How do continuous glucose monitors (CGMs) like Dexcom G6 work?

Dexcom's CGM works by inserting a tiny wire, thinner than a human hair, subcutaneously into the tissue. This wire, coated with special membranes, generates an electrochemical signal converted into a glucose value by an algorithm in the transmitter. The G6 features an automated insertion process for improved accuracy and patient comfort.

What are the main competitors to Dexcom in the CGM market?

The main competitors to Dexcom in the continuous glucose monitoring market are Abbott, known for its Libre product, and Medtronic.

What are Dexcom's key priorities in developing CGM devices?

Dexcom's development framework centers on four key priorities: performance (accuracy), patient convenience and usability, cost reduction, and producing meaningful healthcare outcomes. The G6 represents significant progress in accuracy and user experience.

What is Dexcom's partnership with Verily and Google about?

Dexcom partnered with Verily (a Google/Alphabet company) in 2015 to co-develop future CGM products. This collaboration combines Dexcom's core sensor technology (membranes and algorithms) with Verily’s expertise in electronics, miniaturization, and data analytics to create more consumer-friendly and convenient devices.

How does CGM impact health and behavior beyond diabetes management?

CGM provides real-time feedback that drives significant behavioral change. By continuously tracking glucose levels, individuals gain insights into how food, exercise, and stress impact their body. This immediate feedback helps them make better decisions, improve glycemic control, and can lead to healthier overall lifestyles, even for non-diabetics.

What are the challenges in the US healthcare system for CGM reimbursement and access?

Despite high coverage rates, access to CGM is complicated by documentation requirements, inconsistent co-pays, and its classification as durable medical equipment, leading to seasonal purchasing patterns. Economic models are still being developed to demonstrate long-term cost savings to payers, especially for younger patients who might switch insurance plans frequently.

Why is CGM not available over-the-counter (OTC) without a prescription?

Currently, CGM is classified as a Class 2 medical device requiring a prescription, primarily because it delivers real-time glucose values that can be used for insulin dosing. For it to become OTC, the FDA would require evidence that it cannot be used for diabetes treatment and that users, even with self-insertion, cannot harm themselves. OTC versions would likely offer stripped-down functionality, such as delayed data or only displaying ranges/colors, to prevent insulin dosing errors.

What is the future potential for CGM in hospital settings and gestational diabetes?

Dexcom sees significant potential for CGM in hospitals, particularly ICUs, to replace frequent finger-stick tests and improve patient outcomes by continuously monitoring hyperglycemia's effect on healing. They also plan to pursue labeling for gestational diabetes, recognizing its value for pregnant women and its diagnostic potential with blinded sensors and predictive algorithms.

How does Dexcom maintain an innovative 'startup culture' while being a large public company?

Dexcom balances its growth as a large public company (with a $12 billion market cap and 2,500+ employees) by retaining a 'startup mentality' of curiosity, nimbleness, and a willingness to learn and fail. They actively seek diverse perspectives, like Peter Attia's critical feedback, and foster a highly engaged employee base through in-house studies and direct patient interaction, ensuring the company remains focused on innovation and patient needs.

Key Moments

#54–Kevin Sayer, CEO of Dexcom: Continuous glucose monitors–impact of food, sleep, & stress

Peter Attia MD

People & Blogs4 min read105 min video

Jan 10, 2020|5,333 views|114|7

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Key Moments

TL;DR

Dexcom CEO discusses CGM tech, its impact on diabetes management, and future innovations.

Key Insights

Continuous Glucose Monitors (CGMs) like Dexcom's offer profound insights into glucose levels, aiding behavioral change for diabetes management.

CGM technology has advanced significantly, with newer models offering improved accuracy, user-friendliness, and integration capabilities.

The US healthcare system presents unique challenges for CGM adoption, including insurance coverage hurdles and regulatory complexities.

Dexcom is exploring partnerships and collaborations to expand CGM use beyond type 1 diabetes, into type 2 diabetes, pre-diabetes, and even wellness applications.

Future CGM development focuses on miniaturization, enhanced data analysis, automated insulin delivery integration, and broader clinical applications.

