Jake Leach, thanks for joining me from ADA. How is the conference going? Let's just start with what Dexcom is presenting and talking about there.
Yeah, certainly. Well, first off, Stacey, great to see you. Great to be here. I always love our time together. So, yeah, we're at ADA, just got started a couple days ago and at this conference we have some really exciting news. First off, we have our Connect study that we'll be presenting the results later this afternoon. That is a study in people with type 2 diabetes that use other glucose-lowering medications, not using insulin. So, GLP-1s, SGLT2s, and then a portion of the folks in this study don't use anything, no medications. They're all using diet and exercise lifestyle to manage diabetes. And so, it's a large randomized control trial. The goal is to show the impact of CGM in this population, which hasn't been done in a randomized control trial of this size. It's been done through real-world evidence. We have lots of evidence that shows how CGM impacts this group and the improvements that are driven by using CGM, but this study, I think, is going to be the cornerstone to further advancing access for people to CGM around the world. So, at this point, we now have a complete data set spanning all the way from type 1 diabetes through the different stages of type 2, the evidence needed to show the impact this product can have. So, now, at this point, all people with diabetes, we have the evidence that proves what CGM can do and the benefits. So, very excited to release that later this afternoon. We also had new news where we acquired a company called Nutrisense, which is a company that is based on nutritional coaching guided by CGM for users. And we've been working as a partnership together for quite a while. I've been really excited about what they've been able to drive in terms of outcomes and better metabolic health. And so, I wanted them to be part of the Dexcom team. So, we're just looking to close that acquisition here in the coming weeks and very excited about that. And we've also got a whole new version of Stelo that we're launching here at the show. We've got new people getting access to it. It's a whole new mobile app experience. We've talked about it before, but we're actually starting to have people use it outside of Dexcom.
What is different about the Stelo? About the hardware is the same. Software's different.
Yeah, software's very different. So, this design is, you notice from the moment you open the app, it's a very design-forward looking app. It looks very, very different. It's more akin to some of the most loved mobile tech apps out there. Our partner Aura has done a really nice job in that user interface. So, ours, while not copying them, has a lot of similarities in terms of just the way we use colors and the design. So, we kind of took a fresh look at the design aesthetics, but the other thing we did was we've put insights that are generated from the mobile app experience up front in the way that we display, because a lot of our users who are using Stelo, the number one piece of feedback is, 'I love this real-time data, but what else can it, what does this mean? How does this, you know, we're trying to connect the dots for them.' And we found that sometimes the insights get a little hidden, and so we put them right up front. It also has an AI coach built into it, so you can ask it all kinds of questions, like, 'How am I doing today? How does this glucose look? What should I have for, like you can ask it all kinds. How do I lower my glucose right now? Like what can I do?' Like I get that question actually all the time. People are like, 'My glucose is running kind of high, what should I do?' And I'm like, 'Well, go take a walk.' Like there's a lot of things you can do. And then it learns the individual and what works for them. So, it's a really exciting experience. We're pulling in more of the activity data, sleep data from partners, and using that in the coach as well. So, it's a great experience. Looking forward to getting it in people's hands.
For clarification, and I think most of my listeners know this, Stelo is a product that is over-the-counter. It is for people who do not use insulin. Any plans to export that kind of software, those, you know, it's got, and I've used Stelo, it already had, when I used it last year, a really great knowledge base in there. You could ask it a lot of questions. It had a lot of really basic stuff about type 2 diabetes that I think people found very helpful. Any plans to give that to the type 1 or LADA community?
Absolutely. Our goal is to transition all of that, you know, new design and new design thinking, as well as features. We know there's a lot of overlap, particularly when it comes to nutrition, anything about like carb counting, and right now the Stelo, the new version of Stelo, you can take a picture or enter the food, meal information into the app, and it'll not only analyze it, but it'll also give you the macronutrients associated with it. So, carbs, protein, fat, and it also gives it a meal score in terms of what we anticipate it'll do your glucose. That could be really helpful for all of our users, right? And so, that's where we want to transition this same technology across the whole portfolio of products. Stelo is kind of our ground where we do introduction, we do some experimenting, and so we really like what we're seeing here, so we want to move it over to the whole portfolio.
Okay, tons of questions for you, focusing mostly on things you're not presenting at ADA, but really first on my calendar is, you know, July 1st, G6 ceases production. For, can you talk about why? It seems very soon. I know it's probably not if you look at the timeline of Dexcom, but nuts and bolts and why you're doing this for a product that, you know, Jake is beloved.
