One of the biggest digital health success stories of the two decades is in the diabetes space, especially the continuous glucose monitor (or CGM). The first CGM was approved by the FDA in 1999, but in the last decade we’ve seen CGMs become smaller, longer lasting and more comfortable, and we’ve seen huge strides in datasharing as CGM-phone connectivity went from novelty to commodity.
Dexcom has been one of the undisputed leaders in this trend — it was the first company to get a CGM through the FDA that did not require fingerstick calibration and the first to connect directly to a phone. The company has seen impressive financial returns, but in some ways has struggled with its own success, running up against manufacturing capacity issues.
On the sidelines of the JP Morgan Healthcare conference last week, MobiHealthNews sat down with Dexcom CEO Kevin Sayer to talk about his company’s latest news, future plans, hot-button issues like noninvasive monitoring and CGMs for Type 2 diabetes, and the myth of “good problems” in healthcare.
Let’s start with your news from the conference. You announced a partnership with Livongo, and something with [Eli] Lilly [and Company]?
Lilly had been announced earlier. We formalized a relationship with Lilly where we’ve been working for quite some time to develop interconnected devices with Lilly as they develop insulin delivery systems. They have pens that are going to have Bluetooth connection capability and they’re working on an insulin delivery system as well for themselves, and our CGM will be integrated into the software platforms that they built. So we’ll provide them CGM data and patients will be able to view CGM data on their apps.
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And the Livongo announcement, that’s a data relationship. You know Livongo has a coaching platform and they coach patients based on, right now, fingersticks. Our relationship with them is through our APIs. And what we will do is provide them data, and their coaches and analytics can go through the CGM data and see if there’s recommendations that they would offer patients based upon what they see there. We believe it will provide a much richer experience for those patients.
Livongo’s interesting. They got a lot of press this year because of their IPO, and a lot of people are aware of the space they’re in who weren’t before. But on the hardware side, they’re not super sophisticated; it’s just a white-labeled glucometer that has been around for ages. So it’s interesting to see them connecting to parts of the industry where the technology is cutting edge, like Dexcom.
We’re glad we’re connecting to them. We’ve certainly worked with and spoken to others. Onduo, Verily’s diabetes management platform, has been taking data from us to power their stuff forever. I presented some UnitedHealthcare data yesterday in my presentation whereby they’re working on developing diabetes data and metrics based on CGM data. And we’ve even done some of this stuff on our own. So we’re looking at every possible angle to grow our business and provide patients with what they want. If patients truly want a Livongo experience and their software is better than anything we can develop, then — look, they’re buying sensors, they’re using our sensors, it’s all good. And we have to look at what are we best at. What we’re best at is making great sensors and making sensors that are safe and sensors that are accurate. And we’re good at the app we’ve created and the stuff we’ve done.
But if somebody wants to make a sensor for some completely different use in a market they understand better than us, why not serve up our sensor data to them and let them put it in that platform? That’s been our mantra all along.
I’ve been talking to several folks in the diabetes space the last couple days here at JPM about how incredibly fast the space has moved in the past five years.
It’s moved incredibly fast in the past five years. Because that’s when we were the first company to ever go to the phone. We went directly to the mobile platform in 2015. And once that happened, all these avenues are open because you now have data that can go from a body to a server that’s real medical data. That’s actionable medical data.
One of our board members said something really interesting. I’m a doctor, I’ve been at this forever, but CGM really is what personalized medicine was supposed to be when we started way back when. And this is where you have an opportunity to create personalized medicine for people with actionable information out of this data.
Watching you guys, Abbott, Medtronic and Senseonics to some extent — there’s something of a market share race going on, right? Especially in Europe?
Let’s take a step back. We’ve grown remarkably over the last couple years. We’re over 40% growth, compounded every year since 2010. So our growth trajectory has been nothing short of remarkable. Our strategy has been to make our product very much fit within the Type 1 market for insulin-using patients and to seek reimbursement. We’ve not rolled out highly-expensive cash pay platforms or gone the commercial route that many of our competitors have at this point in time.
I think over the next several years you’ll see us move that way. They have grabbed a bunch of patients in Europe, but our Europe business is growing nicely too.
And you do have a well-known brand and a relationship with patients.
We do! And if we do something wrong, they’re also very happy to let us know. It’s OK.
What does 2020 look like for you? What are you excited about?
The first thing we’re excited about is we’re going to double our G6, our current product manufacturing capacity, again this year. We have been capacity-constrained ever since we launched that product. So we’ve not been able to go do some of the aggressive commercial things that we would have liked to have done as far as getting word out to more people.
That being said, we’ve just needed product.
Has that bottleneck been on the manufacturing side?
It has — not only with us, but with our component suppliers. So we’re beefing up our supply chain as well as our internal stuff.
We do have a big G7 year planned. We’ve finalized our product configuration and we’re down pretty much to the end on that where we should be. We’ll start our clinical studies and execute those.
But our 2020 launch is going to be a limited launch; it’s not going to be a big launch. If we’ve learned one lesson from the G6 platform, it’s that we can’t possibly launch this product when we’re not ready to produce tens of millions of them. With G6 we got an early approval and rather than wait until we’d built up a bunch of inventory we rolled it out. And we’ve been running out of product every month ever since, pretty much. We’re not going to do that again. When we get G7 approved, what we’re going to do is we’re going to build up inventory and when we launch it we’ll turn on the faucet and have availability across the board. So that’s more of a 2021 event rather than a 2020 event.
What’s the big leap from G6 to G7, especially in terms of patient experience?
The first thing they get is size. The G7, it’s smaller than a [Freestyle] Libre. It is probably in diameter a little smaller than a quarter, a little bigger than a nickel, and it doesn’t sit up very high. It is very easy to use — it’s literally a two-step insertion.
And how long does it last for?
We’re working on a longer-labeled application, 14 or 15 days. That length of wear will be determined by the accuracy of the data. Our current product is a 10-day standard. So we’ll see. That’s currently the plan of record to get it out that far.
It’s just a different experience for our patients. Right now for example we have a transmitter that pops in, so you have to buy a transmitter and a sensor. No more transmitters. It’s one thing, you peel it off, you pop it in. You don’t have to put anything together. It’s very much ready for prime time.
Source: MobiHealth News