] by the FDA. It was a special designation, and what that really meant was that it was the first time performance standards were established for CGM. Before that, you did clinical studies and reported what your performance was, but there was no bar you had to meet. 

So now we have this performance bar you have to meet, which means that if you meet the accuracy bar, it's generally safe to integrate with other devices like insulin pumps. That was one of the key integration points of our history; we were the first CGM to pair with multiple insulin pumps from different manufacturers.  

The unique thing is that the ICGM standard then started unlocking confidence in the reliability and the accuracy of CGM to the point where fast forward to earlier this year, we got an over-the-counter indication for a continuous glucose monitor named Stelo. 

[Stelo] is intended for people who are not taking insulin, because the features of the G7 product have protections and safety alerts around low glucose and things. Stelo doesn't have those; it's really focused on helping you better manage glucose variability and overall average glucose throughout the day, throughout the month and as you go on.  

That was a huge milestone in 25 years of CGM development, getting to the point where it's now available over-the-counter, no prescription required, at a cash pay price of less than $100 a month. 

Users are all over the map. We've got people with pre-diabetes, people with diabetes and we've also got people that are generally interested in health and wellness and categorize themselves as not having either diabetes or pre-diabetes.  

As we move forward, one of the things that Stelo does today is it imports sleep data. So whether you're wearing an Oura Ring or have the Eight Sleep mattress system or an Apple Watch, it all imports into Stelo, as well as the activity data.

One of our goals is to start using some of those data feeds to establish even more personalized insights. Right now, we are doing insights around your glucose excursions and we have the spike detect feature.

Stelo also helps you understand how medication impacts you. So, if you take a GLP-1, these therapies that are so impactful and so effective for both weight loss and diabetes management and probably a whole host of other things that we're going to learn through data, you actually can see how much that truly impacts your glucose and whether it's that you're not eating as much or you're picking better foods. All of those things show up on your glucose graph.

MHN: What's in store for the future? How will the company enhance its product line?

Leach: What we're doing with G7 and with Stelo is we're basically coming out with software releases about every six weeks, not too dissimilar from what you see from other typical tech companies, but we historically have not done that. 

We've had large generational advancements of our technology, and we do some iterations over time, but with Stelo and G7, we did a refresh of our software technologies to modernize them. We built out a much larger team, we built out all kinds of capabilities and so now we're running through these trains of releases that have all kinds of new features.  

With Stelo, we just launched a basic insight engine that runs spike detection that basically personalizes the detection for your type of glucose spikes. If you're somebody who has type 2 diabetes and is still trying to get under control with big glucose spikes, we're going to pick the most impactful ones that are quite different than for someone who's a health and wellness user who has more moderate spikes. We're going to try and find the most influential ones that are the most impactful, and just target those. We're not going to tell you every time your glucose spikes. That engine is kind of in its initial first run. There are all kinds of features that are coming behind that.  

Stelo initially is very targeted towards people with type 2 diabetes or pre-diabetes, but I've had lots of people that are in that health and wellness category. I've actually been surprised; we've had more health and wellness users than I would have anticipated.  

So, there's a lot more we want to do to broaden the applicability of the data that Stelo is generating and also consuming with the idea of activity data and sleep. It's pretty clear in the sleep data that you can see a difference in your glucose dynamics whether you had a good night's sleep or not, and right now, we don't know that you had a bad night's sleep. We do import the data, but we're just starting to use it in the algorithm.  

MHN: Dexcom must collect a vast amount of data.

Leach: Yes. We have all of our connected devices flowing back to our secure cloud, and we use a lot of that data to help develop algorithms. It's all de-identified. But it does help us learn in terms of population health how to develop these algorithms to maximize the benefit for people. 

So, yeah, it is data. There's quite a bit of it. For our G7 product, we have that remote monitoring feature, which is so impactful. We've been toying with what we could do competition-wise with Stelo, like, how you could build a social community around competing with glucose.

Our goal right now is to bring a lot of awareness that this type of technology exists, because people with diabetes, particularly insulin-dependent diabetes, they've been using it for a long time. So, one of our big goals with Stelo is to bring much more awareness, because most people who have pre-diabetes don't actually know they have it. So, this kind of tool can really help there.

Watch Part 1 of this video interview.