Yes, you know, G6 has been an amazing product that we launched 8 years ago. And so it has been a fantastic product and we basically are at the point now where one, we've already done lifetime buys on number of materials that are in that product. So don't have any more raw materials to build G6s. That's part of it. The other part too is that I need to transition those manufacturing lines over to G7 so we can make enough sensors. The G7 manufacturing lines are much more efficient than G6 in terms of like I can build more sensors in the same amount of space and so we need to be able to transition so we can serve the growing number of users. We're also really proud of where G7 is in terms of product performance, reliability, and its ability to meet users' needs. And so we're real stable with that at this point in time. So it's the right time to do this transition. So it's kind of like a combination of all those things. We still have some G6 out there in the market. And we're basically most of our users have already moved over to G7. Particularly most of our pediatrics have already moved over. But we still have some folks using G6 that we want to transition over to G7. So we've got a number of folks they can contact us. We can help them get an educational sample of G7 so they can give it a try before they switch over. I think that's always been my most helpful when folks, they love their G6, right? But you know, we need to move to G7. So give one a try. And so I think that's a great way to help to get the educational experience before they moved over.
If I remember in the past too because we've done this, I mean since the podcast in 2015, we've done this a few times with G4, G5. In the past there have been a few devices and partnerships that have lagged. Are there any devices, are there any pump systems that only operate on G6 internationally or in the United States? There aren't, right?
No, we just, there was one internationally, but we just moved over to G7. They just announced that. So, we're good across all systems, and in the United States all of our pump partners are also compatible with the 15-day sensor as well. So, both G7 10-day and 15-day are compatible with all pumps.
Okay. And on, and forgive me, you know, we do this a lot rapid fire with my limited time I have with you. But, with the G7 15-day, not approved yet for pediatrics?
No, it's not. It's only approved for adults and that was really around, as we designed the products, we want to make sure that a really significant number of sensors last all the way to the end to 15 days. Right? And we know when you put a sensor in, what really dictates how long it lasts isn't necessarily the physical sensor itself. It's the biology of where the sensor, when it was inserted that we call the wound site, but basically where that sensor is in the body is interacting with the sensor on the first day and throughout the whole wear time. And in pediatrics, we tend to see that the sensors don't last as long on average out of 15 days. So, we really have said right now based on where the technology is at, 10 days is the right product for pediatrics because we want to make sure that people always have the sensors they need and we don't want to be replacing their sensors all the time if they're trying to use a 15-day out. Majority of pediatrics could get a sensor to go 15 days, but the experience for a kid, right? There are totally, I mean, it's like that, so, you have that experience, right? You know, like 10 days is the right technology for pediatrics at this point in time. I do, there will be G8 will be 15-day for everybody, but we're also going to do unique things about making sure that people have the sensors they need even if it doesn't last about the 15 days, which usually it's either tape falls off or the sensor probe is no longer able to sense glucose in the wound site. The thing that actually, what's been really, we did this customer advisory council which has been a really important part of listening to our customers. One of the things that really has resonated with that group has been our kind of explanation of the other things that are going on that have impact sensor beyond just the sensor itself. And a lot of it has to do with the interaction with the body and biology. And that has really landed quite well. And so we cover some of that in the report that we just published for everyone to see towards the output of that council. But that's a big part of sensor survival.
I do want to talk about the council. Let's put that aside just for a moment though. A quick question about the 15-day. Why does it have a 60-minute warm-up?
So basically in that 15-day algorithm for the extended survival, to make it work right it needed an hour of warm-up time. But we are working on a 30-minute warm-up for all sensors in the portfolio. So the goal would be to get back to a 30-minute warm-up for that product. But one of the things that's really unique about Dexcom is you can put your sensor in an hour before you plan to change away from your old one. So you can overlap them like that. And it is a really powerful feature that you basically have no downtime. And so that's one of the things that many, it sometimes takes a little bit of time for folks to understand that. I'd like people to understand that right up front. You can basically put that sensor in a little bit early and avoid any downtime. Just got to remember the pairing code.
You got to remember which one. I mean, you can. I just remember giving Benny a bath years ago and having two pump sites. And like, 'Oh, no. You know, he's 4 years old. Which is the old pump site? Which is the old one?' You make an X on it. You've got a couple of things coming out that I haven't heard discussed in too much detail. I'd like to ask you about. I understand a hospital product is coming pretty soon. What is that? What does that mean?
