Diabetes is a disease caused by the body’s inability to produce or effectively use insulin, a hormone produced by the pancreas that carries glucose into the body’s cells and stores excess glucose in the liver. Its absence can trigger a hyperglycemic state, where blood glucose levels rise to abnormal levels, which can lead to long-term chronic conditions like heart disease, blindness, kidney failure, and limb amputations. Diabetics can overcorrect by taking much insulin, giving rise to a hypoglycemic state that in certain instances can lead to loss of consciousness and even death.
There are two types of diabetes: with Type 1, insulin-producing pancreatic cells are destroyed by the body’s immune system. The 1.6mn US adults and children who have it require daily insulin injections. Another ~32mn Americans are afflicted with Type 2, a metabolic disorder linked to inactivity and overeating as well as genetic factors, where the pancreas produces insulin but cells are insensitive to it. Something like 5% to 10% of T2 cases are “insulin intensive” (IIT) and require multiple daily insulin injections (MDIs) while other non-intensive cases just require one daily injection of basal (or “background”) insulin or no insulin at all. All diabetes can be harmful, though Type 2 cases are generally less severe.
Besides the danger it poses to 34mn Americans, diabetes also inflicts negative externalities on the healthcare system, with 1/4 of healthcare dollars going to treating diabetics, who consume 2x more medical spending than non-diabetics1.
Source: Dexcom. 1) Total healthcare costs for people with diabetes, divided by total US people diagnosed with diabetes. Source: 2007, 2012, and 2017 ADA Economic Cost of Diabetes Reports (Diabetes Care). 2030 amount applies 3.6% annual CAGR calculated between 2007-2017 thru the year 2030.
Most insulin intensive diabetics still monitor blood glucose levels by dripping blood on a test strip and feeding that strip into a reader. This method only captures blood glucose levels at discrete points in time, which means patients may be outside a safe range for hours without knowing it and are unable to test themselves during sleep, when the risk of hypoglycemia is particularly elevated. Also, those with elevated readings may overcorrect with insulin, unaware that their glucose levels are actually trending down. Finger stick devices are also inconvenient and painful to use. Diabetics must carry testing kits around with them and prick themselves with needles several times a day. Those who develop diabetes during pregnancy (gestational diabetes) are supposed to do this 8 to 10 times/day to mitigate risk to the fetus.
A continuous glucose monitor (CGM) from Dexcom is a major upgrade. The patient inserts a sensor the width of a human hair beneath the skin, usually on the arm or belly, and the sensor automatically measures blood glucose levels in the interstitial fluid every 5 minutes for up to 10 days. A transmitter containing a radio, battery, and a microprocessor snaps onto the sensor patch above the skin, translates the sensor’s electrochemical signals into blood glucose levels, and Bluetooth transmits that data to a smartphone app. This data can also propagate through APIs to Electronic Health Records and a number of third party health tech apps, or be delivered to friends, family members, and care providers.