Episode 37: Dexcom G7 and ONE+| Adam Dawes | GNL Podcast

Most people with T1D have switched their CGM high alert off. Not because they do not care - because it goes off every time they eat and there is nothing they can do about it. Episode 37 is about what Dexcom built to fix that.

Adam Dawes, Senior Medical Affairs Manager at Dexcom UK and Ireland - and a former paediatric diabetes nurse specialist - joins John Pemberton for the third manufacturer episode of the CGM Series. An honest clinical conversation about the Dexcom G7 and ONE+, what separates them, and where Dexcom is heading next.

This episode covers:
- Dexcom G7 vs Dexcom ONE+: same hardware platform, different software, and what that means for matching the right sensor to the right patient
- Delay 1st Alert: why it is one of the most underused alerts in CGM, how it eliminates alarm fatigue without reducing safety, and how John uses it himself
- AID integrations: Tandem T:slim X2, Omnipod 5, mylife, and the Tandem Mobi
- CGM for type 2 diabetes: the biofeedback argument and why immediate glucose feedback changes behaviour in ways a quarterly HbA1c never can
- The Dexcom roadmap from ATTD 2026: 15-day sensor, Dexcom G8 next generation sensor, EPIC integration, Clarity updates, and generative AI
- Why insulin dosing will never be a commodity market - and what people with T1D need to understand as new CGMs enter the UK
- The FDA manufacturing findings: what happened, how Dexcom responded, and why the new Ireland factory matters

Show notes: https://theglucoseneverlies.com/episode-37-dexcom-g7-one-plus/ | CGM Series: https://theglucoseneverlies.com/10-13-cgm-series/

Have more questions about CGM, the Dexcom G7 or ONE+? Ask GNL Grace: https://theglucoseneverlies.com/gnl-grace/

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Collaboration: John Pemberton — john@theglucoseneverlies.com

Creatives: Anjanee Kohli — anj@theglucoseneverlies.com

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Transcript

SPEAKER_01 0:11

Welcome to the Glucose Never Lives podcast. This is the next in the series of the CGM series. We're actually going to hear about the specific devices. So if you listen to the first two episodes, you would have heard Professor Other Mosa tell us about the needs of transparency, study design, and calibration alignment. And then we've just finished one with the Diabetes Specialist Nurse Forum where we actually walked through of the available devices which have a set of data that we can reliably look at and understand the risk of insulin dosing. So obviously, quite clearly, DEXCOM is one of those. And I'm glad to say I've got Adam Dawes from DEXCOM, who's a good friend, but also someone who's very, very knowledgeable about the DEXCOM portfolio because that's his job. So Adam, welcome to the show.

SPEAKER_00 0:54

Do you want to introduce yourself? Yeah, thanks a lot, John. Thanks for having me on. It's a great podcast, really useful for the diabetes community. So yeah, my name's Adam Dawes. I am the Senior Medical Affairs Manager for DEXCOM UK and Ireland. Um, my professional background for those uh who probably don't know, I'm a pediatric diabetes nurse specialist. Worked in London for a number of years before going to Cambridge, uh Adam Brooks, and then eventually, yeah, made the jump over to industry and have been at DEXCOM now for just a little over four years. And it's been, yeah, it's great. It's great to work for a company, for a product that you had such a lot of faith in as a clinician. So, yeah, that's kind of why how my journey got me to DEXCOM.

SPEAKER_01 1:37

Perfect. So you look after in the UK, kind of you look after the medical affairs side, looking after stuff like the product and making sure that the information that's coming through from a um evidence-based perspective is passed out towards obviously the the I guess the the ecosystem of people with diabetes, healthcare professionals, etc. etc. across the UK. Is that that about right for your role?

