Issue No. 142: The Business of Glucose Monitoring

Courtney Powell

Diabetes tech is trending.

A product of poor nutrition and sedentary habits, Americans face a metabolic health crisis.

Offering a potential solution, a growing number of startups have gone all-in on continuous glucose monitors (CGMs).

Forget activity trackers; should we all be wearing CGMs? Let’s take a look.

An Overview

What it is: A “diabetes biowearable,” continuous glucose monitors are typically prescribed to help the 34M+ diabetic Americans track minute-by-minute fluctuations in their blood glucose and keep health complications at bay.

A leap forward from traditional tracking methods like urine tests or finger pricks, CGMs have revolutionized diabetes health since their FDA approval in 1999.

How it works: CGMs consist of a plastic disc with a small metal filament inserted just below the skin. This device wirelessly transmits signals to your phone, which outputs a glucose level reading.

Providing real-time feedback, CGMs show how your body reacts to different glycemic variables—all 42 of them—and can help you adjust your eating, sleeping, or fitness habits to keep your blood glucose at healthy levels.

Why it matters: As the population ages, the Centers for Disease Control and Prevention (CDC) predicts the number of Americans with diabetes to triple by 2050. The COVID-19 pandemic likely accelerated these projections — two separate studies found that pediatric diabetes increased by 180% during COVID.

Stepping up, CGMs promise solutions that could disrupt personalized health ($493B), nutrition ($16B), and even sports performance ($12B). Experts predict a “watershed” moment for CGMs this year as metabolic health startups expand beyond diabetes.

A Metabolic Mess

A silent killer, prediabetes affects 88M Americans, yet 84% are unaware of their condition. Lacking clear symptoms, prediabetes can go undetected for years until serious health symptoms—like heart disease or stroke—manifest.

CGMs could be life-saving for the 40% of Americans who will develop type 2 diabetes, but there’s an even larger cohort of potential consumers — everyone else.

Diabetic or not, 88% of Americans are metabolically unhealthy and at increased risk for accelerated onset of death and disease.

Meanwhile, the number of Americans who want to track and improve their health is at an all-time high.

  • The fitness tracker market is expected to top $92B in 2021.
  • 1 in 5 Americans use a smartwatch or fitness tracker.
  • The personalized nutrition industry is projected to reach $64B by 2040.

It’s evident that we all want to live healthier, but nutrition and health science are notoriously imprecise. 59% of Americans say conflicting information makes them question their eating choices.

Touting glucose monitoring as one of the best metrics to follow, Mehdi Yacoubi, co-founder and CEO of metabolic health startup Vital, writes:

“There are a lot of general health principles that explain high or low energy. But it’s often hard to keep track of all of them and to make sense of a given feeling. It would be far easier to see the exact biological reactions of our body to get a real sense of what’s going on.”

Monitors for All

More accessible than ever, CGMs are poised to take off.

Entering new markets, metabolic health startups are leveraging cross-industry business models to go direct-to-consumer.

Taking after Tesla. a16z-backed Levels Health, which raised $12M in 2020, offers CGM via prescription in the US. The company is “shamelessly copying Tesla,” constructing an initial high unit-cost model ($399/month) and aiming to push down costs over time.

Trickle-down health. Sports technology company Supersapiens secured $13.5M in funding this April. Mimicking a tactic used by WHOOP and Hyperice, Supersapiens is constructing a tailored training ecosystem for high-performance athletes before broadening its customer base.

Taking a different approach, January AI raised $8.8M in early 2021 to support its proprietary algorithm, which predicts glycemic responses before users even eat foods. Meanwhile, NutriSense harnesses CGM tech to cater to the weight-loss crowd, a $200B market.

Innovating further, some companies are looking to eliminate filaments and needles with noninvasive solutions. Among the most promising: photothermal tech by Berlin-based DiaMonTech and saliva tests developed by researchers at Australia’s University of Newcastle.

Hey Siri, pull up my blood glucose. The $42B diabetic care market is too large an opportunity for Big Tech to pass up, who have been ramping up their capabilities with patents and third-party collaborations.

