We had so much good content this week, it didn't all fit between Monday and Friday. So, because of that, you're getting a special episode today, Adree with Jake Leech from Dexcom.
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That's good to see you, Jake. I just hit record, just so you know.
Yeah, sounds good. How's Ardan doing?
She's doing really well. I appreciate it. She's 21. She's had diabetes 19 years now. She's still in college. She had a little thing where she woke up in her sophomore year, beginning of her sophomore year, and she's like, I don't think this is the right place. But she kept going and then she's like, I'm going to switch gears. And I was like, okay. So, she went from Savannah and came home and changed to a psychology degree.
We had an issue where she had to get an injection, but she has sort of a, she's got a bit of a needle phobia, which is I guess an odd thing for some people to think about with type 1 diabetes, but yeah, we were like commuting to her to help her with stuff and it was like it was getting too much. So, yeah.
No, it's incredible. That's actually, that's really interesting. You talk about the needle phobia, but I can see, you know, with the more modern technologies we've all been working on continuing to develop and innovate, it does kind of get to a point where someone with needle phobia can or, you know, has an issue with needles doesn't have to always face that because the technology is so much better.
Oh, for certain. I mean, you know, I didn't realize it at the time when you guys went from I guess it was G5 that had the plunger, right?
Yeah. G6 was the first auto applicator for us. It was just a button push.
Yeah. And I remember at the time when you made the switch, there was a segment of people who came to me and said, 'This is such a big deal.' And I couldn't wrap my head around it. I was like, 'Why does it matter?' Like that one wasn't bad. Like you pinch it, you push the thing, you pull the collar back, it was over. It wasn't, you know, I didn't find it to be difficult. It's not till now that I realized that some people do not want to see how the sausage is made. So,
Oh yes. When we were designing the auto applicator for G6, I remember I had a video of a woman that was, she had posted on the internet and it was, she was chasing her daughter around with a G5 trying to put it in her arm or in, you know, in her abdomen.
And I showed it to the team saying, 'Okay, this is what we're going to try and solve.'
Yeah. Exactly. It's the anxiety of having to chase your, you know, four-year-old around to put a sensor on them. And so, yeah, it was the team got a kick out of it. It really, it helped get everybody excited. I think you don't realize sometimes till you look at it. There's a great story somebody at Omnipod told me that they used to have a photo of Ardan up as like a 5-year-old in the office and she had the pod on and they always thought like, oh, it's, you know, it's so small. It's so great. Then they saw it on a little kid and they thought, I wonder if we can make this any smaller, you know, because on her it looked huge. And then they shrunk it down. And you know, little stuff makes a big difference to people, I guess, is my point.
Absolutely. Yeah. So, what have you guys been up to? What are you here to tell me about?
Oh, we've been doing all kinds of stuff. You know, we've got new innovations coming on the G7 platform. We've been working on Stell. We've been, you know, broadening awareness. You know, it wasn't that long ago that CGM was really kind of a tool focused on more intensive insulin users. And I think that's, you know, that's where the initial evidence for clinical outcomes, all that stuff was generated. But now, you know, as we continue to grow and can serve more customers, as we look at this type 2 population, you know, type two diabetes continues to increase around the world and CGM is an amazing tool to help people better manage it. A lot of it in type 2, as you know, a lot of it's around kind of lifestyle and, you know, food and activity levels. And so, you know, CGM's a great tool to help people manage that differently and more effectively. And so, we're just really out there trying to drive the messages around type 2. And we have a type 2 report, basically a state of type 2 in the United States, specifically around CGM. We did this in our European region earlier or I guess late last year. And so now we did it again in the US. We talked to over 100 healthcare providers. We talked to a lot of people, over 300 people have diabetes type two and most of those folks are not taking insulin. So, they're treating their type two with oral medications or other non-insulin medicine and really just getting after their experience with CGM, the benefits, and really around the prescribers asking them. And, you know, they very much see CGM as a critical tool for managing all of type 2, not just those insulin users.
What are they reporting back? What are people getting out of seeing the CGM data?
So I think the main thing is that they all believe that 100% of these folks said CGM should be used in combination with GLP1s and SGLT2s all the time. You should always have CGM alongside so that you can see basically how those different medications are helping improve blood glucose. But also the medications, as you know, they're not the only solution, right? A part of this is changing choices and habits and forming healthier habits to manage diabetes and CGM is the perfect tool to show that because it's just that instantaneous feedback of a meal or, you know, activity level that causes glucose to be so much better controlled.
They learn that very quickly, right? People when they see that, you see in your own data, it's extremely quick to figure it out.
So, you know, it's a lesson you hear people with type one talk about all the time. I mean, genuinely, I interviewed a person this morning, 44 years old. She was diagnosed when she was 22. And she said she kind of was able to pretend she didn't have diabetes. That was her coping mechanism. Then she got on a CGM and then suddenly saw what was happening and realized like, I can't, how am I going to ignore this, you know? And I even think back to, I mean, I don't know how long you guys have been coming on the podcast but way, way back Kevin told me, I'm wearing the product, you know, like I don't have diabetes but I'm wearing it and here's a list of three foods I don't think I'm going to touch anymore. Just seeing what it did to my blood sugar while I was wearing it.