SPEAKER_00 1:59

Yeah, so lots of medical education. So yeah, taking new data, making sure it gets in front of HCPs. You know, obviously our big focus at DEXCOM right now is increasing CGM use in in general practice. So lots of my role is getting in front of GPs and and really selling clinically the need for CGM. But then, yeah, it's also it's working with researchers, working around evidence generation, working, getting messaging out to healthcare professionals to make sure that everybody knows everything about Dexcom. Um so yeah, lots to do, keeps me busy, keeps me out of trouble, um, which is good.

SPEAKER_01 2:39

Yeah, and I've obviously done a couple of podcasts for DEXCOM where you've been the host, so it's actually quite nice to be on the other side. So I'll get the ones who asked the questions this time. I was gonna say, remember how nice I was. Brilliant. Um so yeah, we're not gonna spend any time really on the accuracy of the product, apart from to say it's one of the two systems we've got available in the UK that has ICGM approval, which there isn't an international standard, but if there was one, that would be the highest bar. So that puts you obviously right at the top in terms of from an accuracy perspective. So we won't spend time wasting that because that's what we want to know is okay, we're happy, insulin dosing, no problems. Yeah. What does it do other than give reliable readings for insulin dosing? What are the key things that are benefit to people with diabetes? What are the integrations, etc.? So I'll sort of set the scene a little bit because I personally use the DEXCOM and have done since the G5, the G6, now the G7. And where I work, we are a very predominantly DEXCOM. Um, children and people we look after about 300, I'd say 280 of those are on our DEXCOM. And our preference for that has always been you have the option for optional calibration should you need it, which for schools is quite important because we teach them, obviously, if there's a discrepancy or they don't feel like the CGM's right, do a finger prick. And when that happens, if there is a discrepancy bigger than 20%, sometimes then they don't know what to do and how to trust it. So being able to calibrate back up to um where the the CGM, sorry, where the finger prick is, then it just takes away a bit a bit of hassle. But obviously the good thing about the school teachers is they do the finger picks properly. They kind of get to wash the hands and do the finger picks. So you can be happy about the calibration going in. And also for us, we've now got what 275 of 300 on AID systems, and obviously the DEXCOM's got uh probably the largest integration with the different AID systems we have in the UK. So for us, it's kind of there's a practical aspect, but there's also then the integration aspects. That's a kind of to give people a flavor, I will be dropping in some personal anecdotes. Not that I'm biased towards any company, but that's just kind of the way that my professional and personal life are, and that's just reality. Um, I think it's always good to drop a bit of that in. So giving that as out of the stage, you know, kind of when you're when people are thinking about a DEXCO system, which really we're now talking about the Dexcom G7 or the OnePlus. So maybe you can start off by explaining the difference between those so that people have an understanding.

