The first time I saw my glucose levels skyrocket after a cold beer on a crisp summer evening, I experienced a special kind of surprise, then panic. It was a biological push notification from the fluid just under my skin that the carbohydrate-packed drink was interfering with my health and weight maintenance efforts.
For years, people with type 1 diabetes have worn a continuous glucose monitor, or CGM, to track blood sugar spikes and make sure they’re getting enough insulin. CGMs are small patches with tiny needles for sensors that pierce the skin and are usually worn on the abdomen or back of the arm.
Now, a wave of technology companies are selling CGMs to the public. This made me curious: Will this work for me? What will I learn?
Devices connected to apps with personalized analytics and meal planning suggestions are being touted as a behavior-change path to better health and athletic performance, consistent energy, and overcoming the dreaded weight-loss-weight-gain cycle once and for all.
For people without diabetes, tracking the glycemic response of foods can identify which foods significantly raise blood sugar, leading to subsequent blood sugar crashes and then lethargy. Excess insulin and glucose in the bloodstream can signal the body to store excess sugar, leading to weight gain.
The new-age, health-monitoring ecosystem extends beyond CGMs, leaving traditional step counters in the dust. A tracker in the form of a sleek, titanium ring that monitors movement and sleep made by Ultrahuman — and can be paired with a glucose-monitoring patch. Hoop’s wearable technology, which tracks respiratory rate, blood oxygen and other health measurements, can be embedded in a sports bra. Another device, Lumen, analyzes breath to determine whether the user is burning carbohydrates or fat.
The market for this technology is huge, from Olympic athletes to office workers looking to avoid post-lunch doldrums. The nation has long been known to have an obesity epidemic that is often in the throes. From 2017 to 2021, 26% of Americans, on average, said they were “seriously trying to lose weight,” and more than half said they wanted to, according to the Gallup survey. And about 96 million U.S. adults have prediabetes, which increases their risk of chronic diseases like type 2 diabetes and heart disease, according to the Centers for Disease Control and Prevention. Prediabetes affects people who are lean and overweight, although obesity increases the risk of diabetes.
Investors are taking note. About $3.5 billion has been poured into U.S. weight loss digital health startups from 2020 to the first half of 2022, according to an analysis by venture fund Rock Health for KHN. CGM startups Level, NutriSense, Cynos and Jan have collectively raised more than $140 million in funding, according to company funding database Crunchbase.
There is a lot of hype about the data they provide.
Advertisements online and on podcasts often feature active 20-somethings. They also promise unique insights into how users respond to food, exercise and sleep in real time by homing in on metabolic health and how well they’re controlling their glucose levels. CGM-based company Signos says, “We are trying to give every body a voice to lose weight. A promo for Lumen shares: “You hold the secret to sustainable weight loss in your lungs.”
But while people in the field have seen “significant” results from incorporating these tools into weight loss programs, they admit that no single method seems to be able to do it. For example, Eric Kusher, a doctor of chiropractic who runs an intensive weight-loss program at Compass Fat Loss, says he still relies on the human element, too, falling back on the dietary advice of his staff, not the meal guidelines provided by apps.
The level of reality is also important, said Dr. Nirav Shah, senior scholar at Stanford University’s Center for Clinical Excellence Research. “If you’re a stressed-out mom trying to take care of three kids and holding down a job, you won’t have time to monitor and create the perfect green smoothie,” she said. “You’re going to buy dollar meals because it’s easy and cheap for your kids — and then you’re going to eat what they won’t eat.”
Sarah Schacht, a 42-year-old government innovation consultant in Seattle, has tried all kinds of health technology, including Level and Lumen, to tackle weight loss and inflammation. The generalized “eat less, move more” — flawed advice for many — wasn’t working for him. The Level app allows the user to log meals, exercise and other significant events; Combines information with CGM data; and then provides insight and advice on how users can maintain a gentle glucose curve. Since starting the level a year and a half ago, she has lost 5 pounds, her weight has stabilized and the inflammatory response has decreased. But her body hasn’t changed dramatically, she said.