This year, however, rumored glucose monitoring features for the Apple Watch Series 7 and the Samsung Galaxy Watch 4  have been mostly quashed, put on the backburner for 2022 or 2023.

Challenges Ahead

Hardware bottlenecks. Amid looming competition from Big Tech players, metabolic health startups must contend with a critical weakness in their pipeline — their dependence on incumbent manufacturers Abbott and Dexcom.

Commanding the CGM market, Abbott and Dexcom enjoy a “duopoly” over hardware prices. Dexcom, for example, had its “best year ever,” growing 31% YoY. The manufacturer launched a venture fund to invest in adjacent businesses and is rolling out its G7 system this year in hopes to double revenue by 2025.

Does it work? In the past, experts have questioned whether health apps and wearables actually help; CGMs are no exception. A groundbreaking technology, few studies have been done to gauge actual health outcomes for nondiabetics.

It’s a “waste of money” for those without the condition, says Robert Eckel, endocrinologist and former president of the American Diabetes Association (ADA).

Additionally, guidance hasn’t been established for how nondiabetic individuals should respond to their glucose level data — and worse, devices have reportedly inaccurate readings.

Patient pushback. Finally, some members of the diabetes community have spoken out against the popularization of CGMs, claiming that startups targeting hobbyist biohackers trivialize their experience. In particular, low-income patients without access to glucose trackers face otherwise avoidable and adverse complications like amputations, kidney disease, and blindness.

But this very popularization, experts argue, can only be beneficial for this population. With wider uptake, increased demand, and more funding, manufacturers can make better and cheaper products for everyone, diabetic or not.

Looking ahead: Like all new technology, CGMs will encounter growing pains. But mirroring a broader trend in digital health—personalized, tailored approaches to care—diabetes tech may hold powerful health insights for a wider market.


💪 Forging Ahead

Anxiously awaiting the end of the pandemic, Pilates-based boutique fitness studio [solidcore], is expanding amid the uncertainty.

On the Fitt Insider podcast: Bryan Myers, president and CEO of [solidcore] joined us to discuss taking over as chief executive, raising new capital from VMG Partners, and COVID’s impact on the business.

We also cover: The company’s digital content partnership with Equinox+ and whether or not [solidcore] will launch at-home equipment.

Listen to today’s episode here.

🏅 Championing Mental Health

What’s happening: Citing mental health issues, six-time Olympic medalist Simone Biles withdrew from two events at the Tokyo Games last week. “The weight of the world” was on her shoulders, Biles wrote.

Her decision follows tennis star Naomi Osaka’s mental health-related exits this year from the Wimbledon and French Open. Penning “It’s O.K. Not to Be O.K.,” for TIME magazine, Osaka divulged her battles with depression and anxiety.

Culture shift. Among other high-profile withdrawals this year, widespread support for athletes struggling with mental health highlights a shift in the sports zeitgeist.

17 years ago in Athens, rower Sally Robbins withdrew from the Olympic finals out of anxiety and was vilified and slapped by her own teammate. In sharp contrast, Simone Biles’ recent departure, while criticized by some, has met overwhelming support from both teammates and fans.

Biles joins a growing movement of activist athletes, from Michael Phelps to Kevin Love, who are taking up the torch to fight mental health stigma.

Her sponsors, too, are lauding her courage. In a statement released by Athleta, chief brand officer Kyle Andrew said: “Being the best also means knowing how to take care of yourself.”

Healthy body, healthy mind? Despite bringing in over $700B a year, the sports industry has little to no infrastructure in place to support their athletes’ mental well-being.

“There’s been a bifurcation of physical health and mental health in the world of elite sports,” says sports psychologist Michael Gervais. In his view, athletes compromise mental health for “peak performance.”

The investor athlete. Hoping to turn things around, athletes are backing mental health startups, contributing to a record $2.4B in funding last year.