SPEAKER_00 5:02

Yeah. So yeah, we have two products that are really readily available now from DEXCOM in the UK, and that's the DEXCOM G7 and the DEXCOM OnePlus. The important thing, they're both built off the same hardware platform. So from a sensor kind of the sensor filament, the transmitter, all of that kind of stuff. It's all built off of that same. So they're they're essentially the same hardware. It's the software where we really target the right patients for for for the right sensor. And that's really the DEXCOM message in the UK. So the G series, that's where we really cut our teeth as an organization. So DEXCOM's been around for 25, well, we're in our 26th year now, and we really focused on supporting people living with type 1 diabetes. That was our major focus. And to do that, you want the very best quality sensor, the very best accuracy in a sensor, and you want the very best features to keep them safe. So that's where our G series sits. Let's talk about some of those features while we're here, then we'll move to OnePlus. So this is where we have our predictive alerts. So we've had urgent low and urgent low soon. There have been two alerts that we've had since uh late G6, I think late G5, actually was uh the second version of G5, uh, the updated version of G5, we had some of those features uh in as well. So we've had those features in for a long time. We've got a really solid evidence base that actually for people who are at risk, higher risk of hypoglycemia, especially with unawareness attached to it, these predictive alerts that let you know about 30 minutes before you hit a low a level that you can set, a hypoglycemia level, is gonna let you know beforehand. So you don't have to wait till you get low to do something about it, which from a quality of life point of view, I don't live with diabetes, but I can imagine from a quality of life point of view, hypoglycemia is just generally rubbish. So if you can actually do something before you feel really rubbish, from a quality of life point if you're alone, that's be great. But from a safety point of view, you're stopping anybody hit that risky zone. So that's great. We really that's very much what the uh the G Sewers foundation came from. We've added to that now with kind of the other end of the scale, the delay first high alert. So really focusing on hyperglycemia. We've got hypoglycemia pretty well sorted, switch the focus to hyperglycemia. And this was really listening to people living with diabetes. Um we were told in market research that uh that high alerts are useless. We either switch them off or set them so high so they never go off. Because otherwise, every time I eat, guess what? My high alert goes off. I get annoyed, switch all my alerts off, miss a high high alert after dinner. So, yeah, we really wanted to go back to the drawing board with the threshold high alert. And delay first high, I think is an amazing, really underutilized alert. And this is yeah, uh, so essentially what you can set, so let's say you'd set your high threshold at 14 millimoles per litre, rather than the alert going off as soon as you hit 14, you set a delay. So let's say I always recommend two hours. You're gonna say, I don't want to be alerted until I've been above 14 for two hours. And when you hit that two hour mark, that's when you get the alert. And the great thing about that is you're getting that alert at a time when you can actually do something about it. You can take a correction dose of insulin, you can potentially get up and do some activity, whatever it may be, whatever it's that you're prescribed from your healthcare professional, you can do something about it. And that change.

SPEAKER_01 8:58

Yeah, I'll definitely jump in there because that's I think that's one thing with people with diabetes, and certainly the the kids and the families that we look after would set about CGM is that uh alarm fatigue is a real thing. You want an alarm at an action point, you don't want it at a pre-warning. And obviously, with the earlier models and still some of the other models, you have to set it at 14 because that is ideally the action point of testing ketones, yeah, and to see then whether you need to, if you're on an AID system, change the pod, or if you're on injections, whether the ketone level are building. But obviously, as you've described, after eating, especially after breakfast time, typically the glucose level, at least two or three times a week for most people is going to rise above there, which means what are they gonna do? And the the answer is just be annoyed by it because the advice is only take action when you're 90 minutes or to two hours above at that range. So that for us, the the delayed first high is actually becoming really useful because number one, it takes an annoying alarm out for schools, and that's a really big thing, and also for the kids as well, who don't want to be beeped at to let them know they've got diabetes when there's nothing they can do about it. But then when it goes off the second time, that's the action time to actually test the ketone. So it comes with the alarm goes off, it's the ketone test, and then you can decide, oh, look, it just needs a correction, it's gonna come down. Maybe you do some activity, or maybe you're a bit more vigilant. So I've got I have to say that that um certainly in our recent practice, because we've migrated people over from the G6 to the G7, we've been quite keen on making sure that that gets utilized straight away. Because to be honest, it's gonna take away typically at least once a day an alarm that is unnecessary. And it also then it's a little bit like the boy who cried wolf. If it keeps going off and you've got nothing to do, you just ignore it or you say it higher. But actually, when it goes off, there's an action to take. It's better for the person, but it also is easier for the healthcare professional because when you come back, you just see the alert that went off and then was the action taken rather than these multiple alerts where you're like, Well, I don't even know what to advise you at this particular point. So I have to say that that for our practice more recently, since we're having the changes across, it's pretty helpful. And me personally as well. Like I have my delayed first high set of like nine, which for most people are like you, what are you doing? But for me, that's actually pretty it's pretty important because I'm bound to go over nine initially after eating pretty often, but I'm normally back down below nine in two hours. But if I'm not, then I want to do something about it, which for me is get my ass moving and get moving. So for me, it's probably cut out well before I had to compromise, I'd have to set it at 11 because definitely 11, I'd need to go walking, but I'd often between nine and eleven, do you know what? I'm fine with that, but I'm not fine with that for two hours, I'm only fine with that for a short period of time. So yeah, I think um there's probably a lot of people, healthcare professionals and people with diabetes who maybe haven't had that described to them or the way that they could possibly engage it and think of how's that what you know, what's the purpose of it? Like it's just alarms are just a pain in the ass. Actually, it's a way of making alarms actually relevant and context you know specific. So that's that's been our experience.

