Welcome back everybody. Today I'm speaking with Jake Leach, president and CEO of Dexcom. Jake is joined today by Peter Simpson. He is the executive vice president and chief technology officer. Jake, Peter and I are talking about the goosenecking issue with G7, different ideas around their support and replacement policies. We'll talk a bit about accuracy around G7, a little bit about 15 days, some adhesive stuff, and I even sneak in a question at the end about the G8 sensor coming up sometime in the future, but probably not as far away as you think. While you're listening, please remember that nothing you hear on the Juicebox podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. And if you're new to the podcast, check me out at juiceboxpodcast.com. We have content for everybody living with type 1 diabetes, adults and caregivers alike. Juiceboxpodcast.com. Are you newly diagnosed? Check out the Bold Beginnings series. And if you're working on making things better for yourself, check out the Diabetes Pro Tip series. There's that and much, much more available at juiceboxpodcast.com. Listen on Apple Podcasts, Spotify, or wherever you get audio.
Hey, Scott. Jake Leach, pleasure to be here. I'm the president and CEO of Dexcom.
Jake, I appreciate you coming back. And you brought somebody with you today. Who is this?
This is Peter Simpson. I'll let him introduce himself, but one thing I'll tell you is so Peter and I have been working together at Dexcom since the day I joined. And he is one of the founders of our technology, an amazing person, but also an incredible scientist and engineer and really a lot of the advancements you've seen. He has led almost all of them when it comes to sensor performance.
Oh wow. Well, it's nice to meet you, Peter. Also, there's no video here, Peter, so this is just audio. You don't have to sit up and smile the whole time if you don't want to.
All right. Awesome. Scott, it's a pleasure meeting you. My name is Peter Simpson. I'm the chief technology officer here at Dexcom and as Jake mentioned, I've been here for going on 24 years. So, I've been involved in all of the generations of the product and really seeing the evolution both of CGM but also the impact that all these new technologies have had on people with type 1 diabetes. So, it's been amazing to be a part of that evolution and really excited about the future as well.
I would imagine too you both have a perspective that is almost uncommon in a business like this, right? I mean you from the beginning till now you guys have seen it all. You have kind of an institutional memory of it. How does that help you?
It is really a significant benefit. One, because we're intimately familiar with all the things that have led to the success of the company and the success of the technology and it's not like you're trying to learn that while also trying to figure out where the next place we want to go is. And so I think that is a significant benefit. And also, when it comes to my role, a big part of what I do is making sure that we've got the right culture within the company. And there's some parts of our culture that have made us successful over time that we want to keep and then there's parts of the culture you want to continue to evolve, particularly as we scale. It was very different days when Peter and I actually used to go down and watch them ship the sensors out the door for that day to the users, right? And we're talking about hundreds of sensors, right? And now we're shipping millions and millions of sensors every week. So it's very different in the things that are important when you scale. You need to have those capabilities and how you look at it is all continuously improving. So that is a big part of what I do and I lean on the history and the experience. And the other thing, too, is things aren't always easy. I mean, we've done it's been many decades of very hard work and really persevering through lots of challenges. You know, when things happen and don't go as planned, you kind of fall back on the yeah, this we've been here before and this is how we're going to fix it.
What's it like to try to keep that culture of patient first, worrying about people, worrying about customers, but then scaling up in the way that you did? Do you talk about how many sensors you ship a year now versus back then?
Well, we're well north of 100 million sensors. We have more than three and a half million active users using the sensors today. And that number grows, we grew that by 20% last year in terms of the number of people that use Dexcom every day. So, and we're going to continue to grow it. The patient-centered focus for Dexcom is so core and it's always been there. We've always been a customer-focused company. That's actually the easy part. You don't have to convince anybody. People come here because they are passionate about our mission and they want to, they know what we're trying to achieve for our users. I think the hard part is making sure we always show up that way. Like the intent is there, right? The intent is to always be user-focused and we meet the needs of users. But when you scale and grow, you have to start changing the way you do things to better match the scale. And there's lots and lots of examples from manufacturing all the way through customer support where we need to keep evolving and improving. We can't keep doing things that what worked for a smaller number of users doesn't work when you get to the large number of users for lots of different reasons. So I think that's the part that is harder but very achievable. As the new CEO, this is something we're going to show up. We're not adding to people's burden. We're relieving the burden of diabetes or at least helping to relieve that. We should never be adding to your burden as a user.
Can that be a pothole? Like you're focused on who you are. You know what you think you're doing, but somehow it gets away from you and you don't realize it right away. Or is it a thing you see, you're like, 'We got to get to that, but we're so busy.' When those things ebb and flow, how do you keep your eye on them when they're moving? You know what I mean? Because your intention's the same.
Yeah. I think it's really the feedback mechanisms. That's the number one thing that helps you understand how you're doing is the appropriate feedback mechanisms. And it's actually one of the reasons why we started the customer advisory council is because we have many feedback mechanisms we've developed over time. But I wanted to hear more from the community around all the things that we're doing well that we can double down on, but also the things that we're not doing, where we're not meeting users' needs, where we're not showing up the way our users want us to. And so we put the advisory council together which you're a participant in Scott which I really appreciate you doing that. And it was a diverse group and we wanted to hear straight talk like what are we doing well, what are we not so that we can improve it. And the goal is to make sure that the feedback from that council shows up in the actual experiences our users are having whether it's product or support or anything around your experience with Dexcom. We want to make sure it's meeting everybody's needs. You got to have those mechanisms.
Well I can say for sure that you wanted to hear the feedback because I didn't just bring my own. I brought feedback from the audience which was pretty extensive and I was invited back to the second meeting. So I figured you actually wanted to hear about it.
