Thank you so much for that lovely introduction to today's conversation, talking about Stelo, and truly a call to action.
Again, my name is Dr. Helen Barron. I am a clinical researcher and academic endocrinologist. I serve as the medical director of diabetes at Eisenhower Health in Southern California, and it is an absolute delight to be here today speaking to you about something that is near and dear to my heart.
And it's not only the management of individuals with dysregulated glycemic control, but now we have something even more exciting. Now we have something even better to offer, because as we know in life, it's the same as medicine. Every big problem starts as a small problem. An ounce of prevention is worth a pound of cure, that the earlier we intervene in an issue, the better the chance for a course correction and being able to bring better things forward. That's why I'm so thrilled to be able to come here before you today to talk about Stelo, from metabolic health to prediabetes.
Seeing is believing with this device. It is time to make the invisible visible, to put on our biochemical goggles, dig beneath the surface, and not just guess at what's going on in an individual's body or biochemical makeup, but to actually get to the heart of the matter, to actually get to the root of the process. To understand in a very bespoke and customized way for every individual that we have the pleasure of working with, what their needs are, what their goals are, what their challenges are, and to give them a very specific way that we can achieve that together.
Now, friends, come on here. I won't notice if you sneak up to the front. I see the back is totally filled. You guys have lunches. Are you eating on your lap? That's a tragedy. We've got tables up here. I'll turn away. I won't look if you want to sneak up front. No worries. We're just glad you're here, and in all sincerity, you've got a boxed lunch on your lap. I wish we had Tide Pens to hand out as well. Come up, eat in here.
Okay, my disclosures: consulting, speaking, or advisory board. I love diabetes, I love talking about diabetes.
Here we go. Impact of metabolic health on the human body. It really knows no bounds. Here we have but some of my favorite things to talk about, and please don't think that this is an all-encompassing list in terms of the issues that we face within metabolic health.
As we focus on the tree of life in our individual patients, remember not to be so caught up in pruning one individual branch, but to be able to look at the root of the issue. And the root of many issues in medicine is inflammation, and more often than not, we do focus on that one particular branch that's being afflicted by inflammation at the roots of the tree of life.
In my realm, that is diabetes and dysregulated glycemia. I'm sure it is in yours as well, but it also includes heart issues and kidney issues and liver issues and brain issues and pulmonary issues and other metabolic syndromes. That's just a catchall for everything else. Well, look at that. I'm so good, I knocked out the lights.
And polycystic ovarian syndrome, too, and you know it has a new name now, and of course, obesity and dysregulated glycemic control.
It's not just about diabetes. It's not just about, be it type 1 or type 2 or any flavor you could want of overt diabetes. But again, we want to intervene sooner rather than later. We want to get to that individual with prediabetes, stage 2 diabetes, if you will. We would love to be able to take it even one step earlier. Stage 1 diabetes, pre-prediabetes, if you will. What about individuals who appear to be the biochemical picture of health, but they have one or more parents with diabetes? Wouldn't you be curious to see where they stand on the biochemical landscape?
What about other individuals that are just intrigued by their own health? We all know the type. Individuals that wear, I don't know, Apple Watches or Fitbits or Oura Rings that just love the data. This is something we can do to offer individuals bespoke, customized, not guessing, but knowing information.
Glucose matters, absolutely, and I know I'm preaching to the choir here. One in three United States adults have prediabetes. Over 80% do not know it. In some of those cases, I'm sorry to say, the provider knows it, but has not yet conveyed it to the individual, which in my opinion, is not right. Seventy percent of individuals with prediabetes are projected to develop type 2 diabetes. That is why we are so invested in prediabetes. Where does prediabetes go when it grows up? The vast majority of it becomes absolute diabetes, and that is where we want to intervene sooner on the process. Not stage 3, stage 2, stage 1. Every big problem starts as a little problem, and it's easier to course correct with a little problem.
Fifty-four percent of U.S. adults don't get enough sleep. I'm not even going to go further here because all my apps will tell you I had a horrible night's sleep last night, so this doesn't apply to us.
Professional guidelines prioritize healthy lifestyle behaviors. TLC, what we want to give to everyone. I don't mean tender loving care, I mean therapeutic lifestyle changes. We all know what they are. They are medical nutrition therapy, daily aerobic activity, and weight loss if clinically appropriate for every given individual. And we preach these things time and time again for any condition, because it's good for what ails you. You don't have to have any biochemical undoing to benefit from a good diet, good exercise, good sleep, good habits.