SPEAKER_00 11:58

Yeah, listen, I don't I don't think we did a great job, you know, cards on the table, of really shouting about how transformative I think delayed. I've just done it for you there.

SPEAKER_01 12:08

There's there's there's some free marketing.

SPEAKER_00 12:10

We'll we'll pop that on the website. Um but yeah, no, and and and we are getting that message out now, and it's great to hear that that there are centres that are really starting to engage that delayed first high. And again, with delay first high, I think it has more application. Now, I'm limited about what I can say definitively because we don't have evidence around it, but from a common sense point of view, and I think you kind of alluded to it with delay first high and AID. You know, actually, if you set that for two hours, if you've been above 14 for two hours on AID, guess what? Your AID system has failed. Yeah, something's gone wrong.

SPEAKER_01 12:48

Yeah, I mean, our our advice, our advice is this we have to put on a caveat and say if you if it goes, it's unexpected, because it's expected to like stay above 14 for that if you've just eaten 70 grams of carbs, no insulin. Like no AID system is is covering that. But if you if you've done everything that you're supposed to do, quote unquote, if you're still above 14, two hours after, you're either horrible at carb counting or you haven't given insulin for what you've eaten, or you need to change your set. So I mean that's that in our literature or our advice is if you know you've been above 14 for two hours and it's unexpected, you've just got to change the canular or change the pod because it shouldn't be there.

SPEAKER_00 13:26

Exactly. No, that's great. So yeah, again, I think there's there's potentially more to come around looking at how we utilize delayed person fiber. I think it it's an amazing alert, and like I say, really transformative of clinical practice.

SPEAKER_01 13:39

I mean, it probably just came out at the wrong time because it came out the time of AID and everyone's kind of like, you know, it's AID, everything's AID, and and it it kind of is for pediatrics, but then when you get with the reality for the adults, you know, there's there's a nice guidance and everything, but the reality is we're probably never going to get more than 25% of adults on an AID system, which means it's 75% of people with type one who are going to be on MDI for one reason or another, whether it's local funding or whatever, that actually this is a really it's a really big thing in terms of alarm fatigue, taking action when it's needed, and actually getting a bit of reduction of the friction of diabetes in your daily life. So yeah, I think it just timing was probably one thing, but now you're kind of getting those messages. It's um certainly time to revisit, I think. I think so too.

SPEAKER_00 14:24

Yeah. And and it's great also that that delayed first five feature is also on the DEXCOM One Plus. So I wasn't aware of that's good.

SPEAKER_01 14:31

Yes. Yeah, I was going to do that.

SPEAKER_00 14:31

So yeah, we'll come to that and talk about DEXCOM One Plus. Yeah. Back to G7, I suppose, yeah, the last big thing with G7, great segue from AID, is that's our connected sensor. That's our sensor that we we build the connections on for our insulin delivery partners as part of an automated incident delivery system. Um so as of right now in the UK, um, we connect with the tandem T Slim X2, we connect with G7 with Omnipod 5. Soon to come, we are well Ips theMed have announced, or My Life IBT scare, sorry, have announced that they are piloting G7 right now in another country with their G7 integration. So we're hoping that we can talk about that a lot more soon. And then obviously pumps coming in the future. There's more and more pumps coming. You know, tandem have to have the Moby, which we're all very, you know, I think lots of people are very excited about.

SPEAKER_01 15:29

And I'm right in saying in the States the G7 speaks to the Moby in the s in the States, right? Yeah, absolutely. Yeah. So we're not gonna be. Have they got control IQ plus over there yet in the States? The next version?

SPEAKER_00 15:40

In the States, the well, the updated version.