So, I guess my point is that when we can talk to type ones who lived before CGM and hear from those adults who are seasoned and they're veterans of the fight and they can tell you how big of a deal it is to see the feedback, it's interesting that we almost didn't immediately just apply that to type two. Like, why did we have to go talk to people to figure that out? You know what I mean? Like, it's really great. I mean, it's fantastic that it's getting out there. So, but how does it get out there? Like are you counting on an endocrinologist or a GP? Are you counting on the people who do you want to say, 'Hey, you should try this thing.'
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Short answer to that is everybody, right? I think it's a big focus of ours is just raising the awareness that CGM technology exists. Many people who have private insurance, we're starting to see coverage for all diabetes. You know, we've got three of the largest PBMs now have Dexcom CGM on their lists of covered devices. So, we still have work to do with, you know, Medicaid and Medicare and all the payers like we always do, but we're starting to see lots of real world evidence being generated by people using both G7 and Stell that have type 2. And we're starting to see their outcomes and how much improvement. It's no surprise the improvements that they're making when they start using CGM. You can, you know, within the first month, we're seeing significant improvements in time in range.
Yeah, I love these studies where we show, you know, a whole, a large population of folks go on CGM at this point in time at the beginning before they've used the CGM. Their first week, you know, they've low time in range, nowhere near the 70% goal for type 2 diabetes that the ADA has put out there. And then, you know, within that 30 days, you know, you use three sensors and before you know it, they're hitting a time in range goal that, you know, probably maybe felt not attainable without the right tools. And so, you put CGM in their hands and it's really exciting to see. And that's while they do have a physician, I mean, a lot of that's just their own. They manage it themselves. They now have data. They can do something about it. They can hit their goals that have been really hard for them in the past to achieve. So, I love those studies.
There's lots of people starting to use CGM, but it's awareness around the physicians. You know, if you have coverage, we want you to get a prescription and get it covered by your insurance company. If you don't have coverage, we've got the Stell option. You go sign up for a subscription, get it, you know, less than $100 a month. You could have CGM full time, right?
Do you think those people are just seeing the impact of food and making different food decisions? Because I mean, seeing a turnaround that quickly in a few weeks, right? Like it's not like they upped their medication if they're on an oral or something like that, right? They just saw what was going on and they're like, 'Oh, I'll make different decisions here.'
That's the vast majority is different decisions. I think one of the other things I love to hear about is when users understand that, you know, modest levels of activity can have a significant impact, you know, just a walk, you know, just a moderate walk around the block. We're not talking about running on a treadmill. That can also really help their glucose levels and so just a little bit of activity. But I think, you know, the biggest impact is usually around diet, you know, food choices, meal compositions, all the things that we, you know, may have been told before through diabetes education but when it's your own data coming out in real time and you can see those numbers, you can see the graph, you can see on Stell we've got the spike detect feature that really helps try and focus in on the more impactful spikes during the day and help you think through what happened there and what could you do different. It's an amazing education tool. And I just love hearing when folks are able to make some changes on their own simply that improves their health.
Like what's the level of, like I guess where does your A1C have to be if you're type two like before you're eligible? Because insulin resistance can start way before your A1C goes up, right? And if you're going to see a ton of people on GLPs mostly have a lot of success, that success is going to be because they probably have insulin resistance that might not have thrown them into pre-diabetes for years. Like to me, like that'd be a place to grab those people.
Yeah. There's definitely approximately 100 million people in the US that have pre-diabetes and, you know, hundreds of millions more around the world. And the vast majority don't know they have pre-diabetes, right? They haven't been diagnosed. They're not aware. That's the group where raising awareness that the technology exists to give it a try. There's definitely people who, you know, didn't understand their metabolic health or their glucose health until they tried Stell and then they realized, wow, okay, there's some stuff going on here. Should take a closer look. Yeah, it's an amazing tool now that it's available over the counter. It's such a new thing. But raising the awareness, getting it out there by all means possible is kind of the way we're looking at it.
I've shared it a lot on the podcast, but I'll fit in enough of it here that, you know, people will know I'm serious about this. I started taking a GLP two years ago. I just told you that I'm 62 pounds lighter than I was. But what I learned was it had very, it did not have nearly as much to do with what I was eating as it did. I don't really know a way to describe that. Like I used to be anemic all the time for no reason. My body never absorbed iron. I went on a GLP that stopped immediately. I used to, my digestion didn't work well. That stopped. It fixed things about, I hate to say it like that, but it changed things about me. I don't even completely understand. My back doesn't hurt anymore. It used to be, I'm so embarrassed, Jake, but like if we all went out to dinner and ate the same thing, I'd be 4 lbs heavier the next day just retaining water. Yeah. No, I don't drink. I don't smoke. I don't do drugs. I don't, like, I'm active. Like, didn't matter. It didn't matter what I did. And then, you know, I started using the GLP. So, my point is if that's true, and I believe it is, and I've just recently had an interview with a doctor who's kind of behind the scenes on helping to talk more about how diagnosis are going to go in the future. He seems to feel like it's not just going to be type one, type two, you know, but he said you're going to see dual diagnoses soon for people with type one who also have insulin resistance. It's going to be, he believes, like a real diagnosis. I think that explains why some type ones go on a GLP and see great benefit and some don't see any difference at all.