“I feel like some of the success stories I’ve seen, people who have radically changed their bodies, spend a lot of time on their eating strategy,” says Schacht. “Not everyone has that mental capacity, time or budget.”
These devices are not covered by insurance, so, with associated subscriptions for data, the cost can be hundreds of dollars annually. There is also little research on the effectiveness of CGM in improving health in people without diabetes, let alone weight loss. Without solid results, many health care providers are skeptical. Some experts also worry that the constant flow of data can encourage disordered eating.
Dr. Carolyn Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston, said she doesn’t see the use of expensive CGMs especially for new weight-loss drugs for someone without diabetes. Within reach. Those drugs will certainly carry a hefty price tag.
“It’s hard work to lose 10 pounds,” Apovian said. “A CGM is going to wipe out your money so you can’t join a gym.”
Logan Delgado, co-owner of BioCoach, said the majority of people with insulin resistance and metabolic disease are low-income and a minority who cannot afford CGMs. BioCoach has FDA clearance for glucose and ketone meters, which test for blood glucose levels and ketones — a sign that the body is burning fat for energy. Its more traditional finger-prick technology keeps subscription prices down to $30 per month and still lets people without diabetes know about their metabolic health, albeit not with continuous data. The company has amassed a large following on TikTok, where Delgado and others raise awareness about sugary foods and diabetes.
CGM startups typically offer one of two CGMs: Abbott’s FreeStyle Libre, which is cheaper and requires a manual scan of the sensor by a smartphone, or the Bluetooth-connected Dexcom G6, which updates automatically on a smartphone. The monitors are provided by “off-label” prescription to people without diabetes because the FDA has not yet approved the devices for the general public.
CGMs are available over-the-counter in Europe, so the companies are betting that the FDA will approve making them available on drugstore shelves in the United States, which will lower the price of the sensors, which can cost hundreds of dollars.
But January already said it can use artificial intelligence to predict a person’s glucose levels after a user wears a CGM for two weeks. The algorithm, backed by a library of published research and food nutrition information, can predict a person’s glucose response to thousands of foods before users decide what to eat, not after. It brings costs down, essentially creating a virtual CGM, CEO Nausheen Hashemi said in January. The company is rolling out a new version of their app this fall.
Across the board, startups are mostly working, with some still conducting research to back up their marketing claims and taking different approaches to using the technology. A common theme for startups, though, is going direct-to-consumer first — to people who can afford the idea — before eventually seeking coverage from insurers, said Bill Evans, founder and general partner at Rock Health Capital.
Companies are trying to add new twists to how their apps use data to reach health and weight-loss goals, each with a library of informative blogs, lessons and activities. Their costs range from hundreds of dollars to more than a thousand annually, including the cost of hardware, subscriptions to wrap services, and in some cases nutritionist support charges. Companies are banking on the idea that customers will sign on for the long term.
Taking a more packaged approach, NutriSense has leaned toward building an 80-person nutrition team that works closely with customers, according to Cara Collier, the company’s vice president of health.
Signos, which focuses on weight loss, uses artificial intelligence to set a “weight loss range” for customers based on their normal glucose range and level of fitness.
Out of curiosity, this reporter signed up to the Level app with a CGM stuck to the back of his arm for 10 days. At first, the metrics were boring. As a person without diabetes, I have never calculated my glucose levels before.
Then I started to recognize patterns that made sense: drinking beer always spiked my glucose, but a bagel after a long morning walk kept my blood sugar relatively stable. Avocado toast or eggs for breakfast are better options though. And a salad with chickpeas, tomatoes and turkey for lunch earned top marks.
Digesting data alongside each meal definitely made me more difficult about what I ate and when I exercised. But it felt like a lot of extra homework.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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