SPEAKER_01 15:43

Yeah?

SPEAKER_00 15:43

Yes. Yeah, control IQ, yeah, IQ plus. Not the brand new algorithm.

SPEAKER_01 15:47

Yeah, but the the updated algorithm. Okay, so not the one down to age of two yet. I don't believe it. That's to come soon. Yeah, so I was I was at an ad board where they were going through some of the information on the the the control IQ plus, and obviously it'll be going down to the age of two, which will be interesting. Um, and obviously again having you know that the the G7 tens there will be will be really helpful. Because I know certainly our certainly for our under fives, we use a bit of control IQ off label because you have a really wicked dusk phase of insulin resistance that most of the systems can't keep up with. But with a control IQ, you can just pump the basil up at that time, make the correction factor really strong, get on top of that dusk and then drop it off like a stone for the night. And for us, it's the only one that you can really do that with. So to actually have it um available on license, and the other thing to say, just in case the people are listening to this and they're interested in doing control IQ with younger kids at present, even though you can set the correction factor up to 33, the algorithm correction factor only goes to 11, and that really tricks you because you think, oh my god, it's really strong. We've put the correction factor at 33, but at the moment it goes to 11. But with a control IQ plus, that's different. So that was what kind of middle will make it possible and easier for the two-year-old. So just a little bit of a call control IQ plus exclusive there for the people.

SPEAKER_00 17:04

Wonderful. I really like that's why I really like control IQ. I've always really liked control IQ because you it it's the only, yeah, probably the only algorithm left that you've got that level of kind of adaptability. It's good it's good for it's good for the diabetes nerds like me and you, that's for sure. Absolutely, yeah. Perfect. Right. So yeah, that's kind of G7 in a nutshell. It was our first all-in-one sensor. That's been a big change for us, obviously, from and also look, it's a big, big reduction in waiting time.

SPEAKER_01 17:31

So a lot of the kids and the families, not that is a big thing. So obviously, to go from two hours to half an hour, especially when you're on AID is big. And obviously, if you stick the next sensor in an hour before, sorry, half an hour before, there's no lag time. And you also get a 12-hour grace, which a lot of families find useful, especially if they're about to go to school and the alarm goes off. Previously, they'd have been like, I'm done here, because like we're gonna have to change it and wait two hours, and then they get 12-hour grace till after school. So it's that just even things like that, it's like it's it's a big deal for families that when they come back and they're like, Do you know what? To go from two hours to half an hour and now nothing is amazing. And actually, those couple of mornings when it, you know, we change the sensor and then we get 12-hour grace, it does things without to really make a difference.

SPEAKER_00 18:10

Yeah, no, that shorter warm-up, we we worked really hard to get that shorter warm-up time. And we're continuing to really look at that because actually the reason you know you have a warm-up time in CGM technology uh sensors is because of that initial kind of brutal part of putting the sensor in. Yeah, yeah. The area obviously has to recover. While it's recovering, all kinds of things go wrong that can affect the accuracy. So, yeah, that's why you know we had it at two hours because if you remember G five, the way it was going in, that was brutal. Yeah, yeah, yeah, yeah. G6 just kind of was a similar thing but automated. So moving to a 90-degree insertion meant along with some other really clever things that our boffins in San Diego figure out with the algorithm really helped to bring that down. And we're continuing, like I say, we recognise that's probably one of the biggest pain points. Because, yes, like you say, unofficially, you can on the G series, on a G7, on a OnePlus, have a six-row warm-up time by O think. Oh, I know you can't say that. I can say that. Yeah, you can say that, absolutely.

