Back on August 26, 2024, Dexcom, Inc. introduced its first over‑the‑counter (OTC) continuous glucose monitor branded as the Dexcom Stelo (see https://www.fiercebiotech.com/medtech/dexcoms-stelo-first-over-counter-wearable-glucose-biosensor-hits-market for more). The Stelo CGM uses the exact same sensor as Dexcom's G7, which has a 10‑day wear time, and the same sensor as the G7 "Plus," which lasts 15 days. Abbott followed with its own OTC product, Lingo (see https://www.drugdeliverybusiness.com/abbott-launches-lingo-otc-cgm-walgreens/ for more) , built on the same hardware lineage as its Libre 3/3+ sensors. In other words, neither company created new technology for the OTC market; they simply repackaged existing CGM sensors and removed the features that might trigger prescription‑level regulation or conflict.
Dexcom claimed that its Stelo product was "designed for adults 18 and older who are not taking insulin"— a group it says includes roughly 25 million people with Type 2 diabetes in the U.S. The health insurance industry has long refused to cover CGMs for this population, not because the devices lack value, but because covering them would dramatically increase insurance claims costs. The "fingersticks are sufficient" argument is simply the cost‑containment rationale which payers use to defend that position. The OTC strategy was meant to sidestep that particular market barrier: if insurers won't pay, maybe consumers will.
But Dexcom and Abbott invested very little in educating physicians or building clinical pathways for these OTC devices. And the fundamental flaw in the strategy has become very obvious: the insights provided by Stelo and Lingo don't necessarily require ongoing use. Many people wear a few sensors, learn how their food and activity affect their glucose levels, and then stop wearing them. The OTC products behave like short‑term learning tools, rather than long‑term therapies. That's why the repeat‑purchase rates look nothing like they do for the G7 or Libre devices, which have strong, predictable refill patterns among insulin‑using patients.
Pricing behavior has quietly confirmed this.
Both companies launched their OTC sensors at premium cash‑pay prices, clearly assuming recurring use. But within a short period, the market began to tell a different story. Dexcom started leaning on subscription discounts for wearers and periodic price reductions, and Abbott rapidly expanded Lingo into Amazon, Walmart, and Walgreens — a distribution pattern that usually signals the need to widen the distribution funnel when retention is soft. Retailers began offering introductory promotions, loyalty‑program discounts, and bundled pricing. None of this is typical for prescription CGMs, which don't require front-end discounting because a clinical need drives continuous use. With OTC sensors, the pricing drift has become one of the clearest indicators that trial is impressive, but repeat demand is rather weak.
CGM Makers Can't Hide Refill Data on OTC Sensors Indefinitely
Wall Street analysts have noticed, and every quarter they keep trying to press both Dexcom and Abbott for refill and replacement‑rate data. Both companies continue to refuse to disclose it. But the pricing shifts, channel expansion, and promotional activity tell the story anyway.
Dexcom's backdrop is even more complicated.
Dexcom has been navigating a CEO transition while also dealing with the negative Hunterbrook investigation (I covered that at https://blog.sstrumello.com/2025/09/corner-cutting-at-scale-management.html for more), which has raised some legitimate questions about Dexcom's corporate transparency, quality controls, and handling of its known G7‑related issues. It's a challenging moment to be expanding into consumer markets, while also refusing to answer basic investor questions about retention, all while also facing public scrutiny over internal controls.
And that brings me to my headline.
When a company ships a device that COULD theoretically provide alarms and data sharing — because the hardware already supports it — but deliberately disables those features for regulatory and commercial reasons, it creates an obvious vacuum. Hackers tend to notice when manufacturers remove functionality that users might actually want. They restore it. They always have. We haven't seen much backer movement on OTC sensors yet, but given the size of the installed base and the obviousness of the missing features, it's hard to imagine that lasting. At least I personally hope that does not last.
Hence, I am inviting hackers to step-in and fill the void. Users want these things, and you are positioned to do it.
And, it's the users' data anyway, that CGM reading information does NOT belong to Dexcom or to Abbott, it belongs to the patients. And, I would remind regulators need to beware of that not-so-little detail before they throw a stupid hissy-fit over it. In most cases, third-parties already access Libre 3/+ and Dexcom G7/+ data using the wearer's Libre or Dexcom login information. Consider third-party entities like "Sweet Dreams – Sugar Tracker" which enable users to access their CGM readings on an Apple Watch, including on Libre CGM sensors as well as Dexcom CGM sensors and it enables watch wearers to locate the readings anywhere THEY want the readings to be featured on their watch face (whereas Libre does not do it at all right now, and Dexcom limits their app to the periphery of the watch face). I don't know anything about how an OTC sensor might (or might not) be enabled, but it does not really seem to be an impossible feat to hack.
Maybe some enterprising hackers with some time on their hands would be willing and able to crack that? By all means, please do so! As a patient, I see value in having that ability.
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