Dexcom CEO Talks Stelo for T2D Care, G7 Issues, and the Responsibility of Diabetes Tech-makers

Julia Flaherty
Jun 30
7 min read

In 2023, Kevin Sayer, Chairman and Chief Executive Officer (CEO) of Dexcom, got a rideshare home from a stranger.

The man was roughly 5'5”, weighing about 280 pounds. Upon recognizing that Sayer was affiliated with Dexcom, he opened up about his struggles with type 2 diabetes (T2D), expressing his feelings of helplessness regarding the condition.

“So I talked to him about continuous glucose monitors (CGMs) in the car, and I said, if you'll send me a prescription from your doctor, I'll get you three sample sensors to wear,” Sayer said.

Over a year later, the man picked Sayer up again. He’d lost 140 pounds.

“Do you recognize me?” the man asked.

Sayer paused. He looked familiar.

“You couldn’t recognize me!” the man insisted. “I’m down half my size.”

Sayer wondered what had the greatest impact.

The Power of CGMs for Type 2 Diabetes Care

The driver explained to Sayer that the combination of the type 2 diabetes medicine he recommended, along with his new CGM, transformed his health journey. According to the American Diabetes Association (ADA), type 2 diabetes occurs when the body does not use insulin properly, resulting in insulin resistance.

The Cleveland Clinic states that factors contributing to insulin resistance include genetics, excess body fat, physical inactivity, hormonal disorders, chronic stress, poor sleep, eating highly processed foods or foods high in saturated fat, and certain medications.

Symptoms of type 2 diabetes include frequent urination, excessive thirst, insatiable hunger, overwhelming fatigue, blurry vision, slow-healing cuts or bruises, and tingling, pain, or numbness in the hands or feet.

“It was the first time he had a scoreboard to track his progress,” Sayer said. “If we can give folks a scoreboard and better data, we see better A1Cs.”

An A1C test measures your average blood glucose level (BGL) over two to three months.

“Standards of care are mentioned a lot in our recent report,” Sayer noted. “Physicians believe it (CGMs) should be a standard of care for patients with type 2 and type 1."

In Dexcom’s latest press release ahead of the American Diabetes Association's 85th Scientific Sessions, the company shared that “96% of providers surveyed in the U.S. agree that CGM should be the standard of care for individuals using multiple daily insulin injections, and 94% agree that CGM should be the standard of care for those on basal insulin.”

Will Standards of Care Push Standards of Affordability?

Members of the diabetes community have known this for a while—anyone using potentially blood sugar-lowering medication should have a CGM in their toolkit to support their survival with any type of diabetes. CGMs can not only enable a proactive approach to diabetes management but also provide life-saving responses when things go awry.

Having the data to affirm this understanding may help standards of care progress forward.

Still, similar to type 1 diabetes, the affordability and accessibility of technology for diabetes management remain concerns for people with T2D across the United States. Regarding access and affordability of their product suite, Sayer said, “We played a big role in getting PBMs (pharmacy benefit managers) to cover Dexcom G7.”

“We initially designed Stelo for people with type 2 diabetes as a cash alternative when insurance wouldn’t pay,” Sayer said.

Stelo by Dexcom is a new glucose biosensor launched within the past year that helps people with type 2 diabetes who are not on insulin, those with prediabetes, and the general public monitor their glucose levels, regardless of whether they have a doctor's prescription. Glucose biosensors differ from continuous glucose monitors, but in Dexcom’s case, they are built using the same advanced technology.

Stelo offers 15-day wear, a 12-hour grace period, spike detection, in-app learning, and user insights. It does not provide real-time alerts, unlike the Dexcom G7, which is beneficial for people with diabetes who require them. Additionally, it is only approved for use in individuals aged 18 and above, among other differences.

Dexcom says they are the number one covered CGM across their product suite, with most users paying “under $20 per month” for G7 supplies. Meanwhile, Stelo offers a monthly subscription for $89 or a 3-month subscription for $252.

Price Isn’t the Only Diabetes Device Accessibility Factor

Accessibility was on Sayer’s mind when discussing Dexcom’s portfolio updates.

Despite notable advancements, a doctor prescribing Dexcom recently told Sayer that a 78-year-old patient on Medicare at his clinic didn’t care about graphs or charts; they just wanted bigger numbers. This interaction highlights the need to support and accommodate visual or auditory impairments, as well as ensure ease of use for those who aren’t tech-savvy.

As Dexcom considers future updates, Sayer affirms these needs are on their minds.

“My HR person can tell you about how sensors work,” Sayer said. “My lawyer can tell you about how insurance companies pay. My amazing salesperson can tell you how they're manufactured. We live this. It's all we do. So when people tell us something's not working right, we try to address it.”

