Chapter 2: Patient Empowerment Through Use of Over-the-Counter (OTC) Biosensors Like Stelo

Video Transcript:

Rachel Stahl Salzman: Welcome, everyone, to our discussion on Stelo, the first over-the-counter glucose biosensor available without a prescription. My name is Rachel Stahl Salzman, and I'm a registered dietitian and diabetes care and education specialist based in New York City. And I'm joined by my esteemed colleagues here, Natalie and Diana. So, Natalie, why don't you introduce yourself? 

Natalie Bellini: Hello, everyone. My name is Natalie Bellini. I am a nurse practitioner and Assistant Professor of Medicine at Case Western Reserve University and the Program Director of Diabetes Technology at University Hospitals in Cleveland, Ohio, where we follow approximately 100,000 lives of people with diabetes. 

Diana Isaacs: And hi, everybody. My name is Diana Isaacs. I'm an endocrine clinical pharmacist, also a certified diabetes care and education specialist. And I am the Director of Education and Training and Diabetes Technology at the Cleveland Clinic in Cleveland, Ohio. 

Natalie Bellini: So, our second question is, what are the key factors that make over-the-counter glucose biosensors empowering for patients? So, Diana, do you want to start? 

Diana Isaacs: Yeah. Well, there's so many. So, I can start with a few. So, one of them is that I love now there is the ability to take pictures of food and incorporate that in with the data. And I think, wow, that is so cool that people can actually see—they can take a picture of their morning cereal and then see what their sugar is before and what it is after. And really, it helps to make those connections of, "Oh, so this, what I thought was a very healthy bowl of cereal actually spiked me to 200." 

And we counsel, we educate on this all the time, right? And I let people know, "Hey, a hard-boiled egg, protein, won't raise your blood sugar as much." But the labeling on the box, it just looks like it's got to be so healthy. 

Natalie Bellini: It says low sugar. 

Rachel Stahl Salzman: And high fiber. 

Natalie Bellini: Exactly. 

Diana Isaacs: Right. And so, the next day, sure enough, they try that hard-boiled egg, piece of whole grain toast and it's not going up as much, right? They're hitting like 130, 140. And so, those picture tools, it's a great feature, great way to go back on it as well. 

And then, the other thing—I know there's so many. I'll let you guys share some too. But, I have to say, I'm so excited about the Oura Ring integration. Now, I'm actually wearing an Oura Ring, so I am utilizing it myself. 

And it's so neat because the Oura Ring incorporates a lot of things like stress. It incorporates sleep. It incorporates my readiness for the day. But now, the glucose is paired with all of that to see all of those different patterns. And so, I can see my glucose both in the Stelo app but also in with the Oura app. And I think that integration, it's such a neat feature. 

Rachel Stahl Salzman: Yeah. There are so many great features with Stelo and really ways to help empower people. Some of the ones that I love are the educational library of content. I mean, you get a person. They're in your office. They're newly diagnosed with pre-diabetes or type two diabetes. They're overwhelmed. 

And we are—as busy clinicians, we wish we had all the time we could to talk to them, educate them on everything possible. But they're there for that first visit. Let's give them a tool like a CGM to let them learn on their own. 

So, they've got the self-discovery with their logging their food and looking at their data. And then, when they've got some time—maybe they're commuting down the road. They're waiting in line at the grocery store. They can check out the Learn tab where they could look at different articles, understand about what glucose data is, what matters, what are the different factors. And it's available in those bite-size modules, short articles, and videos, ways that are easy to understand. 

And so, I think that's a really key factor of having support between our office visits. It helps our jobs and it helps them to really connect the pieces. And the only other one I wanted to cover is that Insights tab, where people could look back after seven days of their data after a full sensor wear and get insights over their data and their information. 

And now, with all these integrations, it's pulling in more things related to their steps, related to their sleep. "Hey, your time and range increased 6% over the past week." Alongside that, your steps increase and your sleep. So, it gives people the tools of what are the factors that are helping to drive up my time and range, which again, is empowering. It's not here to judge and be negative. 

Natalie Bellini: Absolutely. I love that. I also love—so, the first time I wore Stelo, I had this little warning that came up. It said, "Your glucose is rising. Is this stress-related? Have you had something to eat?" It's asking me, it's, like, here we are. We have this little spike going on. What's it from? To help you  identify, what is going on right now? Because what happens is when someone says, "Well, what did you have for breakfast Tuesday?" I don't know what I did this morning, you guys. I'm not that person. 

And a lot of the people that we see with glucose challenges or want to understand their glucose more don't remember either. So, what this does is it says, "Right now, what's going on in your world right now? Tell me. Push the button so that when we look at the analysis later, you can then remember what's happening." 

And to me, that was everything. It was like, "Oh, this is wonderful." Because I was driving to work, my blood sugar, glucose, was spiking. My glucose is going up. I'm like, "I got to get to work. I'm late. Here I go." And that's a stress response that raises glucose. 

So, it made perfect sense to me. But it was like, "Hey, you might not need to do anything about this, or maybe you need to leave 10 minutes early." Maybe that alone would reduce that spike every day. So, I thought that was really interesting. 

Diana Isaacs: I love the spike detection feature. It really is so good. And like you said, it helps you reflect, was it stress? Was it your sleep? Was it what you ate? But the other great thing is that there are not these intrusive alerts. 