So, it's a, our goal is to have the first continuous glucose monitor approved for use in the inpatient setting. I don't know if that's surprising to some listeners, but there is actually no continuous sensor that's been approved for use in the hospital for subcutaneous use in the United States. So, our goal, there's such a need there. If you look at how many dysglycemia events happen in the hospital, it's a lot of people with diabetes, but also people without diabetes that have stress-induced dysglycemia, usually hyperglycemia, from major surgeries. That glucose control, there's a lot of people who actually are put on insulin in the hospital that don't have diabetes, but they're trying to help the body, the physicians are trying to help the body manage that glucose level. They use finger sticks and lab tests. They don't use continuous glucose monitors. And so, there's been this significant demand coming from that environment from the anesthesiologists, from all of the physicians in the hospital for a better tool. And so, we feel like our technology is really well suited for hospital use. And so, we're working on getting a product approved that will be used in the inpatient setting. And the idea there is to basically guide the glucose management in the hospital, whether you have diabetes or not, guide it with CGM instead of intermittent finger sticks, which we all know the challenges with doing that.
Yeah. Is this product basically a G7 or a G8 that you just have to test in a hospital setting or is it something completely new?
It's a G7 type of product. There's some different features that are designed around the hospital. But the hardware, and we'll move to G8 quickly. One of the things that for the hospital that be important just like for else is this idea of multiple analytes being able to be sensed subcutaneously. There's quite a few that could be helpful. I mentioned one recently around a potassium sensor managing potassium levels. Obviously, it's easier in the hospital because you have access to large volume you can draw blood from the patient and run it on an analyzer, but it sure would be easier to have continuous measurement particularly for people with kidney disease or cardiovascular disease. So there's other ones too that I think lactate would be another great one. And so that G8 platform will be important for the hospital product in the long run.
Yeah, this is my very next question is why potassium. And you've led right into it, but it seemed to me that when Dexcom announced that the first analyte it might focus on, an analyte, you know, I got to tell you Jake that was a word I had to look up. But as you listen, it is just the thing being measured. So some companies, Abbott is going to be, just got their ketone measurement, ketone CGM approved in Europe. They're going to work on United States approval. But you're working on potassium. And this is a little bit more clear now as we're looking at hospitals. But you mentioned lactate as the second one not ketones. Talk to me about the analyte issue that's now in front of CGM companies.
Well, just so I'm clear, when you say analyte issue, you mean choosing another analyte to sense, is that a really different...
Looks like the next frontier. So how do you decide what you're going to measure? How do you decide what you're going to promote that you can measure? Because my assumption is that once you figure out how to measure, period, you can do all these things. You just have to figure out how to get the readout to be accurate to the user or the doctor.
Yeah, I think the number one thing that we're focused on is making sure we're meeting customer needs and enhancing and improving on that. And one of the things we recognize is there is still plenty of opportunity to make glucose sensing more reliable and more accurate. And I think we all have experiences where majority of the time sensors are fantastic, but sometimes they need to be calibrated, sometimes they're not as accurate as you want, sometimes they're not as reliable as you want. So G8 has a lot of technology built into it that's brand new that really focuses in on glucose reliability. But then the next, so that's why I want to make sure we don't forget about glucose. There's still a lot to do there. But when we talk about additional analytes, again it's around this making sure that you have a clinical outcome for the user that you're trying to drive. Potassium is a very clear example of there is no at-home test for potassium. You cannot do a finger stick and test potassium. You need a larger sample of blood. And I can go into the details around hemolysis and why, but the main thing is there is no way to monitor this at home. And so patients have to go to a lab or a hospital to get it measured. And it can be deadly when it gets out of range. And a lot of people with type 2 diabetes suffer from other chronic diseases where potassium monitoring is very important. And they need to, it's kind of a life and death situation. So we feel like that is a very clear unmet need that we want to do. Lactate is another. Ketone is one where I think there is value in ketone sensing, but I think there's a lot of work which we're doing to determine the right way to introduce it clinically. Like what are the right levels to alert at, how do you alert, and what is the guidance given to the user? There's no actual clinical data at this point in time that talks about here's what you would do with a continuous ketone monitor. So, I think it's not, when we think about priorities and what we're working on, further enhancing our capabilities in glucose is priority number one for us. Then as we look at the analytes where we have multiple ones in development well beyond just ketones.
