It's no secret that Dexcom has lost some trust in the community after some Dexcom G7 debacles over the past few years. This has led to users clinging on to the Dexcom G6 as long as they could until it was eventually phased out just recently. Dexcom got the message. Last week the company published a report highlighting feedback from a recently formed advisory council on recurring issues with Dexcom sensors and its plans for change to gain community trust back. And today we're speaking with Dexcom to learn more about the fixes already implemented and what comes next with products like Dexcom G8. Welcome to the show. I'm Justin. I have type 1 diabetes and I'm here I talk all things diabetes tech news and research with industry leaders, those building the tech themselves and the people using the tech. Dexcom's council is made up of users, caregivers, healthcare professionals and community leaders. I'm actually lucky enough to be part of the group. So far we've met several times this year and the company plans to continue this open forum to identify product issues and attack them head-on and be more transparent with the community. I sat down with Jake Leach, Dexcom CEO and Peter Simpson, executive vice president and chief technology officer about the improvements Dexcom's making now and in the future. We get into the motivation behind the council, the key takeaways and how they're addressing them, new developments including updates to the G7's adhesive, algorithm and accuracy enhancements as well as manufacturing updates and we dive into all the updates coming to Dexcom G8 from 15-day wear being the new standard for Dexcom to its self-adapting technology that's two decades in the making. Keep in mind that anything you hear on this show is not medical advice and is for educational purposes only. Always consult with your healthcare team before making changes to your treatment. All right, let's get into it. Peter, Jake, welcome to the show. Good to have you here. Thanks for coming on.
Let's hop right into it. Let's start with this advisory council that I am part of. So, thank you for having me as part of that. It was really great. It's been great to meet with all the other people in the council, get to talk directly to you, hear from you about all the work you're on. Kind of just explain to us like the reasoning behind starting the advisory board.
Sure. Yeah, so one of the things that, you know, I'm new to the role of CEO at Dexcom. I'm just starting my fifth month here at the beginning of June, but have been part of the team for a long time and we've always prided ourselves in user-focused innovation and learning and listening to customers, but one of the things I recognized is it felt like we needed some other opportunities to really hear from a diverse group of our users, whether it's, you know, someone with type 1 diabetes who uses our product, type 2 diabetes, the clinicians that prescribe our product, those that take care of some of our customers from a caregiver perspective. So, we really wanted a diverse population of people who could give us feedback both what we're doing well, but also really importantly, what areas we can improve in. And I didn't feel like we were getting enough feedback from users on places that we could improve. And so, we launched this council specifically to capture the feedback and it's been, you know, really appreciate you, Justin, being part of it and also the other community members that have really helped us and guided us. And I think, you know, ultimately, our goal is to take the feedback. Some of which we had heard before, but also some of it was unique and new, which was really exciting to see that. And so, that is going to show up in the product and in the experience that people are having with Dexcom. So, I think it'll be a long-lasting group. You know, over time the membership may change, but in terms of the concept of the feedback loop, it's one of a number of different feedback loops we have, but it's really important for us to know exactly what our users are experiencing.
Everyone brings in such a unique perspective. Like I was learning things that I never realized because there was a parent or caregiver in there or a healthcare provider, and then I was able to bring my own experience, and that's what I love about what I do is I get to use my platform to ask questions, have you on here, and get to know more about what's going on or push for things to go on. What's some of the overall consensus that you heard coming out of that?
Well, I'll start, and I think Peter can also fill in quite a bit. So, what I would say is my biggest takeaway, the biggest learning for me from the advisory council was really around we as an organization could do a better job of communicating to the community and to our users when we've, you know, for example, launching new improvements, making sure that they understand, you know, what we've done and why we've done it. And I think we historically, we have a tradition of always improving the products over time. You know, even something like G6, you know, before it was obsoleted, we were continually improving that product for many years after it launched. G7, we've done the same. And so, the need for clear communication around those enhancements, and ones that we're working on as well, not just because part of this is, 'Hey, here's something I'm experiencing as a user. It'd be great if you guys could fix this.' And it's like, 'In fact, we're going to whole bunch of projects working on just that.' I think it being more transparent and having mechanisms to communicate that was a big takeaway that was new learning for me.
Peter, did you have something to add or?