SPEAKER_01 19:20

I'll say it's a good one. We don't recommend that right now. Well, a lot a lot of the families find that helpful because they'll put it in before the allow the area to calm down. No problems. A lot of used people with G6, a lot of people with G6 would stick it in a day before, give it a chance to completely settle down. So, you know, people who with diabetes, it they know what's going on. They know the sensor performance is on every single sensor on the first day. It can't be as good because you've got an area recovery, and so it kind of makes sense to get it in beforehand and kind of let the area settle. So when you get it, bang, you're onto the good stuff straight away. Absolutely. Okay, so I'm just gonna recap there. G7, we've got kind of the urgent low soon, which is the sort of 30 minutes before you're gonna go low. So take action before you go low. We've now got the delayed first high, which is taking away the unnecessary first alarm, and that's gonna go off whenever you decide in a period of time after and at a level, nerd like me at nine, the average person at 14. So you take action where you need to. You've got those two things. We've got obviously a smaller form factor um without a separate transmitter, and obviously reduction in warm time, warm time to half an hour, and we've also got a grace period of 12 hours. So that kind of covers is that the sort of G7 you'd say that they're the kind of like the main point. And obviously, integrations. The integration is AIDS, yeah.

SPEAKER_00 20:33

That that that's our G series. It's really there for people living with type 1 diabetes who are at a increased risk from hypoglycemia. That's really where the G series really lives. Then we've got Dexcom One Plus, like I say, hardware, same platform. It's the software really that we've kind of changed on the DEXCOM One Plus, and that's because it's not targeted at people who are at a really high risk of hypoglycemia. Yeah.

SPEAKER_01 21:02

So just so I'm just so I'm clear with this, you kind of pretty much obviously for the people on AID, they're obviously going to be having a G7, and then you've got the people with hypoglycemia issues who are also going to be on a G7 specifically. But then, you know, maybe that's whatever portion of the population it is, but then the other people in primary care, typically type people with type 1 diabetes who are maybe not a risk of hypose, people with type 2 diabetes on insulin and sort of potential hypoglycemia therapy, um, who haven't got that risk of hypoglycemia. What we're talking about for those people, probably the common sense is the one plus, and you've designed a system which is more friendly to them, with probably less exactly alerts and bits and pieces and more so it's so it's simpler for them.

SPEAKER_00 21:42

Yeah, essentially we've taken out a couple of the alerts. So the urgent low, urgent low soon, they don't exist in OnePlus. Kept, like I say, the delay first high, because actually that does that does really benefit that group um who are perhaps maybe long established MDI. To having high thresholds switched off, move to a OnePlus, switch them back on. And actually you can see, yeah, I probably should be doing a little bit more the same target. So yeah, that's that's really where OnePlus is really focused. People using insulin who aren't a who aren't at as high risk of hypoglycemia. Good hypoglycemia awareness, essentially. And then really looking at people living with type two diabetes, which is a brand new area really for us at XCOM. You know, we're like I say we've been hyper focused on people living with type 1 diabetes, but now we're really starting to see that people living with type 2 diabetes can really benefit from this technology. The evidence base now is it it you know it went from a trickle five to ten years ago uh uh of of studies um to now there's uh overwhelming uh you know uh yeah it's well.

SPEAKER_01 22:53

Yeah, I saw I saw yeah, I saw a couple things at ATTD. I know Emma Wilmot presented some data of people on basal insulin who are using CGM got a big benefit, and it makes total sense. It's like, I mean, I think back as a dietitian, so people have come for weight management to come and see me and you say, Oh, well, we could do this and we can do this and we can do this, and you'll get the result in three to six months' time. And it's just you know, as soon as you said you get your result in three to six months' time, the eyes are all in the back of the head, the motivation disappears and it's all gone. Whereas with the CGM, that was the best thing ever for people for dietitians, I think, because all of a sudden the the dietary things you're suggesting, the things they did tomorrow, they would see instantaneously on the the readout in front of them, and they will know whether it works or it doesn't. And all of a sudden, that positive feedback you get. And it's just the same for people with type 2 diabetes, like, oh it's a good idea to kind of do more activity and do this. It's like you do it for a bit, but then you fall off. But actually, if you've got something which goes, actually, when I do it, I've got this percentage timing range versus this. Actually, the more of this I do, it becomes a game, you can gamify it, but you need a you need a fast-paced return on your investment to keep you going. And I think that's the you know, kind of beauty of CGM in that space with behaviour modification. It's just a tool for immediate feedback that you know and positive when it goes well, the carrot, and then the stick when you're you know you've eaten that big piece of carrot cake and it goes high. You need you need a hit with a stick.

