As Dexcom prepares for the release of its latest continuous glucose monitor, Dexcom is working on building a larger enclosure for the devices that can be used in patient care. The San Diego-based company announced the results of a study earlier this month showing it could potentially be used for patients with type 2 diabetes.
The randomized study enrolled 175 adults who were taking a longer-acting basal insulin, which means they would only take it once or twice a day. Those who used a CGM for eight months saw their hemoglobin A1C levels drop from 9.1% to 8%.
However, the idea of using CGMs for people with type 2 diabetes is still controversial. Without insurance, the devices can be expensive and are not always insured.
An editorial published in American Family Physician last year noted that the technology was not ready for widespread adoption among patients with type 2 diabetes, citing the high cost and lack of long-term results. But Dexcom’s recent results could steer 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 dealing with a growing number of competitors.
Answers have been edited for length and clarity.
Given your recent study results, do you see greater interest in the use of CGMs in type 2 diabetes?
We’ve been around for quite some time. Especially considering that even with type 1 diabetes, the majority of patients do not use a (continuous blood glucose meter). We consider Type 1 to be maybe 50% penetrated. But type 2 users, who have the same needs as a type 1 patient, are much less used there because many of the doctors who see them are general practitioners don’t know, so we need to raise awareness.
… In the MOBILE study, a study that enrolled patients who used basal insulin to treat their type 2 diabetes, we put these patients on CGMs. If you only take one shot a day, why does someone need a CGM?
Your decisions are just different from someone who’s on insulin all the time. You don’t have to make an additional decision on how much insulin to give myself with each meal. But they still need to make the same decisions about their meals and exercise, they should be aware of sleep and stress and how that affects their day, and they can change their behavior. The gist of it all is that these patients achieved a full point reduction in A1C by receiving CGM for six months.
We’re being thrown into that device category and people don’t want to pay for this device for Type 2 patients at first, but when you look at the data it becomes very imperative that if we can better control people’s complications, it becomes very imperative that you hesitate.
Have you seen any movement of payers in terms of coverage? Do you have other plans to make the device more accessible?
In terms of global coverage for Type 2 patients without insulin, we are not there yet. We really didn’t start by presenting this case because we are so poorly penetrated with the heavy insulin users that we don’t want to distract the payers from this core task first. So let’s get the coverage we want there and our business arrangements there.
They have a payer at UnitedHealthcare who pays for sensors for type 2 patients with their Level2 program. This is a different business arrangement for us than our commercial business and our typical core users because we learn from it and consider different business models for the patient group. … And there are some employer plans, but it’s remote, it’s not for everyone, it’s not a standard for who pays Type 2 coverage for someone who isn’t on insulin.
They’ve gotten more competition in recent years, including Abbott. How do you deal with it?
Given Dexcom’s success, a lot of people want to build CGMs. We looked at many of these early stage technologies. I would tell you that there is a big difference now than I started here 10 years ago
When I started here 10 years ago, the biggest challenge by far, as we didn’t have that many customers, was the technology. We need to improve this technology so that it will be adopted by more people. When we launched our G4 in 2012, I think that was the turning point in the whole industry.
… This industry has grown so large that scaling is also problematic. Where we struck our toes – I’d like to say I’ve never made a mistake, I’ve made a lot – is that we spent money on technology in the early days before we spent money on a large scale. There have been situations where we were sold out for almost a year and a half when the G6 was launched. And we were limited to how many customers we could reach with it.
Where we’re making our investments in the future is that we’ve built a very large factory and distribution center in Arizona and other factories here in San Diego to build the G7, so we’re scaling this project out. We are also expanding an international plan to Malaysia so that we can share the production and distribution burden with suppliers and other regions with logistics costs.
Scaling will be the most important thing. Abbott is a huge investor in scaling, and in addition to us, they are capable of producing many millions of sensors a year, and so are we. We’re going to go from 10 million to hundreds of millions in terms of capacity. We have to make sure we have markets for it, but we are sure we will.
It’s easy to build 10,000 sensors that work. It is very difficult to build 10 million working sensors. And it’s even more difficult to build 200 million working sensors. … We really had to see things differently than in the past, but we think we’re making really good progress here.
You worked with Verily on a CGM sensor. Do you still work with them?
You worked a lot with us during the design phase of the G7 product, particularly focusing on the electronics. … Now that the G7 design is done, we don’t work with them that much, but we do have open dialogues on a regular basis. Verily’s diabetes group, Onduo, uses a CGM to treat Type 2 patients and we have a sales contract with them to use the product.
A long-term goal in the industry was the establishment of a closed control loop. How far is it and what does it take to get there?
With the technologies we have today, we are much closer to a closed system than ever before. I would also tell you that closed loop systems will not be for everyone. Because not everyone wants an insulin delivery device to be either attached to the skin or attached to a pump.
Our role in this process so far requires four things: an algorithm that powers this closed system, a glucose measurement, a drug, and a drug delivery system. We never get into the drug world. We have algorithms and science that can drive these systems forward. And we have our glucose meter.
… What’s out there now still requires 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 grow and get better and better, it’s just a matter of patient preference.
Image Credit: Dexcom