Yeah, first of all, really appreciate the opportunity to listen and get the feedback from some of our customers and some of the people who really interact with a lot of our customers in the field. A lot of things that I took about, you know, first of all, product quality has always been absolutely critical and essential and, you know, one thing that just we get reminded of is how important it is to continue to earn the trust of our customers with the best possible product quality. And we've been focused on that for many years, but a really renewed focus over the last year to make sure that every product that we're making, every sensor that we're making is of the best quality and making sure that the customers understand that that is as essential and we see that as just absolutely the highest priority from what we're doing and in what we're producing. I'll reflect also on the communication part where, you know, we have a process of continuing to improve our products and continue to innovate. We've got new patch technology, we've got new antennas coming to the G7, but what we heard was people want to know when that's coming and when have those changes happened and more of an announcement from our part to say that, hey, you're going to experience something different and give us the feedback and we'd love to hear the positives and if you're finding any issues with these new changes, please tell us. I think the other thing was just clarity on our replacement policy and just making sure that everybody knows that if there's ever a product failure, we will replace it, no questions asked. We just go and it happens. There's no limit to that. I think that's another big thing that maybe was confusing for a little bit. And then finally, there seemed to be a lot of interest on how the technology fundamentally works and especially how it interacts not only on the bench top and how to make it great on the bench top, but how it's a challenge with different physiology and different people's biology and where that's some of the fundamental limits of the technology that we continue to improve on, but that's where some of the issues that people experience come from. I thought that seemed to click with a lot of people and really resonate.
Yeah, while we're on that, I found it fascinating when you educated us on the equilibration process of a CGM and kind of the lifespan and how the body interacts with it. Like I don't want to get stuck on that for too long, but can you just explain to my listeners like kind of all of that physiology that's happening there?
Yeah, so in contrast to a lot of other devices like the point-of-care devices and such, our device has to work under the skin in the body in a very stressful environment that, you know, the body's throwing all sorts of stuff at it. And it really a lot of the interaction happens in two places. The first place is when the sensor is first inserted under the skin. You know, we are creating a very small wound there and there is something called a wound response where the body is trying to clean up the wound environment and in doing that, there's a lot of metabolically active cells that are gobbling up glucose in that local environment. So while the sensor is working perfectly fine, sometimes the glucose doesn't always get to the sensor. And so that's one of the challenges that some people experience on day one. And the interesting thing is it doesn't happen to most people, it happens to some people and it's just depending on their biology and the particular of that wound site. So it's something that we continue to improve upon, but it is a fundamental biological response to the sensor. And then after day one to about near the end of the use of the device, it's kind of the sweet spot. Everything is very stable. But the last thing that the body tends to do is it tends to then encapsulate the sensor. It sees it as a foreign object and so it's encapsulating it and trying to starve it of glucose and oxygen. And that's exactly what our sensor needs to function. And when it starts doing that process, we do have algorithms that can detect it and so sometimes you'll see a sensor get shut off early. It's because it's detecting that issue that's happening with the biology around it. And so, again, it doesn't happen for some people, it never happens. They get the sensor to last all the way up to 15 days. And then some small percentage of the people it does happen. And so, their sensor will be a limit in their use life. So, again, another biological problem that we are continuing to make improvements on with our sensor technology, but is a challenge for CGMs in general.
So, you put out this report and it says that you're going to enhance sensor accuracy and reliability in the near term with several updates and enhancements. What are some of those enhancements or updates?
So, within the G7 family, we're continuing to make improvements. So, one thing just in terms of product quality, we've been working very closely with manufacturing and I've personally spent a lot of time at the sites with the manufacturing team to make sure that every product we're making is of the best quality. And, you know, we've seen some significant improvements there. And our accuracy complaint rates are at an all-time low. So, we've got some really significant improvements that we've seen just in making products more consistently. And, you know, that's always a challenge when you scale. And we've just really doubled down on that to make sure that our product is of the best quality we can make. Now, there's some specific improvements that we are rolling out now and that we're going to continue to roll out in the next year. One of those is a challenge with the reliability of the product, specifically the patch. And, you know, our patches are pretty good. But you can have some, again, very different biologies. People have different skin types. So, some people it works great for 15 days. Other people it starts to peel off. And we've developed, we've worked with our vendor partners to develop a new patch that's even better than the current one. And it's significantly better in our testing. It's about 11% more reliable than the current G7. And so, very excited to get that out on the field. And that's rolling out right now. We're starting to produce those and ship those. So, that's an improvement in reliability out to that 15 days. And then there's also some improvements in antenna technology that we're working on that will improve particularly the cross-body communication. You know, when you're communicating to your cell phones that's usually a pretty solid communication. Pump partners, that's when it's essential controlling an AID system. Sometimes if you have your sensor on one side and your pump on the other side you can have some challenges of communication. Cross-body is basically mostly water and that blocks that BLE signal.
And so does Bluetooth only work like in a straight line? It doesn't really curve around?
No, it can curve around and Jake actually has some expertise in this but it can reflect off of surfaces and such. But the cross-body is one of the more challenging and so what we are developing is a new antenna that does a little bit better there. Now with pumps it's always a two-way street because you need a good signal sending out but you also need to have a good antenna on the other side to receive it. And so we're also working very closely with our partners to make sure that the product as a whole is working the best it possibly can. But let me pause here, Jake, do you want to add anything?