But especially when we start to see inflammation attacking the roots of the tree of life and start to implicate and infect some of these branches in metabolic health, that's where TLC shines, and the sooner, the better. To have an individual with type 1 diabetes, stage 3, stage 3 type 2 diabetes, TLC will help. But where we really get the bang for the buck is earlier on, stage 2, stage 1. Help kick that can down the road as long as possible. And don't just take my word for it. What about ADA? What about ACE? Everyone agrees, do the right thing for your body.
So let's talk about Stelo, its features, and personalized health insights. It gives you connectivity with smart devices and digital health apps, free of alerts. Highest waterproof rating of any glucose biosensor. Very important for me, living in the Southern California area, where water is part of our livelihood. We're in the pool, we're surfing, we're diving, we're snorkeling. So the fact that it can be submerged up to eight feet, up to 24 hours at a time. Don't recommend a full 24-hour submersion, but you got it.
Customizable target ranges: type 2 diabetes, not on insulin, 70 to 180, and you can customize. No diabetes or prediabetes, 70 to 140, and you can customize. And guess what? I do not have diabetes or prediabetes. I'm wearing a Stelo right now, and when it goes below 70 overnight, I tend to run in the mid-60s overnight, no alarms, no problems, no issues. So this is really built for metabolic insight, metabolic knowledge, and understanding your own glycemic patterns.
Photo logging, let there be light. Personalized glucose insights, in-app learning, pattern spike recognition, up to a 15-day wear time, and not only no prescription needed, there's no prescription, period. Individuals get it themselves. More on that in a moment.
But first, everybody welcome Emily. So Emily is 52 years young. She is menopausal. You go, girl. Suffering from some unintentional weight gain. BMI is 32, waist circumference is 35. High cholesterol trending up year by year over the past five years. She has a new diagnosis of prediabetes, or shall we say, stage 2 type 2 diabetes, with a hemoglobin A1c of 6.1%.
And I truly admire, respect, and agree with Dr. Shaw's message. And I think the best take-home analogy is, look at cancer: type 1, type 2, type 3. I think that's really a diagnosis that hits home. And also the stages of CKD, the stages of CHF. Why not with dysregulated glycemia? Diabetes is not a light switch. There's no one day that you were totally fine, the next day not. There is a trend, and we need to be on top of that.
So she's on a GLP-1 and a statin. Put a pin in that. We're having some issues with the GLP-1 because her girlfriends told her, "Hey, once you go on a GLP-1, that is fantastic. You're going to lose weight and you can eat anything you want." Famous last words. We're going to see that that's not necessarily the case. Perhaps a little info and a little insight will show us what really we need to do.
She walks her dog, hopefully does that daily, and practices yoga twice a week. Plan: recommend the Stelo to provide bespoke, customized, non-guesswork, true information to really look at the impact of food and activity on her glucose levels.
Emily thinks because she's on the take-it-and-forget-it, once-weekly GLP-1, she doesn't have to food log. She doesn't have to worry. The only thing she does kind of different, aside from just eat what she wants, if she feels a little GI malaise, she reaches for ice-cold carbonated beverages and simple carbs. What could be wrong with that? Let's see.
So before we get back to Emily and see how she's doing, how do individuals in the wild really react to the information the Stelo provides? So this is a study looking at adults with established type 2 diabetes, with prediabetes, stage 2 diabetes, and with zero diabetes, zero prediabetes, normal glycemic control at this time. Have them wear the Stelo and then query them. How has the Stelo worked for you?
Across the board, be it no diabetes, prediabetes, or type 2 diabetes, you can see powerful impact in changes made from, first and foremost, dietary eating patterns. So yes, that means that even individuals with prediabetes or no diabetes, there was still very powerful guidance, information, and changes that were made in that cohort. Weight management, physical activity. Medication adherence was a little bit here or there because some of the members and some of the groups weren't on any meds to begin with.
But remember, the beauty of putting on our biochemical goggles and digging beneath the surface and understanding, not guessing, what our biochemistry tells us is priceless. The mind, once stretched by a new idea, never regains its original shape. And this is opening up someone's third eye to that which lies below.
