When it comes to the diabetes space, Dexcom is one of the heavy hitters. Its work in the continuous glucose monitoring space has put it on the map. In 2018, its Dexcom G6, an integrated continuous glucose monitoring system, got the greenlight from the FDA, making it the first interoperable CGM to get the designation. This means that it could be part of an integrated system compatible with other devices, which include automated insulin dosing systems, insulin pumps and blood glucose meters.
While personal CGMs for diabetes patients have been the staple of Dexcom’s business, as it moves into the next decade the company is looking at hospital use, and CGMs for nondiabetic patients.
This week, MobiHealthNews sat down individually with Dexcom CEO Kevin Sayer and CTO Jake Leach to discuss how COVID-19 has changed the company’s focus, the lessons it has learned from past glitches, and even a little bit about the G7.
In July the company will begin to ship its G6 Pro – which differs from other versions of Dexcom products, because it allows for blinded and unblinded modes of use, and can read glucose values as often as every five minutes.
“First of all, the G6 Pro is going to be able to give physicians the opportunity to give patients, if you will, a CGM checkup in two different ways. One of them is they can blind it; so, they can put [it] on the patient and they can wear it blinded,” Sayer said. “The patient says 'I take my meds every day,' 'I don’t eat too much,' or whatever. They’ll wear a CGM for 10 days and the physician will be able to watch and see what is going on and go back and point it out to them.”
Given the ongoing industry-wide trend of increasing consumerization, Sayer noted that patients are looking for more data – which the G6 Pro is aiming to meet.
“The other thing that they’ll be able to do is, if a patient wants a live CGM experience, the patient can see the data,” he said. “This also enables it to be used in a number of different applications: Type 2 patients for example, who are not intensive, who are on different medications but not on insulin, will be able to see the effectiveness of those meds for those patients and point things out directly.”
The impact of the coronavirus
The coronavirus has also impacted the direction of the company. Sayers said that the pandemic has presented new opportunities for Dexcom to use its CGMs. He sorted it into three buckets, saying that the tech will let families and caregivers monitor their loved ones’ glucose levels remotely, doctors can use the tech during telehealth visits, and lastly that hospitals are now starting to implement the tech in caring for hospitalized patients.
The latter is a new direction for the diabetes company, which has up until now focused primarily on patients in a home environment.
“We had not been in the hospital before," Sayers said. "We had ongoing discussions with the FDA about things we would need to test [to] make sure the system performed in a hospital environment, where patients are subjected to numerous drugs and lab tests, and other things they aren’t subjected to in daily life, [and] to make sure that there is not interference with sensor performance as COVID started."
So far, he notes that hospitals have reported a reduction of personal protective equipment needs, and of the time it takes to discharge patients. These early efforts could translate into future market opportunities for the company. And while Dexcom's current focus is meeting the needs of patients and healthcare professionals on the front lines, they are asking hospitals that are using the tech to participate in studies around overall viability in the inpatient setting.
However, this early exposure with the hospital setting has given the medtech company some take -home lessons to work out.
“What we’re learning is that the sensor performs well in that environment, and we’ve also learned that there are basically ways that we need to look at integrating the G6 better into the hospital data systems and infrastructure,” CTO Jake Leach said.
CGM’s for people without diabetes?
To date the bulk of CGM use has been for individuals with diabetes; however, Sayers said that this may change in the future.
“I don’t have diabetes but I wear CGMs frequently and I have learned all sorts of things. For example, if I put a good workout in in the morning, my average glucose levels for the day are 10 points lower,” Sayers said. “So you can get these learnings from nutrition, you can get these learnings from exercise. We’ve actually seen groups in the past use it as a sports-training tool, because there appear to be patterns. If you are an extreme athlete, your glucose rises and falls, and rises and falls again, and you are kind of out of energy.”
There are a lot of possibilities when it comes to potential users, he said. The list includes individuals with prediabetes and general health risks, as well as athletes to zero on in performance.
While individuals who do not have diabetes may benefit from the CGM tech, it may have to look different than the traditional CGM.
“I think that the way that you access the product will be important for those markets,” Leach said. “Today the product’s covered by insurance and there’s ... a prescription required. I think as we move outside of diabetes, prescriptions I don’t think would make sense. It really needs to be a nonprescription device for those folks. It also needs to be tailored for what they’re trying to get out of it.”
Sights on the G7
Now that the G6 Pro is released, all eyes are on the G7, which Sayer said will have a complete overhaul. The tech is expected to have a limited launch in 2021 – which was pushed back slightly because of access to research labs during the pandemic.
“We’re literally changing everything from the way it works, the way it's inserted – everything is going to be a little bit different than what we’ve done in the past,” Sayer said. “Most companies have never done a major undertaking like this so quickly and close to the previous platform. They would just make a slight alteration and call it something else.”
Leach said the new device is expected to be slightly larger than a nickel. The company is also aiming to make the device easier to use than previous versions.
“One of the benefits of G7 is it’s an all-in-one CGM component. So the sensor is not separate from the electronics that measure the sensor and communicate with [is],” Leach said. “So the device today that’s on G6, we call the transmitter – the little gray component – that’s actually part of the sensor and part of what gets deployed when you press the button. So, much simpler in terms of nothing to keep track of, other than to snap in. You just take the G7, deploy it and go.”
The executive team also said, one other element we can expect from the G7 is a lower price point for the product.
Leach said they are zeroing in on manufacturing processes to scale and make the products cheaper going forward.
“One of the specific design intentions of G7 was to ensure that we used manufacturing processes that lower cost and [are] more scalable than what we’ve used in the past. So that goes from everything from the sensor’s probe to the wearable patch. Everything that a user uses as part of their CGM is important to ensure that it can be manufactured at large volumes.”
G7 may be the next big advancement coming down the pipeline. However, Sayers said that in the future he wants to look at all different kinds of analytics the company could measure, noting he sees Dexcom as a sensor company.
“I’ve never been in a place that’s grown this fast where when I’ve woken up in the morning, the runway is bigger today than it was before,” Sayers said. “We need to get CGM on everyone managing diabetes and on everyone in a way that is affordable. It provides some of the information they need, and we get the outcomes that patients truly deserve.”