Real-time feedback from CGMs drives significant behavioral changes in diet and lifestyle, more effectively than delayed metrics like A1C.

THE EVOLUTION AND IMPACT OF CGM TECHNOLOGY

The discussion highlights the significant evolution of Continuous Glucose Monitors (CGMs), particularly Dexcom's G6, emphasizing its impact on diabetes management. Unlike traditional finger-prick glucose meters, CGMs provide real-time data and trend information, offering individuals unprecedented insight into how food, sleep, and stress affect their glucose levels. This continuous feedback loop is crucial for driving behavioral changes, empowering users to make more informed decisions about their health and well-being. The technology itself has advanced through improved sensor accuracy, new membrane technologies, and sophisticated algorithms, making the user experience more seamless and less invasive.

DEXCOM'S JOURNEY AND TECHNOLOGICAL ADVANCEMENTS

Kevin Sayer shares his personal journey into the diabetes technology space, starting with his early involvement in insulin pump development and the initial stages of CGM. His leadership at Dexcom has been marked by a commitment to technological innovation, including the development of models like the G4 and G5, culminating in the highly accurate G6. A key focus has been on improving the user experience, such as an automated insertion process that minimizes discomfort and engineer-driven algorithm improvements leading to enhanced accuracy. This dedication to performance and accuracy remains Dexcom's core principle, even as they explore miniaturization and cost reduction.

NAVIGATING THE US HEALTHCARE SYSTEM AND INSURANCE BARRIERS

The conversation delves into the complexities of the US healthcare system and its impact on CGM accessibility. While Medicare and CMS approval in 2017 was a significant step, obtaining insurance coverage for CGMs, especially for type 2 diabetes patients using intensive insulin, remains a challenge. Payers can be hesitant due to cost concerns, sometimes imposing strict documentation requirements. Dexcom actively works with a dedicated team to navigate these reimbursement landscapes, negotiating terms and demonstrating the economic benefits of CGM technology, such as preventing hospitalizations and reducing long-term complications. The classification of CGM as durable medical equipment also leads to seasonal purchasing patterns due to deductibles.

EXPANDING HORIZONS: BEYOND TYPE 1 DIABETES

Dexcom's vision extends beyond type 1 diabetes to encompass a broader range of conditions. The company is actively developing solutions for type 2 diabetes, recognizing the vast population that could benefit from continuous glucose monitoring, even those not requiring insulin. Partnerships, such as the one with Verily, aim to co-develop future products that are smaller, more convenient, and potentially less costly. Discussions also touched upon the potential for CGM in pre-diabetes and general wellness, where real-time feedback could drive healthier lifestyle choices and improve metabolic health metrics beyond just weight.

THE FUTURE OF GLUCOSE MONITORING AND ARTIFICIAL PANCREAS TECHNOLOGY

Looking ahead, Dexcom is focused on developing sophisticated algorithms that can provide more advanced decision support for users, moving towards a more automated insulin delivery system. This includes integrating CGM data with insulin pumps and exploring applications for those on multiple daily injections. There's also interest in expanding CGM use into hospital settings, particularly ICUs, to improve patient outcomes and reduce the burden of frequent finger-pricks. The company is also exploring new applications, such as gestational diabetes and even predictive analytics for health and wellness, leveraging the rich data generated by CGMs.

THE POWER OF REAL-TIME DATA AND BEHAVIORAL CHANGE

A central theme is the profound impact of real-time feedback provided by CGMs. Unlike delayed metrics like A1C, continuous data allows individuals to immediately see the consequences of their choices, fostering significant behavioral shifts, particularly in diet. This immediate correlation between actions and physiological response is a powerful motivator for adopting healthier habits. Even for individuals without diabetes, the insights gained from a CGM can fundamentally alter their understanding of food and its impact on their bodies. This personalizes health management and empowers proactive lifestyle adjustments, underscoring the device's value beyond just disease management.