It's an insight-driven tool for supporting early behavior changes in metabolic health, to help strengthen the understanding of glycemic patterns with what an individual eats, when they eat, how they eat, the order in which they eat the different macros on their plate. It can help motivate users through real-time learning of glycemic patterns, so that that individual who sat down for a breakfast of instant oatmeal with dried fruit and syrup or honey and brown sugar, who then has this huge spike in their blood sugar and then is thinking, "But I thought oatmeal was healthy." Right?
No more guessing. No more wondering. No more making assumptions, which may be faulty, about how macros work for you. Now you know.
Supported behavior change through iterative and self-learning, promoting accountability through continuous data, reinforcing ongoing engagement, and facilitating data-driven conversations with us, the medical team, to help make changes and have deeper, more meaningful conversations. Dexcom CGM in prediabetes or stage 2 diabetes: significant improvements in psychosocial health and lifestyle themes. It is a self-learning tool, can help with improving food choices because of that immediate feedback. Perceived improvements in blood pressure, weight, overall energy, opportunities for improved engagement.
This is a little Jiminy Cricket of glycemia, if you will. I don't know if you've seen the Disney animated feature, "Pinocchio." It's an oldie but goodie. But Pinocchio is a little wooden boy who wants nothing more than to be a real boy. He doesn't have a conscience yet, so he's got a little Jiminy Cricket who sits on his shoulder all the time and in real time, real moments, helps say, "This is the course we're on. Maybe we need to course correct." Welcome to Stelo.
I have to make sure we have no affiliation with Disney here, where it's a little kind of glycemic Jiminy Cricket or, if you will, a sugar Santa. What do I mean by that? It knows when you're sleeping, it knows when you're awake. It knows when you've been bad or good, so be good for goodness' sake.
This is real-life opportunity for course correction and information in the moment. Recall that well over 90% of every glycemic decision that an individual makes is out in the wild, far away from us and our counsel. Why leave them hanging? Why leave them unprotected, unguided, and unknowing? Why not give them a little something, something there to help guide them?
Stelo operationalizes four ADA lifestyle pillars daily with nutritional insights, physical activity integration, sleep optimization, and stress management. You know, all the good stuff we always tell people what to do. Do as I say, not as I do. It is important to live the good life, eat well, exercise, sleep well, be stress-free as much as possible. And of course, we can utilize all these different tools that feed into Stelo: glucose response scores, meal detection, spike detection, trends, insights, coach, logging the data, working in synergistic capacities with Apple and Google Health integration, working with the Oura Ring, which is awfully cool, if I may say so myself.
These are wonderful ways that, with data acquisition, we can make the chatter matter.
All right. Let's get back to Emily's journey with Stelo. Closing the gap with new key capabilities. Now this, please note the little box in the top corner, coming soon. How soon, you ask? Very soon, I say. How about within maybe this summer or so? We're going to see new capabilities like advanced nutrition within the app, looking at blood sugar in real time and being able to understand target ranges, personalized attention with bespoke, customized, germane feedback to the individual about what's going on, perhaps tips for improvement. Progression over time. Let's not just be great in the moment, let's be better tomorrow. How can we either capitalize on today's success, or how can we turn that biochemical frown upside down and be better tomorrow? This we can do with the Stelo.
Let's power new insights with glucose impact visualization. So here we can talk about meals. For instance, this is an absolutely yummy pancake and maple syrup breakfast. But, uh-oh, there was an impact, a big impact in glycemia. Insight kicks in. Your glucose rose 53 milligrams per deciliter after the pancakes and syrup. Adding protein or a healthy fat might have slowed absorption. Why don't we think about a short walk now to help speed glycemic recovery?
So it's not just a blood sugar is abnormal, good luck, you're on your own, but the blood sugar's abnormal. What can we do now to work on it, and what can we do in the future to maybe make sure this doesn't happen again? Whoops. Sorry about that.
There are contributors that go into the overall scoring system of the meals that are consumed on the Stelo app. The four big ones are rise rate, rise amount, total change, and recovery. Rise rate measures how quickly the glucose level increases after a meal. You will notice here on the app, when you click into it, it will provide a brief, easy-to-understand description of what it is, and it will then offer some points to fix. For instance, eating protein and veggies first, then carbs, may slow digestion and lead to a more gradual rise rate.