  • NBA star Kevin Love, who suffered a panic attack during a game in 2017, invested in a seed round for “mental health gym” Coa last year.
  • Soccer champion Megan Rapinoe and Vikings’ Eric Kendricks invested in mental healthcare startup Real in April, contributing to its $10M Series A.
  • NFL cornerback Richard Sherman invested in brain and mental health startup Nurosene’s $7.6M IPO in June.

Takeaway: Mental health is a growing crisis, affecting over 41% of the US population and, as elite athletes like Biles and Osaka have shown, even the best athletes in the world.

As sports stars draw more attention and funding towards mental illnesses, the hope is that one day, everyone will be able to access the help they need.

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💧 Cashing in on Clean Hydration

Water is getting a makeover. More and more consumers are turning away from high-sugar and artificially flavored drinks and reaching for cleaner hydration options.

Leading the charge, Liquid I.V. has transformed the category with its clean ingredients, growing to $100M in revenue in just five years. (Of note, Gatorade saw sales drop nearly 10% since 2015.) Last year, Liquid I.V. was acquired by Unilever.

Following suit, Nestlé is acquiring electrolyte tablet maker Nuun as it continues to bolster its supplement portfolio.

With the hydration market expected to top $1.8B globally, upstarts are hoping to cash in:

  • Hydrant raised an $8.5M Series A to sell its hydration packets.
  • Cure Hydration landed $2.6M for plant-based electrolyte powders.
  • beam entered the hydration space after its $5M Series A in February.
  • Gainful, makers of protein powders and hydration products, raised $7.5M in January.

Hangover hack. Hydration companies have found an unexpected following from regretful revelers. With a billion dollars up for grabs, even Barstool is joining in, while toddler-drink maker Pedialyte has embraced its newfound label as a hangover cure.

With all this buzz, do hydration sticks and tablets actually work better than plain old H2O?

Experts say yes — hydration goes beyond drinking water, and electrolytes (sodium, potassium, and magnesium) in these products help your body absorb greater amounts of water at a faster rate while helping regulate crucial body functions.

Next up, a new wave of wearables. Gatorade launched its Gx Sweat Patch earlier this year. Researchers at Tufts and Northwestern have developed postage-sized sweat sensors that can track your hydration levels. And switching it up, sweat itself may power your next wearable.

Punchline: Functional hydration is a hot market, the latest in the healthy overhaul of what we put in our bodies.

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📰 News & Notes

💰 Money Moves

  • SonderMind, a technology-driven behavioral health company, closed a $150M Series C funding round, notching a $1.1B validation.
  • Micro-gym startup Silofit secured $10.25M in Series A funding led by Whitecap Venture Partners.
  • Health and wellness app maker Palta raised $100M in Series B funding led by VNV Global.
  • Merrell and Saucony parent company Wolverine Worldwide acquired women’s activewear brand Sweaty Betty for $410M.
  • Talkiatry, a provider of in-network psychiatric care, raised $20M in Series A funding.
  • Modern Age, a longevity platform, closed $6M in seed funding led by Juxtapose.
  • Revel, a community and social platform for midlife women, raised a $3.5M seed round led by August Capital.
  • Oova, an at-home fertility diagnostic company, raised $1.2M in seed funding led by BBG Ventures and joined by Company Ventures.
  • Vira Health, a personalized menopause platform, closed £1.5M ($2.08M) in seed funding from LocalGlobe and MMC Ventures.
  • Cayaba Care, a maternal health company, raised $3.2M in seed financing from Flare Capital Partners and others.
  • Rey, a mental health and wellness company leveraging teletherapy, medication, and VR, added $10M to its Series A funding round.
  • Gamified mental wellness startup Revery raised $2M in pre-seed funding led by Sequoia Capital India’s Surge program.
  • The New Primal, makers of “clean ingredient” meat snacks, raised $15M in Series B funding from Manna Tree.
  • Planted, a Swiss alternative protein company, added $21M in new funding.
  • Actual Veggies, maker of vegetable-only burgers, raised $2.8M in new funding.
  • True Beauty Ventures, a beauty- and wellness-focused firm, closed its $42M debut fund.

Today’s lead report is from Fitt Insider contributor Melody Song with Joe Vennare and Ryan Deer.