I guess where I'm coming from is I wish somebody would have told me this 20 years ago. I know it didn't exist, but I can see what my life's like now and I wish I would have had this sooner. I guess it's the,
Yeah, the GLP1 class of drugs, although they have been around for almost that long, 20 years, the new formulations, the once weeklies, like all those things have really enhanced the outcomes and I think the outcomes are incredible. You know, I think what we've seen is particularly in diabetes, the best outcomes are generated when you're using the right medication, often a GLP-1, alongside with a CGM. So you understanding, you know, just even the medication adherence part is something that we know doctors recognize when they're writing prescriptions is like, you know, if you can see how impactful the medication is to you, you're more motivated to take it, right? And so I think when you have a CGM and it's showing you that while also helping educate you on meal compositions, activities, and tracking things, and a little bit of accountability too, right? If you lose a sensor, you know, there's an accountability component there too. So I think all that together is how it works to produce, you know, fantastic outcomes for,
I can also see the impact it would have on the physicians who might not believe in it until they see it on the data, you know, because there's still plenty of people I've had doctors say to me like, 'Well, you're going to have to use that for the rest of your life.' And I was like, 'No, I mean, no one says that to a thyroid person who needs thyroid replacement hormones. If this is what it needs, this is what I need.' And you, maybe it would stop people from having that experience where they've, you know, lost the weight, then the doctor takes the med from them and then they're right back in that same situation again. I see a ton of benefit from it. So, I wish you a lot of luck. I hope it goes well getting it out there.
Yeah. No, we're going to keep, we'll keep driving and, you know, the job's global. There's so many people around the globe that either have access to CGM and aren't using it yet, like they have, you know, coverage in some form, or that don't yet have coverage. We're, you know, out there every day bringing the advocacy, bringing the clinical evidence. You know, we have a very large clinical trial running right now in people with type two who don't use insulin specifically, a randomized control trial to show the outcomes that can be generated by wearing a Dexcom CGM for that population. And I think that would be important evidence to use globally, not just here for the United States to continue to get more access and coverage because CGM saves money in the first year. There's not too many therapies that, you know, net the cost of the drug or the device are going to save you money in the beginning, but with CGM people, you know, have the information they need to better manage their diabetes. They're not going to the hospital as often. They're not using as much of the health care system because they are living healthier. All those things bear out pretty quickly. So, you don't have to wait like, you know, months and months to get the outcomes.
I have two hurdle questions. Do you have any data that says what the hurdle is once somebody actually has one to putting it on? And I know that we're not exactly a society of like preemptively getting in front of something. So like because I'm thinking about like a friend of mine whose family is still in India and they talk about how much pre-diabetes and type two is in their family and, you know, there's a large population of people who, I mean, you would imagine that country would get a huge relief if they never progressed all the way to type 2 diabetes or pre-diabetes.
That's right. Yeah. So I think there has to be some level of engagement by the user to take the action. Right. They have to have the interest level, they have to have the knowledge that for example CGM exists and a curiosity around using it, right? And so the biggest thing that we found is just making sure people know the technology exists, what it can do for them, and then also we use our warriors quite frequently to talk about their experiences because I think there's nothing better than someone explaining. I mean, I can tell you how great CGMs are all day long but if you have someone who has a very personal story about how CGM changed their life then I think that resonates really well across users. And so we have more and more now of our warriors are type two in addition to all the type one warriors that we have around the world. I think we have over 30,000 warriors today that are out there talking about their stories, their personal experiences with their Dexcom CGM and how it's changed their life and that's worked well for us. But it's just, yeah, the job will never end in terms of making sure people are aware of the technology. It's, you know, less than 2% of the people in the world that have diabetes are using CGM. So there's still hundreds of millions of people that could benefit from the technology that don't have access to it. So that's our focus as an industry too. It's not just Dexcom. I think we're all focused on making sure people can get access to this technology.
How would you be able to or would you be able to keep up with that? Like what if everybody just woke up tomorrow was like that guy's right. What would you do to ramp?
Jake would be like, I would just give, I'd go home. I'd be like, I did it. I'll see you later. Yeah. No, no, no. Like that. If something like that happened, you know, there isn't the capacity out there between us and all the folks that make CGMs out there. There's not the capacity to service all those people overnight. But, you know, it never happens like that. It happens in stages of access. But, you know, I can tell you one of the things that I'm always, it's exciting but also it's a lot of work all the time is that pretty much every quarter for us is a record number of sensors manufactured and it's been like that for many, many years and, you know, we intend to keep it that way. So I think that scaling is a big part of what we do. We've learned a lot of lessons along those journeys from G5 to G6 to G7 and then to our next generation platforms as well. Big part of this is not just a feature set now. It's about building sensors in large scale, you know, high reliability product over large scale. That's a big part of what we do.