“We hear more good stories than bad,” Sayer admits. “If I wear a Dexcom shirt in the airport, I pretty much get mauled because people love the product. It’s wonderful to experience.”

Dexcom’s Response to Community-Reported G7 Issues

While Dexcom offers a product suite loved by many in the diabetes community living with type 1 and type 2, there was a need to address the elephant in the room. Sayer spoke about it candidly—the community-reported issues with the Dexcom G7, from sensors falling off too early to failing during warmup to not deploying, and so on.

“We lost a bunch of product, as we talked about in our December 2024 earnings call,” Sayer shared. “In all fairness, we were exposed to improper shipping. It was too hot, and we lost nearly a million product sensors.”

“So now we're catching up. We think we have, from a volume perspective. We’ve heard that some sensors have not deployed or have popped up through the hole, and we've implemented every step possible to fix the issue. My team knows more about and cares more about our product than any company I have ever worked for or seen. Please understand, this technology is all we do. If you think you're a geek, come to Dexcom for a day.”

If you experience an issue with your G7 device, Sayer encourages you to call customer service promptly.

“We will always replace it,” Sayer says. “We enacted a policy a year ago about sensors falling off, and that policy worked fine, but if you have a technological failure sensor, you need to call us. We’ll replace it and get it to you in a day. And we have gone through our tech support, people have answered the phone, and we have directed it to be very customer-friendly as people have been calling with respect to what's coming on.”

Nutritional Context for the General Population

In addition to concerns about G7 sensor issues, there is also concern within the diabetes and scientific communities about members of the general population using glucose biosensors.

While there is hope in the diabetes community that providing the general population with access to CGM technology, through glucose biosensors, may help reduce costs for people who need CGMs, there is also concern that they might not be beneficial for people without diabetes and could potentially lead to disordered eating patterns without proper nutritional context.

On this topic, Sayer said, “I've thought a lot about that because what we're telling you right now is ‘you have a glucose spike.’ We're not telling you you've eaten too much. We're not telling you you’ve done something bad.”

“We're just saying ‘you've had a glucose spike’...we're telling you what your average glucose values are for the week,” Sayer said. “We're telling you ‘today's been the best day you've ever had.’ It’s all positive feedback. It is very interesting. I mean, I knew people before glucose biosensors were available, without diabetes, who would stick their finger 12 times a day because they were paranoid.”

Sayer compared this unknown to the unprecedented experience Dexcom had with its “share” feature, which allows users to connect their families and friends to their blood sugar readings through the Dexcom Follow app.

Using Dexcom Share as a Learning Experience

“When we launched ‘share’ in 2015, there was one thing we didn't understand: what would happen to families because kids get very tired of being bothered, but the fact that they can share their data with their parents means their parents don't even have to sleep anymore,” Sayer said. “They can watch their kids' data all night long.”

While the "share" feature was a valuable addition for caregivers or parents of children with type 1 diabetes, Sayer hints at the burden of having constant visibility along with its benefits. 24/7 access may lead to obsessive patterns in some, while providing peace of mind to others.

“We had not really anticipated the familial consequences,” Sayer said. “So my cousin has two kids with type 1 diabetes. He's divorced. Neither kid will let their mom see their data because she's a math teacher and she's a geek. My cousin is a history teacher and a PE (Physical Education) coach. So they'll let their dad follow him, but they will not let their mom.”

Familial complexities have always posed challenges in diabetes monitoring and management, but technology introduces a new dimension.

Regarding providing nutritional information to people without diabetes who might not have received that education through their healthcare system, like some people with diabetes may, Sayer concluded, “We’ll have to monitor that and see.”

Data is a Stepping Stone for What’s Next

This feedback emphasizes the importance of users of any continuous glucose monitor (CGM) or glucose biosensor, whether living with or without diabetes, to consult with their doctors and utilize other tools, resources, and apps to make informed decisions about their food intake.

Data is one part of the story. It is never helpful to make lifestyle modifications based on assumptions about the data or to judge yourself or others for what it reveals. The response to data is in the users’ hands—yes, yours.

Still, you’re not alone in what’s next. The diabetes community, in particular, offers a wealth of information, connection, community, and understanding to help you recognize blood sugar patterns, make decisions that support your personal nutrition needs and goals, and build a healthy relationship with food that isn’t driven by a number alone.

Numbers are moments in time. Health is a culmination of small but mighty habits you build over time. CGM or glucose biosensor data can serve as a launch pad, but it shouldn’t become a rabbit hole.

Disclaimer: I live with type 1 diabetes and use Dexcom CGM as part of my personal diabetes management. I was not paid to write this article, and all opinions expressed are my own. This content is intended for informational purposes only and should not be taken as medical advice.

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