MedTech Firms Cannot Compete With Consumer Grade Devices

Disclaimer: The post is equal parts frustration and reflection on my experience with Dexcom G6. While this is specific to a one device, the frustrations are applicable to other CGM alternatives in the market as well

I am a type 2 diabetic. Over the past 12 months, I had not been able to take care of my health (diet + exercise) effectively and did not adhere to my medication regimen. My A1C levels doubled.

A trip to the doctor and aside from medications, I was able to get a CGM (Continuous Glucose Monitoring) system prescribed. I want to understand the correlation between what I eat and how that impacts blood glucose.

Luckily Dexcom G6 was covered by my insurance and I got it over the weekend

The last 24 hours with the device have been frustrating.

My frustrations are the result of superb hardware design, simplicity & experience standards set by non-prescription consumer grade health devices like rings (Oura), bands (Fitbit, Garmin etc.), watches (Apple, Fossil, Samsung) and even competing BGM services (ex. Livongo).

Let's take the example of Livongo. It is a smart BGM system. I prick my finger and test for blood glucose. The smart monitor shows my blood glucose levels, automatically uploads the data to the cloud, keeps track of supplies (lancets & strips) and automatically ships them whenever I am running low.

As an added bonus, it keeps a track of the BG values and makes some personalized suggestions and connections (diet/ nutrition).

It's simple and it works.

My Oura ring is even simpler. I just wear the ring. Every time i open the Oura app on my phone it automatically connects to the ring, get the sleep and activity data and uploads it securely to the cloud. The ring charge lasts for 5 days post which I can recharge it.

I can opt in for clinical trials (that require sleep data) securely and directly from the app. In addition, the app provides weekly summaries and useful behavioral prescriptive suggestions such as optimal sleep hours, sleep time, balancing activity vs. energy vs. sleep.

Simple.

Let's get to the Dexcom G6.

Frustration #1 : Too many components

Dexcom G6 is sold as 3 separate components, sensors that you stick on your body, transmitter that you stick on the sensor and a receiver that receives the CGM values from the transmitter. A sensor lasts for 10 days and a transmitter lasts for 3 months.

Having a separate receiver (with a micro USB port) is antiquated when most of mobile devices have NFC and Bluetooth capabilities. Apparently the Dexcom has a G6 app that can work as a receiver but only on select devices. For Android users, it only works on Google, Samsung, LG and Motorola phones.

This information is not commonly available and as a result my pharmacist advised me to use the phone and skip the receiver.

Unfortunately I have a OnePlus smartphone and had no other option but to make a trip to the pharmacy again and buy it.

There are versions of G6 app available on the internet that bypass the smartphone compatibility check, and allow any phone to be used as a receiver.

As a user however, I should not have to make a choice between buying a receiver or using an unauthorized version of the app.

They should make the app work on all smartphones and make the receiver as optional (for folks who don't have a smartphone).

Frustration #2 : Second guessing results

Once I set up the G6 sensor and transmitter, I noticed that the initial blood glucose values detected by the CGM were off by more than 100% as compared to the BGM.

I ended up calibrating the CGM 4 times via BGM testing before it accepted the calibration values.

Apparently Dexcom's official help page states that CGM values can vary from the actual levels by 20 - 30% and it usually takes 24 hours for the sensor to self calibrate to the actual values.

It would have helped had Dexcom included this information as part of their patient training tutorial videos.

Frustration #3 : Wait, how exactly am I going to view my data

Once I got over the hump of having the necessary components and calibrating the device, the next hurdle was on how to get the data from the receiver to their cloud service (Clarity) so that I can view the history and get personalized reports/ recommendations.

The only mechanism is for patients to download an uploader software on their Windows laptop/ desktop, connect the receiver and then upload the CGM data from the receiver to the windows laptop/ desktop/ table to the cloud service.

You can view the CGM data either on website or on your smartphone (Clarity app) which displays the data albeit with a 3 hour lag.

The funny (not so funny actually) part is that the uploader software is only available for Microsoft Windows.

If patients have a Mac or a Chromebook, they would need to go and buy a Windows laptop/ desktop/ tablet, in order to upload their CGM data to the Clarity cloud service.

It is not necessary to upload data to Clarity. Patients can still see all the CGM values on their (tiny) receiver screen.

That wouldn't be so bad except that the receiver only holds 30 days of data. So after 30 days, all historical CGM values are lost

I use a Chromebook :(

I am staring at a forced decision to buy a Windows device just to be able to upload data.

Why can't Dexcom make the data synchronization process simple by having a smartphone app connect to the transmitter, receive CGM values and upload it to the cloud?

Frustration #4 : How exactly do I correlate?

One of the prime reasons I had requested my HCP for a CGM device was to be able to correlate the effect of medications, diet and activity/ exercise on my blood glucose values so that I can make the necessary adjustments.

Unfortunately the receiver does not allow me to add details around my diet or medications (non insulin). As as result, I am left to manually noting down separately these events and making the necessary correlations.

This is no different than manually noting down and maintaining a BGM log book back in the day.

To conclude

Medtech companies have a long way to go when it comes to designing and rolling out consumer grade experiences and devices. The process - arduous, hardware - antiquated and experience - lacking

$225 and 24 hours later, my instinct is to return back the device to the pharmacy. However, the potential benefits of the information are more valuable than the hurdles Dexcom G6 has posed.

The good news is that these are all addressable challenges, the bad news is that there in no solution in the present.