{"id":50722,"date":"2019-07-10T09:03:07","date_gmt":"2019-07-10T13:03:07","guid":{"rendered":"https:\/\/asweetlife.org\/?p=50722"},"modified":"2019-07-14T05:09:31","modified_gmt":"2019-07-14T09:09:31","slug":"the-dexcom-interview-part-1-standard-of-care","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=50722","title":{"rendered":"The Dexcom Interview, Part 1: \u201cStandard of Care\u201d"},"content":{"rendered":"

ASweetLife was lucky enough to score an interview with Kevin Sayer, the President & CEO of Dexcom<\/a>.<\/p>\n

We are publishing our interview in two parts. In part one, Sayer sketches out Dexcom\u2019s business strategy going forward, following the runaway success of the G6 Continuous Glucose Monitor (CGM)<\/a>. The G6 was released last year, delighting patients and sending Dexcom\u2019s stock price soaring. The company has big plans, and we consider the upshot for people with Type 1 diabetes. In a forthcoming part two<\/a>, Sayer teases us with the next generation model, the G7.<\/p>\n

The subject of business development flowed naturally from my first questions to Sayer on glucose management. While Hemoglobin A1C<\/a> has long been the single critical measure by which diabetes control has been judged, the rise of the CGM<\/a> has given users new metrics to pay attention to: standard deviation and time-in-range. Forward-thinking endocrinologists have encouraged their patients to pay close attention to these new markers, but as of yet we don\u2019t have enough study validating standard deviation or time-in-range to long-term health outcomes, and as such, we lack consensus benchmarks to shoot for.<\/p>\n

I asked Sayer if the company hoped to drive such work:\u00a0<\/p>\n

\u201cI think these measures will make people much healthier and enable physicians to practice better medicine. It\u2019s something I\u2019ve believed for a very long time, I\u2019m really excited for it. As far as driving these as measures, I think it\u2019s great, but there\u2019s a couple things that have to happen. You can only measure time-in-range if you\u2019re wearing a CGM, so that means everyone\u2019s going to have to have access to a CGM, and there will need to be some kind of CGM that is a diagnostic versus the one that you wear every day for those patients who aren\u2019t on CGM all the time.\u201d<\/p>\n

In fact, this is a very much a piece of Dexcom\u2019s master plan: the more that experts accept that time-in-range (or other, related measures) is the best measure of glucose control, the more doctors and patients will request it, and ultimately, the more insurance companies will feel obligated to pay for it.<\/p>\n

\u201cWe view this as a tremendous opportunity for patients in the future and for us as a business, and as we develop disposable configurations of our system over the next little while I think that will be a wonderful market for us.\u201d<\/p>\n

We spoke a lot of about cost and price during the interview, and I had to remind myself repeatedly that people with diabetes are not, strictly speaking, Dexcom\u2019s market. It is the insurance companies that overwhelmingly pay for the devices, and thus the insurance companies that ultimately need to be convinced of their necessity.<\/p>\n

\u201cIf we\u2019ve learned anything at Dexcom over the years, it\u2019s that technology\u2019s not usable until somebody will reimburse for it. And we have to develop the model for those that pay the bills to pay for it. That\u2019s where we\u2019re focusing a lot of our efforts.\u201d<\/p>\n

Sayer explained that the insurance companies are somewhat trigger shy, based on mediocre results and poor patient compliance in the early years of CGM technology:<\/p>\n

\u201cA lot of the fear in the past of people that buy CGM technology – and this really wasn\u2019t driven by Dexcom technology but by others – they\u2019d pay for the CGM and then the patients would quit using it, and they\u2019ve wasted a bunch of money.\u201d<\/p>\n

He is also extremely cognizant of the barriers that many face in getting insurance approval for their CGMs: the need to, for example, document and re-document risk of hypoglycemia:<\/p>\n

\u201cWe try [to reduce those barriers] all the time, because it\u2019s ridiculous. The best example is I believe Medicare patients have to re-document every year that they still have Type 1 diabetes. We don\u2019t make it hard, the people who pay for the technology make it difficult, that\u2019s how they control their cost. We\u2019re getting better but we still need to make it easier, that\u2019s really one of our core missions\u2026 it\u2019s very obvious now that the CGM is growing as the standard of care, even to the payers.\u201d<\/p>\n

That phrase, \u201cstandard of care\u201d is a lynchpin of Dexcom\u2019s growth strategy. While success in the Type 1 community has been dramatic and unmistakable, the company\u2019s long-term and potentially more lucrative goal is to get its glucose monitoring products accepted in some form as a standard of care for people with Type 2 diabetes, and even with pre-diabetes. For now, Dexcom is exploring ways for such patients to use its CGM in a more limited manner:<\/p>\n

\u201cThe model for somebody with Type 2 who is not taking insulin is a bit different. The people who pay for this technology [the insurers] aren\u2019t going to pay for those patients to wear a CGM 24\/7, 365 days a year. And so we\u2019ve been trying to come up with models and analytics around our device in that population. Does a patient need four a year? Do they need one a year? Do they need one a month?\u201d<\/p>\n

Such patients would use a CGM for limited amounts of time, using the results to help analyze the impact of their pharmaceutical regimen and lifestyle decisions:<\/p>\n

\u201cWith the CGM and Type 2 diabetes you learn very important things. You learn the effectiveness of your medications. These drugs are not inexpensive, how do we know that they work? How do we document that this therapy is working for you? You find out very quickly with a CGM. The other thing that\u2019s tremendous is behavioral learnings. These patients for the first time see the effect of a late-night meal. Or a bedtime snack. \u2018Wow, my blood sugar went up 40%? How\u2019d that happen?\u2019 Not all Type 2 patients need a behavioral change and not all of them need pharmaceutical change, but it\u2019s really easy to tell which ones need which when you put them on a CGM. You could never find that out with fingersticks in a million years.\u201d<\/p>\n

I\u2019m inclined to view this strategy shift as good news for the Type 1 community. In the attempt to tap into the significantly larger T2 and pre-diabetes markets, Dexcom has a huge incentive to make its products more accessible, less expensive, and even easier to use. In our next installment, Sayer will tell us how will they hope that the company\u2019s next generation CGM \u2013 the G7 \u2013 will accomplish exactly that.<\/p>\n

Part 2: A look at Dexcom’s G7<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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