In preparation for the release of the latest continuous blood glucose monitors, Dexcom is working hard to build a larger case for these devices for the care of more patients. The San Diego-based company touted the results of a study earlier this month indicating that it may be used in patients with type 2 diabetes.
This randomized study recruited 175 adults taking long-acting basal insulin, which means they can only take it once or twice a day. Those who used CGM for eight months saw their hemoglobin A1C level drop from 9.1% to 8%.
In other words, there are still differences in the idea of using CGM for patients with type 2 diabetes. If not covered by insurance, these devices can be expensive, and they are not always covered by insurance.
An editorial published in the “American Family Doctor” last year pointed out that this technology is Not yet ready to be widely adopted Among patients with type 2 diabetes, high costs and lack of long-term results are justified. But Dexcom’s recent results may push the conversation in a different direction.
In a recent interview, Dexcom CEO Kevin Sayer shared his hopes for this technology and how the equipment manufacturer is dealing with more and more competitors.
The reply has been edited for length and clarity.
Based on the results of your recent research, are you more interested in using CGM to treat type 2 diabetes?
We have been in this area for some time. Especially considering that even in type 1 diabetes, most patients do not use (continuous blood glucose monitors). We consider Type 1 as a possible 50% penetration rate. However, type 2 users who have the same needs as type 1 patients use it less there, because many general practitioners they see do not know it, so we must raise awareness.
… The MOBILE study is a study of patients with type 2 diabetes using basal insulin, and we put these patients on CGM. If you only take one photo a day, why does anyone need CGM?
Their decision is different from those who have been taking insulin. They have no extra decision to decide how much insulin I give myself at each meal. But they still have to make the same decisions about diet and exercise, they should consider sleep and stress, and how this affects their days, and they can change their behavior. The point of all this is that these patients had a full one percentage point reduction in A1C six months after receiving CGM.
We were put into this category of equipment. People initially didn’t want to pay for this equipment for type 2 patients, but when you start looking at the data, you will find that if we can give people better control, you will delay complications. .
Do you see any changes in insurance coverage made by the payer? Do you have other plans to make the device more accessible?
As for the global coverage of type 2 patients who do not use insulin, we have not yet reached it. We really haven’t started to present this case because our penetration rate among intensive insulin users is too low, and we don’t want to distract payers from the core tasks in the first place. So let’s get the coverage we want and our business arrangements there.
You have a payer in UnitedHealthcare who pays for sensors for Type 2 patients through the Level2 plan. This is a different business arrangement from our commercial business and our typical core users, because we are learning from it, and we are looking for different business models for the patient group. …And there are some employer plans, but it is remote, not everyone, and it is not consistent for who will pay the cost of Type 2 insurance for people who do not use insulin.
In recent years, competition including Abbott has become increasingly fierce. How did you deal with it?
Given the success of Dexcom, there are many people who want to establish CGM. We have studied many of these early technologies.I will tell you that it is very different from when I started here 10 years ago
When I started here 10 years ago, the biggest challenge was technology, because we didn’t have that many customers. We must make this technology better and let more people accept it. When we launched G4 in 2012, I believe that was a turning point for the entire industry.
…The industry has become so large that it has problems with scale. The place where we stepped on our toes — I would say I never made a mistake, I have done a lot — was in the early days before we spent money on scale, we spent money on technology. You may encounter this situation: when we launched the G6, our inventory had been sold out for nearly a year and a half. And we are limited to how many customers we can bring it to.
Where we invest in the future is that we have established a very large factory and distribution center in Arizona, and built more factories in San Diego to build G7, so we are expanding this project. We have also expanded our international program to Malaysia so that we can share the manufacturing and distribution load with suppliers and other regions with logistics costs.
Scale will be important. Abbott has invested a lot of money in scale. In addition to us, they can produce millions of sensors every year, and so do we. In terms of capacity, we will increase from millions to hundreds of millions. We will have to make sure that we will own the market for it, but we are happy that we will do so.
It is easy to build 10,000 effective sensors. It is very difficult to build 10 million effective sensors. It is even more difficult to build 200 million effective sensors. …We really have to take a different perspective from the past, but we think we have made very good progress in this regard.
You have been working with Verily to develop CGM sensors. Are you still working with them?
They have cooperated a lot with us in the design phase of G7 products, especially in the aspect of electronic products. … Now that the G7 design is ready, we don’t have much cooperation with them, but we have regular open dialogues. Verily’s diabetes group Onduo uses CGM in their care of type 2 patients, and we have signed a purchase and supply agreement with them to use this product.
A long-term goal of the industry is to establish a closed loop system. How far is that and what does it take to get there?
We are closer than ever to a closed-loop system using the technology we have today. I also want to tell you that closed-loop systems will not be suitable for everyone. Because not everyone wants to attach an insulin delivery device to the skin or hang it from a tethered pump.
So far, our role in this process requires four things: the algorithm that drives the closed-loop system, glucose measurement, medication, and drug delivery system. We will never enter the world of drugs. We do have the algorithms and science that can help drive these systems. We have our glucose measurement tool.
…The things that come out now still require a lot of patient interaction. I think you will see that the next generation of algorithms will focus more on making decisions for you.
I think these systems can evolve and get better and better, it’s just a matter of patient preference.
Photo Credit: Dexcom