Continuous glucose monitoring company tracks blood glucose in real-time to help you boost your metabolic health.

Leveraging continuous glucose monitoring (CGM) technology, New York start-up Levels is aiming to help people maximise their metabolic health and, ultimately, improve their healthy lifespan. The company recently secured a sizeable $12 million seed funding round, led by Silicon Valley’s Andreessen Horowitz, and joined by several other interesting names, including Netflix co-founder Marc Randolph and former Twitter CEO Dick Costolo.

Longevity.Technology: Glucose dysregulation and insulin resistance is implicated in everything: from infertility, blindness, amputations and cardiovascular disease to stroke, Alzheimer’s disease and non-alcoholic fatty liver disease. To date, CGM has predominantly been used in the management of Type 1 diabetes, but Levels aims to bring its benefits to a much wider audience. To find out more, we caught up with the company’s co-founder, former SpaceX and Hyperloop engineer, Josh Clemente.

During his time at SpaceX, one of Clemente’s key roles was to lead a life support systems team on the astronaut programme, where he came across some research that made him sit up and take notice.

“The research showed that rodents that were exposed to a high pressure oxygen environment could live five times longer without experiencing seizures, if they were on a ketogenic diet,” he recalls. “That totally shocked me, because it was essentially saying that diet alone can impart these superpowers on these organisms.”

As a CrossFit Level 2 certified trainer, Clemente had always believed that exercise was the best way to stay healthy.

“I thought, if you can run fast, jump high and lift heavy weights, you’re healthy,” he says. “This research shifted my worldview when it came to health, and I started to focus on how healthy I really was. I was certainly physically fit, but when I thought about my day-to-day, I was dragging. I’d go through my day in waves – I’d have a big boost of energy in the morning, and then I’d be feeling sluggish by the time I got into the office. And that was a surprising realisation to me – coming to terms with the fact that maybe I’m not as healthy as I previously assumed.”

Determined to find out more about how his diet might be impacting his health, Clemente decided to try measuring his glucose levels using a standard fingerstick testing kit from his pharmacy. But, after pricking his finger around 60 times a day, he realised that he needed more data to be able to get a complete picture.

“I was not measuring much throughout the day because I was working, I couldn’t measure anything while I was working out, I couldn’t measure anything while I was sleeping,” he says. “And so all of these giant chunks of my day were completely without data.”

Have read about CGM technology, Clemente tried to get hold of one. After being turned down by several doctors on the grounds that he wasn’t diabetic, he managed to source a device from Australia.

“Within about two weeks, I had enough full-time data showing how my body responds to the meals I was eating and my lifestyle that told me I was either prediabetic or borderline – and even my doctor at the time agreed with me,” he says.

“That was the moment when everything changed. I didn’t have any outward signs of dysfunction, and yet there was this hidden situation that could easily spiral out of control. And I just happened to stumble upon it.”

Seeing its potential for widespread use, Clemente realised the answer was not simply to give everyone a CGM device. He had spent hundreds of hours researching metabolism, glucose and physiology, and he knew that giving someone a glucose monitor would not going to give them the context they need.

“I saw there was an opportunity to take this amazing CGM technology that was developed for management of a metabolic condition, and to build an experience on top of it,” he says. “To build a behaviour change platform that does the interpretation, takes into account these nuanced patterns and trends, and provides insights and personalised recommendations for the individual. And so that’s what we’re building at Levels.”

Together, Clemente and CarDash founder Sam Corcos have assembled a formidable team of co-founders, from medical experts to some of Google’s top talent. The company has recently rolled out the first version of its product, which focuses on three key areas:

Specific event score
Throughout the day, as users have a meal, for example, they take a photo of their food using the app, which timestamps it.

“In the background, our algorithm looks at how your blood sugar responds to that meal over the course of the next two hours,” explains Clemente. “We provide a score, based on things like the rate of change how high you went, how long you stayed outside the target range, if you exceeded it, variability, number of peaks and valleys.”

“Two hours after eating, the score will tell you the quality, on a scale of one to 10, of that meal for you – and how sensitive you seem to be to it.”

This information can also be combined with data from other technologies, such as wearable fitness trackers, to give users a view of how they respond to combinations of activities. A meal followed by a walk, for example.

Day score
“This is looking at the total of all of the activities that you choose within a day – nutrition, exercise, sleep, stress – giving you a single score for each 24 hour period,” says Clemente. “And that helps you to see the areas for opportunities – if your score in the morning is damaging your day score a little bit more than your scores in the evening, or vice-versa.”

Metabolic fitness score
Still under development, this is a longitudinal metric, that brings everything together into a “best case predictor” for metabolic fitness.

“How well you are functioning in terms of your age demographics, as compared to the population as a whole?” says Clemente. “Where do you fall on the distribution and where can you make improvements? The goal here is that we can have short term, medium term and long term metrics that people can orient themselves around without having to get into hormones, glucose rates and all of these nuanced topics.”

While Levels is currently focused on general health and wellness, Clemente expects that the company will eventually look to seek approval for use in clinical settings.

“Our software is not yet ready for therapeutic use or for diabetes management,” he says. “We do intend to ultimately get that approval, but we’re still very much in development, so right now we are very focused on direct to consumer.”

The product is now in its beta phase and priced at $399 a month. Despite the price tag, demand is high – there are apparently 45,000 people on the waiting list – but Clemente is clear that the company’s goal is to make the product as affordable as possible.

“We know that in order to get to people who are at increased risk of metabolic dysfunction, we have to bring our pricing down,” he says. “This is going to require rigorous research, but we’ll be using our data to demonstrate outcomes and show insurers and self-insured employers, how this product relates to long term quantifiable reduction in risk. That will be our effort to move beyond just direct to consumer and into more of a covered programme.”