When Jake Leach joined Dexcom more than 20 years ago, the company was a 30-person startup with no commercial products and a single, audacious goal: to build technology that could continuously measure glucose inside the human body. At the time, that ambition placed Dexcom squarely in the medical device category—and far from today’s conversation about wearables, consumer health, and AI-driven insights.
Two decades later, the company sits at the intersection of all three.
Speaking at the 22nd Annual Columbia Business School Healthcare Conference—co-hosted by the school’s Healthcare Industry Association and Healthcare and Pharmaceutical Management Program—Leach, now President and CEO of Dexcom, reflected on how the company has grown from a continuous glucose-monitoring pioneer focused on type 1 diabetes into a biosensing company with a solutions for all types of diabetes, and more broadly metabolic health.
Moderated by CBS Adjunct Professor Halle Tecco, MPH, MBA, the conversation explored how sustained innovation in healthcare requires not just better devices, but new ways of thinking about data, users, and scale.
From Engineer to CEO
Trained as an electrical engineer, Leach joined the company to work on hard, technical problems, not to chart a leadership path. Early Dexcom was deeply engineering-driven, focused on solving fundamental challenges in glucose sensing, accuracy, and reliability.
Over time, Leach took on more operational work, sustaining engineering, and cross-functional problem-solving. Those experiences pulled him closer to the full system surrounding the technology: regulation, manufacturing, commercialization, and user experience. Each role brought discomfort, he said, but also a broader perspective.
“Part of my journey was definitely taking on anything you're asked to do and really stepping out of the comfort zone,” Leach said. “Throughout my career, every time I have a new role, I'm a little uncomfortable.”
That systems-level understanding now defines Dexcom’s leadership approach. As the company has grown beyond a single product category, fluency across engineering, clinical requirements, and business models has become essential.
Building a Biosensing Platform Through Iteration and Focus
Dexcom’s early technical ambition centered on an implantable glucose sensor designed to last up to a year. Each design iteration required months-long clinical studies, making improvement painfully incremental.
The strategic breakthrough came when Dexcom pivoted to short-duration wearable sensors—initially lasting three days, and now up to 15. That decision did more than improve convenience. It transformed Dexcom into an iteration engine, enabling faster learning, better performance, and a steadily improving user experience.
From there, Dexcom’s technology stack expanded. Smartphone connectivity turned Continuous Glucose Monitors (CGMs) into networked wearables. Remote monitoring features allowed caregivers and clinicians to engage with data in real time. Over time, Dexcom wasn’t just measuring glucose—it was building an real-time sensing and data platform worn on the body that could provide meaningful insights to users, empowering their health.
That platform orientation set the stage for Dexcom’s most recent evolution: moving beyond prescription-only medical devices. In 2024, the company launched Stelo, the first FDA-approved over-the-counter CGM in the US for adults over 18. While still rooted in foundational glucose biosensing, Stelo represents a shift toward consumer wearables that are designed for learning, engagement, and behavior change, in addition to acute alerts.
Making that leap required Dexcom to rethink product design, documentation, and commercialization. The company brought in talent from consumer technology and built direct-to-consumer capabilities, including partnerships with Amazon and integrations with other wearable ecosystems. The result is a product that fits squarely within the broader health wearable landscape, while still meeting medical-grade performance standards.
"There's just so much more impact we can have in the lives of people with diabetes, and that's before we talk about pre-diabetes, health, and wellness.,” Leach said. “What keeps me excited every day is the impact we can have on global health."
AI as the Layer That Turns Biosensors Into Insight
As Dexcom’s devices evolved into a platform, AI became the connective tissue. Internally, AI tools have improved the company’s software development, testing, and the extensive regulatory documentation required of medical technology companies, quietly increasing speed and scale.
More visibly, AI now shapes how users interact with Dexcom’s biosensors. By combining glucose data with inputs such as sleep and activity, CGM devices can deliver personalized insights that help users understand patterns in their health. These capabilities are being introduced first in lower-acuity, over-the-counter products, where experimentation and rapid iteration are possible, before moving into more regulated clinical settings.
For Leach, this sequencing is intentional. Biosensors generate vast amounts of data, but value comes from interpretation. AI, when applied carefully, turns continuous sensing into actionable understanding, without overwhelming users.
Dexcom’s platform mindset also shaped its response to recent market disruptions, including the rapid rise of GLP-1 weight-loss drugs. While investors initially viewed these therapies as a threat to diabetes technology, Dexcom took a longer view—studying physician behavior and patient data rather than reacting to headlines.
What emerged was a complementary story: medications helped manage calorie intake, while continuous monitoring helped users improve metabolic quality.
“Being able to adapt in a fast-growing industry is important,” Leach said.
Looking forward, Dexcom’s ambitions extend beyond glucose altogether. The company is exploring the clinical validity of measuring additional biomarkers—through future generations of multianalyte sensors. The long-term vision is not a single-purpose device, but a multi-layered health-sensing platform worn continuously and integrated into daily life.