So, there are not the high alerts and the low alerts and the—not that those are a negative thing. But for someone that is not taking insulin, not taking a drug that causes hypoglycemia, those alerts are probably not necessary. And so, I think it's something that can be worn. It's really—someone can look at it as often as they want to, but they don't have to. They're not going to get these cumbersome alerts. And so, the ease of use is really, really good. And I also just want to comment on the education embedded in there, because I love that. And I actually wish all of the prescription CGM would have all of the education. 

Rachel Stahl Salzman: Yes. Everyone needs it. 

Natalie Bellini: Yes. The first thing I said when we started Stelo was, "Wait a minute. Why isn't this embedded into the other products?" Right? Because it's that good. It's that good. 

Diana Isaacs: And the quality of the education, I mean, we're CDCSs, right? So, we've got a high bar to reach. The quality is so, so good, and it is very easy to read in those digestible nuggets. 

Rachel Stahl Salzman: Right. So, I think for primary care providers, people that might not have CDCS support, they have a tool like Stelo to help support the person and give them that education to support them. And it supports us in our practice because they're getting that education that we might, again, not have the time and all the ability to discuss it with them all the time. So, really helpful. 

Diana Isaacs: And then, one other thing I will add is that we can view the data. So we don't have to—depending on where a person goes to receive their care, they can choose to look at it. But if they come to me, I, in general, I want to see their information as well. 

And so, now directly in the app, we can link up to Dexcom Clarity, and they can be linked to my practice, and I can go ahead and pull up their data. So, it's such a great thing, because we can look back—as many days as they're wearing it—we can go ahead and look back. We can look at those patterns. We can even do comparison reports, like, compare the last 14 days to the current 14 days. So, there's really so much that we can do through being able to access all that data. 

Rachel Stahl Salzman: And that goes back to the question, that's what empowers them. When we're looking at them, they're seeing what changes they made. They come to us empowered with the changes. 

I think using a tool like Stelo for them to understand what types of meal combinations work well for them, what kind of activities, and when to do the activities right after meals, that's that self-discovery. That no matter how much we tell them, "Try to eat this differently or try to exercise," when they see it in real time and visualize it with the glucose data, I feel like that's where the magic happens. 

Natalie Bellini: It really is. The other thing, I had a patient recently who was using Stelo back in, several months ago, and ended up with an injection of steroids. We're using a lot of steroids. We're using a lot of cortisone in joints because we have joint pain. This is the first start of how we treat all kinds of different joint issues. 

And immediately, what do they say at the office where she got it? "You might run a little high." And she did. And she immediately said, "Hey." And I said, "Okay, let's look at it. What are we going to do? Are we going to switch a medication? Are we going to make a change or are we going to let it run its course? Can you get a little more exercise? Can we do some upper body? How do you want to address this?" Right? 

She would've never known. And she had been getting injections for years on and off in different joints. And she said, "So, do you think every time I got an injection, my glucose went up?" And I said, "Absolutely.” “I never knew." Right? 

So now, are we going to do a different treatment for her because she might not want that in her body anymore? How are we going to make those clinical changes? These are giving people—she had no idea. 

And so, I think that's a big part of it too—what really does—it's not just exercise and diet. There's other factors. I've had people come in and say, "You know what? My husband," da da da da da. 

"And every time these things happen, my blood sugars are—my glucose is rising. My child is struggling right now, and I'm just—everything. My average is going up." Yes, it is. And let's talk about stress and let's talk about what can we do to help reduce that? 

Can we add exercise? Do you need a therapist? What can we do? Do you have a friend? Those kinds of answers to help someone, but they didn't know their glucose would go up under stress. 

So, whether that's a steroid injection stress, whether that's a personal issue stress, those are all things that make glucose go up. And people don't know this without the use of a Stelo. They had no idea. 

Diana Isaacs: Yeah, no, that's such a great use case for it. And then, another one too is with GLP-1 agonists. Obviously, those are drugs, and we're using a whole lot now. And one of the things that happens is sometimes when people are on a GLP-1 and maybe another drug like metformin, they don't always have coverage for prescription CGM. 

So, I had a patient recently that went out and bought a Stelo because she really wanted to be able to see her glucose readings and didn't want to do finger sticks, which I cannot blame her at all. 

And so, it really helped to facilitate the use of this GLP-1. And, of course, we provide a lot of education on healthy eating. We refer to the dietician, but being able to see her glucose levels in real time along with starting this drug, which was majorly affecting her appetite and sometimes causing her to kind of— 

she’s like, "I didn't eat all day, so I'm just going to eat a bag of chips. I'm still not taking in that much food." But then, seeing how that affected her glucose levels and then also working with the dietician and everything—really coming up with a strategy to eat healthier, balanced meals throughout the day to best tolerate the GLP-1 drug and really get the most of everything and help manage her glucose levels. So, I feel like that combination of CGM plus GLP-1 is just golden. 

Natalie Bellini: Right. It’s magic. 

Rachel Stahl Salzman: Yes. And I think about your phrase at ADA—data for all, right? I'll never forget that. 

Natalie Bellini: Hashtag, data for all. 

Rachel Stahl Salzman: That is the message, right? And now, with these over-the-counter, more people have access to it. So, it's really just a really golden opportunity. Well, thank you all so much for listening to our discussion on Stelo. It was great having you here.