In my early days as an engineer one of my specialties was antenna design and radio frequency engineering so I probably know more about it than many. But I think the Bluetooth environment is quite noisy especially as more and more technology uses that frequency, the 2.4 gigahertz. But it's something that we continually innovate on as to the different manufacturers of the different technologies Bluetooth wise. We've launched a fast reconnect mode so that when there is a break when the signal is lost, the transmitter, the G7 works hard to reestablish the connection. So there's continual innovation coming there and we recognize that it's super critical and we've made a bunch of enhancements we're going to keep making those enhancements and working with those pump partners to make sure that they optimize their radios, too, to receive the signal. Because there's different timing involved because one of the unique things about G7 is it can communicate to multiple devices at the same time. It can communicate to your cell phone and your AID system simultaneously. And so, there's some timing involved there. And so, that's something that we're always working to optimize with pump partners, too.
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So, the G7 15-day has an updated algorithm, improved accuracy. I've experienced it myself, and I can attest to that. Will we see any of those improvements in algorithm and accuracy come back to the 10-day? And if not, why?
Yeah, if not, why? You know, specifically, there's a team working on that right now in terms of bringing those enhancements. Peter, do you want to tell him a little bit about how the enhancements work? What they are?
Yeah, so first of all, probably what most people will notice is the accuracy improvements coming from the algorithm. And part of that is, you know, when we develop these algorithms, we use the data that we have on hand to tune all the parameters. And as we get more experience and more data sets, then we have the opportunity to fine-tune those parameters even more. And so, what you're seeing is our latest and greatest version of the algorithm. Physically, one of the things you'll notice is that the data is going to be much more consistent and smooth in the G7 10-day. You can see a little bit of choppiness in the data, and we've been able to develop some technology that really makes that more consistent and smoother. And then as we said as well on that 15-day, there is a new patch technology that's coming out with it right now. So, that's going to be, I think, being adopted across the board for 10-day and 15-day as well.
It is. Yes, launching across the board. And we really, it's around working on the 10-day, bringing that algorithm just about clinical study, validation, how do we get it approved so we can get it in there. But we know that, you know, all users could benefit. So, we're focused on bringing that to the 10-day, too.
Got it. So, now let's get into the Dexcom G8. I'm sure many people listening are ready for that. But before we get into that sensor, at your investor day, you mentioned that the new standard at Dexcom would be 15 days. Does that mean that G8 will be 15 days for everyone?
Yes. Yeah, that's the idea. Making sure that, you know, when we think about survival, it's actually interesting Peter mentioned a little bit, you know, one of the things that our system does is when it detects a sensor that is physically being encapsulated and it's not reliably sensing glucose anymore, we issue a sensor fail. You know, or like the user gets a, you know, sensor session ended early. There's absolutely nothing wrong with that physical sensor. It's not like a quality issue or anything. It's really that physiology started reacting and we're at the kind of edge of the technology. And so, you know, we want to make sure that users always have enough sensors. They always have a sensor. We don't want them to go days without sensors. And so, replacement programs and how we facilitate that and do it in a frictionless way is really critical as we think about expanding the use life of these sensors for all of our users across the whole portfolio. And so that's one of the things we're eager to, we're working on from a user experience perspective is how do we ensure that users always have sensors. And one of the things we know is pediatrics are a little harder on their sensors. Part of that's physical activity, part of that's, you know, their physiology and their glucose variability, all those things. Just on the average we do see that they're a little harder on the sensors and they don't quite last as long. And so that's why we did a 15-day first for adults. But we do intend because many of the pediatrics could get their sensors to go 15 days if we had a system that allowed it. So that's our plan is as we move towards G8, it'll be 15-day for all. And we're also looking at doing that in the international portfolio as well. For example, Dexcom One Plus is a pediatric and adult product for anybody who's not using AID. And so that is also something we're looking at is bringing 15-day to that whole portfolio.
Yeah, it definitely comes down to education. What you were saying about like how it says sensor failure, but it's really just like the natural physiologic response for some people. Like my body does not respond that way. These sensors last the full lifespan on me 99.9% of the time, but I know for a fact that's not the case for many people that are using it. And so perhaps even on the app like there could be like an information, like it says sensor failure, but you tap it and then it explains, 'Here are the reasons it may have failed. One is this is how the body responds.' Because people think that this technology should be perfect, but the fact is we have come so far with CGM, but it's not perfect. You know, and if you look at where CGMs were just five years ago, I mean we've come so far. So yeah, I think that could work wonders. So at the investor day you mentioned that the G8 would be 50% smaller than the G7, and that it would have a self-adapting technology. Can you explain to us what that is exactly, and how that works? And I guess how it's different than any self-adapting technology that may have already existed on G7?