Mentioned in This Episode

●Products

●Software & Apps

●Companies

●Organizations

●Books

●Drugs & Medications

●Concepts

●People Referenced

Common Questions

Peter Attia and Kevin Sayer met on an airplane about three years prior to the interview. Their conversation began when Sayer noticed Attia looking at watch sites and commented on his choice, leading to an hour-long discussion about watches before realizing their shared professional interest in continuous glucose monitors.

Topics

Continuous Glucose Monitoring Metabolic Health Health & Longevity Mental Health & Psychology Technology & Innovation Business & Entrepreneurship Type 2 Diabetes Wearable Technology Healthcare Policy Type 1 Diabetes Behavioral Change Glycemic Control Medicine & Clinical Diabetes Management Medical Device Innovation

Mentioned in this video

Organizations

Weight Watchers

A weight loss program app that could potentially integrate with CGM data to provide more personalized dietary guidance based on individual glucose responses.

Food and Drug Administration

The US regulatory body that approves medical devices like Dexcom's CGM, and has been progressive with Dexcom's innovations in areas like phone connectivity and data sharing.

Medicare

A US national health insurance program that approved the use of CGM for intensive insulin-using type 2 diabetes patients in January 2017.

New England Journal of Medicine

A prominent medical journal that published a paper in 2001 or 2002 that significantly influenced glucose and insulin management in the ICU.

Products

OneTouch Ultra

A specific brand of point-of-care glucose meter that Peter Attia prefers for its accuracy.

Apple Watch

A wearable device that can display Dexcom CGM data via an app, and Dexcom is developing direct-to-watch transmitter communication for enhanced convenience.

Dexcom

A company that develops, manufactures, and markets continuous glucose monitoring (CGM) systems for diabetes management. Kevin Sayer is its CEO.

Dexcom G6

The current model of Dexcom's continuous glucose monitor, praised for its improved accuracy, automated insertion, and user-friendly design, eliminating the need for finger-stick calibrations.

Drugs & Medications

Fiasp

A specific brand of rapid-acting insulin.

acetaminophen

Also known as Tylenol, a medication that historically interfered with the performance of earlier Dexcom GCM models (G5), but does not affect the G6.

Concepts

Artificial Pancreas System

A futuristic concept for diabetes management where algorithms developed for automated insulin delivery will automatically adjust insulin dosage based on sensor data, potentially detecting meals and managing nighttime glucose.

Companies

Verily Life Sciences

A Google (now Alphabet) life sciences research organization that partnered with Dexcom in 2015 to co-develop future CGM products, focusing on miniaturization, size, and convenience.

MiniMed

A company founded by Al Mann, acquired by Medtronic, known for designing insulin pumps and early glucose sensors.

Medtronic

A medical device company that acquired the insulin pump company where Kevin Sayer previously worked and also developed an early continuous glucose monitor.

Abbott Laboratories

A competitor to Dexcom in the CGM market, notably with its Libre product. Mentioned in comparison to Dexcom's technology.

Google

The parent company of Verily, which initially had a healthcare group that analyzed technologies for future product impact and disease states for better care models.

OnDuo

A company within Verily developing treatments and apps for type 2 diabetes, combining diabetes knowledge with Google technology, currently in pilot phases with various payers.

Tandem Diabetes Care

A partner with Dexcom, developing an insulin pump that integrates with Dexcom's sensor to automatically shut off insulin delivery when glucose goes too low and turn it back on.

UnitedHealthcare

An insurance company with whom Dexcom is doing a lot of work on type 2 diabetes and future pre-diabetes models.

Edwards Lifesciences

A company with whom Dexcom had a joint venture years ago to explore CGM use in hospitals, which ultimately did not work out due to strict FDA requirements at the time.

People

Peter Attia

Host of The Drive podcast and an early adopter and advocate for continuous glucose monitoring (CGM) for optimizing health, even without a diabetes diagnosis.

Jake Kushner

An endocrinologist mentioned by Peter Attia as introducing him to Dexcom CGM technology.

Terry Gregg

Former CEO of Dexcom and a dear friend and associate of Kevin Sayer from MiniMed, who invited Sayer to join Dexcom's board.

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