So that's what we're here to talk about a little bit today, right? You guys are putting out a report based on these meetings. Can you explain to people what all this is and what did it turn up?
Yeah. Hey Peter, do you want to take that one?
Yeah. We've had two of these meetings so far. First one is to make sure that we were listening and then the second one was where we kind of played back what we were hearing and gave a little bit of information about how we were responding to some of that commentary. We're about to publish this report out that basically captures that and talks about some of the commitments that we're making as a company to our customers about the product performance, the transparency, the communication and even things like our replacement policy. I think it's very important for us to listen to our customers but also to know that they are listened to. And I think that this is just a piece of that that we can communicate out to make sure that they know that we are listening to them and really want their feedback.
Yeah. How can you kind of close the time between when the customer realizes something's going on but you don't realize it and then you have to react and figure out what to do and move forward and there's no communication in that time which I don't even know what you would be communicating. I use the goosenecking as a great example, right? Like I think Ardan was using G7 like maybe week one and one of our first sensors it happened to and I don't know I just said call it in put on the next one. I didn't even think twice about it really. And then suddenly you hear other people talking about it online but how long does it take you to hear rumblings like and what would you say to people who would say well why is that not something you already knew was going to happen? How does something in a manufacturing supply chain how does that happen? Bring people into that idea.
So what I would say Scott first of all is for that particular deployment issue we saw it. Because our devices are connected and we constantly monitor feedback from the performance. We actually saw it start increasing early in 25. So the beginning of last year we started seeing it increasing and we saw that signal. What we didn't immediately understand is what was causing it. So we jumped on it and the Tiger team was put together and specifically I'll let Peter describe a little bit about what we found there. But that was an example though of something that we monitor. But what we've also continued to do is that experience taught us that there's other aspects of the product that we can be monitoring in real time in the field. And so we've continued to enhance our analytics capabilities. So that with all of if you think about data technologies, artificial intelligence, ability to spot patterns that maybe we don't immediately spot as a data scientist, that is some of the technology we're trying to apply to be able to monitor performance because we have so many users we can see when something is going out of range and then we can jump on it. But that one sensor deployment issue challenge that we had, happy the team jumped on it, happy that we've corrected it moving forward but that was a hard one. Peter do you want to describe a little bit about that?
Yeah so what you're referring to is I think you've called it gooseneck. This is where our sensor during the deployment process it brings the sensor and the needle down to under the skin and then spring retracts that needle leaving the sensor behind. What happens in those cases is the sensor gets pulled back with the needle and then it's no longer in the body. So you essentially have an out-of-box failure, a failure for the sensor to connect or to sense the glucose. Now our algorithms are able to detect it. So it's not a safety concern. But it is a usability concern. It's a very serious one. You're expecting this product to work and that's your expectation and we need to live up to that expectation. So when we see those failures, even if it's a small amount, we take them very seriously. When we detected it in the field it was very early on and we put together what we call tiger teams and these are groups where we take them off of their projects. They're dedicated to figuring this thing out. They're meeting on a day sometimes twice a day basis to understand what's going on in the manufacturing floor. Is there any changes that were made that could cause this to spike up? And over time we did figure out what was causing it. And a lot of it similar to other issues that we've experienced in the past is when you're scaling you get more variability in your process. And when you identify that variability, it's pretty straightforward or let me not say easy, but you can fix it once you've identified where it's coming from. And that's what happened in this case is the Tiger team was able to figure out what the root cause was and gotten it back down to a very low level. We still have some improvement to do and we've got technology that's going to come out later this year that's going to make it even to the best level that we've ever had in G7. And so while these teams work really aggressively, we have to find the issues quickly and we have to respond to them quickly and then the most important thing is to get those improvements out into the field so that the customers are getting the best product every time with every sensor that we're making. I think what Jake mentioned and through this process, we've learned a lot as a company in terms of being just really on top of everything that's going on in the field. And Jake mentioned some of the improvements that we're implementing where we're doing real-time monitoring on not just that one, but dozens of other attributes that we're monitoring in real time. And as soon as we see something that's slightly off, we'll react. We'll get a team that's on it and really jump on these problems before they hit the field. So, I think that's what we're continuously improving and we're going to be working harder and harder and doing more of that going forward to make sure that every product is meeting the customer expectations because that's what's required.
A couple of follow-ups. So, what you're saying is it's only really a problem if you don't learn something from it. And so, this showed you a way that you could actually track other things as well. So, yes, it was a problem, but you're going to get something out of it.
Yeah. And I want to tell you and Peter, if you have any kind of time in the future, I saw the explanation of how the goosenecking happens. I would sit down and geek out for an hour talking to you about what you figured out and what was happening. I find it really fascinating. And I don't know if everybody would, but in that council meeting when you guys came back in that second meeting and said, 'Here's the answer to how that happened.' I thought that was fascinating. I think the other thing that was fascinating was a description of how the interstitial fluid and the wire works. If you want, I'll do a retrospective series with you about that. I'd be so interested to talk about that, but I don't want to press you. So, okay. So, you guys figured that out. Still improvements to make. Does that mean some people still might see this happen?
Yeah. I think one of the things I loved about this project, while it was challenging and we were trying to solve this issue, it led to new innovations that are going to drive the improvements even farther. So, we're well back to kind of historic levels for this failure mode, which is very very low, but there's even more technology teams working on to drive it even further improvement beyond where we've historically been. So I think that's one of the things that's exciting about anytime you learn something new ways to prove the product and apply it. And so it does happen very rarely still but we want to try and drive as close to zero as possible.