Rise amount, measure of how much your meal caused your blood glucose to increase. For some people, embracing healthy fats may help slow down the absorption. What it is and what we can do, not leaving the individual hanging with just an isolated number or an isolated reading without knowing what it means.
Total change, or in our language, area under the curve. It's a measure of how high and for how long your body's exposed to an elevated glucose level. Next time, increase the amount of protein and/or fiber in your meals, and maybe that can help decrease total change. Not just about, "Don't eat that. Look what it did to your blood sugar." It's about, well, let's really reconsider how we eat it, when we eat it, and in what order we eat it.
Recovery. A full recovery means your glucose went back to about where it was before you ate. If it doesn't come back down, that's partial. Maybe we can engage in some walking. Maybe we can drink some water. Maybe we can do something to make it better. Targeted advice. All of these go forward to contribute to the score contribution of understanding how different meals impact that individual's glycemia.
With connected nutrition, activity, plus sleep, you are now bringing all these data points together to have a more knowledgeable, not guessing, way of understanding where your blood sugars are. If you think you had a bad night's sleep because your blood sugar went too low, well, then you can look at the app and know, especially with integration with other devices, where you can see that.
Show today's events is another feature that can be utilized. Look at the nutrition breakdown. Look at different meals. For instance, if you didn't log a meal, but the Stelo recognized a rise in the blood sugar, it queries, "Was that a meal?" You can go ahead and put it back in. And then you can list the meals. You see the assessment, the high-level view, can go back, analyze, and see what worked for you.
Emily's favorites are spike detection, trends, and pattern insights. Spike detection alerts, so it lets you know if there is a spike, but it does not alarm. It does not beep. It's a nice little header notification on the phone that you can assess and address when it is convenient for you. Trends and insights help you recognize patterns between glucose, nutrition, activity, and sleep. We are squaring the circle of metabolic health.
You can link to an existing event, link to a new event. Sky's the limit in terms of how you can make this a customized guide in your pocket to help you navigate the slings and arrows of your nutritional life.
So Oura and Stelo, game-changing partnership to unlock deeper metabolic health. There is Stelo by Dexcom that you can access from the Oura app. You can combine the glucoses with the sleep patterns and physical activity patterns and truly understand how your body works.
Going back to Emily. Starting Stelo. In the beginning, first 14 days, we see 65% of the time she's in target glycemic range. Gratefully, she's not low, but she's high 45% of the time. She's very high 3% of the time. Her GMI is 6.1%. This is stage 2 diabetes. Let's get rid of that pre term.
Three months after wearing Stelo, without any change in medication, she's only on a GLP-1, and the GLP-1 is actually prescribed for chronic morbid obesity use. She didn't change the dose of the GLP-1, but after a 14-day download, after three months of the Stelo, 90% of the time in range, 1% low, 0 very low, 9% high, 0% very high. That is the power of knowledge. That is the power of insight. That is the power of your sugar Santa, your little Jiminy Cricket on the back of the arm, speaking to you in real life, real-time way to help you be the best metabolic you you can be.
Glucose tells a story from Emily's insights and learnings, three-month follow-up. She made behavioral changes. She incorporated more cardio and strength training. GLP-1 was decreasing her appetite, but she still had cravings for simple carbs. Armed with the Stelo, she was able to see maybe that wasn't the best, even with the GLP-1 on board, and helped her to make different decisions about her food options. She learned about sleep timing, impact of dinner. Recommend that Emily continue the Stelo. A1c from 6.1 to 5.7. Fantastic.
Getting started with Stelo by Dexcom, it is easy. Send individuals to Stelo.com or Amazon. No prescription, $99 a month as a one-time purchase, $89 for monthly subscription. It is FSA, HSA eligible. The order arrives. One box, two sensors inside. Each sensor lasts up to 15 days. You've got the month's worth right there. Readily accessible support, initial and ongoing in-app learning and web resources to assist individuals 24/7.
Stelo helps make metabolic health visible by showing how daily habits affect glucose. It makes the invisible visible. Generic advice becomes bespoke, customized, nutritional, physiologic, sleep guidance and information that you would otherwise probably have to pay a lot to interact with in person.
Instead of judgment, there's curiosity. Instead of static labs, there's the daily context. Instead of delayed feedback, there's in-the-moment knowledge. And basically, the fine print says, just use it as directed.
Thank you so much for your kind attention.
