They gentrified my glucose monitor

I'm diabetic. Not the socially acceptable kind. The punchline kind.

If you don't know what I mean, and if I actually know you, I'll take the time to explain, but it's something I can't always use my words about and I would prefer to handle these chats 1:1. You'd be surprised what comes out of peoples' mouths.

I pay for a continuous glucose monitor. It's a little expensive. "Daily Starbucks" territory, which is fine because I'm diabetic and should stay away from Starbucks. A CGM helps me understand what I can do.

My condition is pretty well managed: I keep processed carbs low, take a normal dose of a cheap med, and exercise. The numbers are pretty good. I could use a finger-stick blood glucose meter, but trying to find a balance between useful regularity and building a routine around that was hard, and I wanted more insight into what my body is doing between measurements.

Insurance won't cover that—just the individual strips for my finger-stick meter—so I pay.  I can afford to.

But the app I use to get my readings, and which I agreed to use to get a small discount and a "prescription" to get around regulatory stuff, is deeply uncomfortable with mentioning my disease at all. It prefers to talk about "metabolic health."

When I first started using it, it was mostly notable for never, ever saying "diabetes" or "pre-diabetes," but now it is beginning to expand its feature set and I am realizing through conversations with coworkers and simple observation that a lot of my fellow CGM users must not have diabetes at all. CGMs are, instead, being sold to people who think of them like something they'd probably rather their Apple or Garmin watch could do, because glucose levels are something they can measure instead of something they must measure. 

So the app's features are beginning to reflect a much more middle class set of preoccupations. It wants to nudge me to do mindfulness time and other general "wellness" features. It continues to pointedly treat the whole thing as a matter of "knowing more about yourself and your wellness" and not "managing a chronic condition." It has come up with an AI gimmick that never actually  "automatically detects the food I'm eating" with a picture of my meal. 

I have no idea what the economics of medical devices are. I do know that I would like to live in a world where anybody with diabetes could get a CGM, because it'd mean people with a chronic illness would have access to much more information about their bodies and their illness.  

I don't know if CGMs could or will undergo some sort of smartphone uptake pattern, where we have to live through the "expensive bauble" years until cheaper components and production techniques allow the manufacturers to start going downmarket and sell whatever the medical device version of a "cheap Android phone" is. 

I know that CPAPs have gone through that: It used to be hard to get one, but now you can buy one uninsured if you answer 10 questions in a web form, pay $99, and get a "prescription" from a CPAP reseller's doctor. For the wealthy people, you can get the one with Bluetooth for a bit over $1000, so you can read your stats on your phone.  

For the less wealthy people (and, I'm guessing, people coming in through the front door with their insurance company) there's the same model except no Bluetooth and it won't start automatically when you put the mask on. That's not bad. I knew someone who died of a stroke because he wouldn't use his CPAP, so it's great that for $99 + $300 you can get a reliable device that doesn't even need to be calibrated by a tech because it can sense what your air pressure needs are. That's not nothing, but it's one Standard Starbucks Month for a potentially life-saving device that will last for years. 

But I'm curious about how the wellness industry's interest in CGMs— and the device industry's resistance to scaring off the Lululemon people by actually mentioning illness— will affect the market dynamics. I assume that over time they'll want to expand their market, and once they have a few generations worth of features they'll begin to differentiate into "the kind that'll still cost more than it needs to thanks to the insurance industry, but you can sell to people well off enough to have health insurance" and "the kind you sell to the wellness market." One will come in a box with pictures of wellness people, one will come in a box that doesn't have pictures. One brand will be a proud sponsor of wellness influencers on TikTok and the 'gram. One will just be the pharma's name in a plain white box. 

And I wonder about the effect all the wellness people using the CGM app and for whom "mindfulness time" is a metric of equal value and meaning to their blood glucose levels will have on perceptions of these devices. Those are middle class people who set the tone in policy conversations, and they don't think of these things as medical devices, but rather as wellness accessories. Luxuries. And if the American middle class is good at anything, it is good at becoming infuriated when poor people or people who need their help seem to have "luxuries."