Dexcom’s CEO claims company has a ‘compelling’ case for broader CGM use

As it gears up for the release of its latest continuous glucose monitor, Dexcom is working to build a bigger case for the devices to be used in more patients’ care. The San Diego-based company touted the results of a study earlier this month showing it could potentially be used for patients with Type 2 diabetes.

The randomized study recruited 175 adults who were taking a longer-acting basal insulin, meaning they would only take it once or twice per day. Those who used a CGM for eight months saw their hemoglobin A1C levels decrease from 9.1% to 8%.

That said, the idea of using CGMs for people with Type 2 diabetes is still divisive. When not covered by insurance, the devices can be costly, and they’re not always covered by insurance.

One editorial published in American Family Physician last year noted the technology was not ready for widespread adoption among patients with Type 2 diabetes, citing high costs and a lack of long-term outcomes. But Dexcom’s recent results might nudge the conversation in a different direction.

In a recent interview, Dexcom CEO Kevin Sayer shared his hopes for the technology and how the device-maker is handling a growing number of competitors.

Responses have been edited for length and clarity. 

In light of your recent study results, are you seeing more interest in using CGMs for type 2 diabetes?
We have been at this for quite some time. Particularly given the fact that even in Type 1 diabetes, the majority of patients don’t use (a continuous glucose monitor). We look at Type 1 as maybe 50% penetrated. But Type 2 users who have all the same needs as a Type 1 patient, it’s much less utilized there because a lot of the physicians who they see are general practitioners are unaware, so we’ve got to increase awareness.

… The MOBILE study, which is a study that took patients who used basal insulin to manage their type 2 diabetes, we put those patients on CGMs. If you’re only taking one shot a day, why does somebody need a CGM?

Their decisions are just different than somebody who’s taking insulin all the time. They don’t have that one extra decision to make regarding how much insulin I give myself with every meal. But they still have to make the same decisions regarding their meals and exercise, they should look at sleep and stress, and how that affects their days, and they can change behavior. The gist of it all is these patients got an A1C reduction around a full point by being on a CGM for six months.

We get thrown into this device category and people don’t want to pay for this device initially for Type 2 patients, but when you start looking at the data, it becomes very compelling that if we can get people in better control, then you delay complications.

Have you seen any movement from payers on coverage? Do you have any other plans to make the device more accessible?
As far as global coverage for Type 2 patients not on insulin, we’re not there yet. We really haven’t started presenting that case because again, we’re so underpenetrated in the intensive insulin users, we don’t want to distract the payers from that core mission first. So let’s get the coverage we want there and our business arrangements proper there.

You have a payer in UnitedHealthcare that’s paying for sensors for Type 2 patients with their Level2 program. That is a different business arrangement with us than our commercial business and our typical core users because we’re learning from that and we’re looking at different business models for the patient group. … And there are some employer plans, but it’s remote, it’s not everybody, it’s not consistent for who will pay for Type 2 coverage for a person who’s not on insulin.

You’ve gotten more competition in recent years, including Abbott. How are you handling it?
Given Dexcom’s success, there’s a lot of people wanting to build CGMs. We’ve looked at many of these early-phase technologies. I would tell you there’s a big difference now than when I started here 10 years ago

When I started here 10 years ago, by far and away the biggest challenge, because we didn’t have that many customers, was technology. We’ve got to get this technology better to where more people will adopt it. When we launched our G4 in 2012, I believe that was the turning point in this whole industry.

… This industry’s gotten so big that scale is problematic as well. Where we have stubbed our toe — I would love to say I’ve never made a mistake, I’ve made lots — is in the early days we spent money on technology before we spent money on scale. You’d have situations where when we launched the G6, we were sold out of inventory for almost a year and a half. And we were limited to how many customers we could take that to.

Where we’re making our investments in the future is we built out a very large factory and distribution center in Arizona and more factories based here in San Diego to build the G7, so we’re scaling up that project. We’re also scaling up an international plan to Malaysia so we can share the manufacturing and distribution load with suppliers and other geographies with logistics costs.

Scale’s going to be what’s important. Abbott is very much invested in scale and in addition to us, they’re capable of producing many millions of sensors per year and we are too. We’ll go from 10s of millions to hundreds of millions as far as capacity. We’re going to have to make sure we’ll have markets for it but we’re comfortable that we will.

It’s easy to build 10,000 sensors that work. It is very difficult to build 10 million sensors that work. And it’s even more difficult to build 200 million sensors that work. … We really had to take a different view of things than we have in the past, but we think we’re making really good progress on that front.

You had been working with Verily on a CGM sensor. Are you still working with them?
They worked with us very much during the design phase of the G7 product, particularly focusing on the electronics. … Now that the G7 design is ready to go, we’re not working with them quite so much, but we have open dialogues on a regular basis. Verily’s diabetes group Onduo uses a CGM in their care for Type 2 patients and we have a purchase supply agreement with them to use the product.

A long-term goal in the industry has been to build a closed-loop system. How far out is that and what is needed to get there?
We’re much closer to a closed-loop system with the technologies we have today than we have ever been before. I would also tell you that closed-loop systems aren’t going to be for everybody. Because not everybody’s going to want an insulin-delivery device to either attach to their skin or hanging from a tethered pump.

Our role in that process so far, there are four things needed: an algorithm to drive that closed-loop system, a glucose measurement, a drug and a drug-delivery system. We’re never getting in the drug world. We do have algorithms and science that can help drive those systems. And we have our glucose measurement tool.

…What is out now still requires quite a lot of patient interaction. I think you’ll see the next generation of algorithms is going to be more focused on deciding for you.

I think these systems can grow and get better and better, it’s just a question of patient preference.

Photo credit: Dexcom

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