SPEAKER_00 24:11

Like I say, John, I don't live with diabetes, but with my job being what it is, I get to wear C uh, you know, Dexcom sensors pretty regularly. And it's great for me, you know. I'm the wrong side of 40 now, I'm carrying a few too many pounds.

SPEAKER_01 24:24

What for 40 48 or 40 inches?

SPEAKER_00 24:28

Well, a gentleman doesn't say. Um yeah, uh so yeah, wearing them, the insights for me, it's just astounding to say, actually, I can see really clearly my resting kind of glucose level creeps up when I'm stuck at a desk all day. Um just getting up and going for a walk drops kind of my normal glycemic level.

SPEAKER_01 24:51

It's great. My my best mate contacted me about two years ago, and he he'd just been to the GP and he said, right, you're you're sort of in the the pre-diabetes, HBNC between 42 and 48, and we're gonna start you on net forming. And he's like, Oh, he's like, What should I do? What dietary stuff? I said, All I'm gonna do is gonna send you a month's worth of CGM and basically stick it on, and whatever it does when you go high, do less of that. And the and the more when you're sort of in target, do more of that. And he found very quickly that when he went from 5,000 to 10,000 steps walking a day, his line was just flat. So it's like, so you need to do a lot more of that. And he was like, Yeah, when at weekend I went out and did that, say, that's once a week when you kind of had a big splurge, you know, and he's like or binned off having the four pieces of toast for breakfast, and I've changed it for this. Like you didn't need a dietitian to tell him that, he just needed something to go, that's probably not a good idea. Ah, that's much better. And that I mean, that's ultimately the people's physiology is so individual that actually having a tool which tells you about your physiology is actually so important because a dietitian will tell you what works for the average person, but the likelihood that you're the average person is well, it's about 30%. 30% fall in the middle, 30% on one side, 30% on the other. If you fall in the middle, 30%, good luck to you. But if not, you need a tool that's gonna tell you what's good for you.

SPEAKER_00 26:04

And generally, obviously, from the evidence fraction, that's 30% of the Caucasian population. Yeah. Let alone when you start throwing in different ethnicities, which you know, everybody reacts differently to think. Sure. So yeah, no, it's that's definitely where I DEXCOM are going. You know, we're starting to think a lot more around biofeedback and what how do we help people make sense of the data? I think that's the key like you said, you know, we don't always have to send everybody to a HCP. Actually, for people like myself, what what what education do I need to be able to make sense of that data? And you're gonna start seeing that drip through into all of our technology. So you know, the product I'm really thinking of there is obviously Stello, which isn't available in the UK, in Ireland, US only right now. It will be launched in Europe at some point.

SPEAKER_01 26:57

That's the over-the-counter CG, isn't it? That's the over-the-counter CG, who are not necessarily prescribed it by their practitioner, but it's available to them so they can gain the insights, especially if they're in that sort of pre-diabetes stage, or even just the dare I say it, the worried well. I'm definitely, I definitely belong in that character. I mean, I've got that one diabetes, but I belong in the worried well 100%. If I didn't have diabetes, I would be on a CGM for sure. But yeah, no, I think it's also important insights for those, but again, making sure that there's a an accurate device uh that they can trust and also that will provide them the type of feedback which is actually going to be useful the vast majority of the time without being um you know telling them things which are not necessarily so close to the truth. So, one plus from what you've just said, obviously, more targeted people without hypoglycemia, taking some of the alarms so we're not getting overburdened by alarms. Obviously, a very simple and easy format to get accessible via the GP for people with type 2 diabetes at the moment. Typical and insulin, and then obviously that's going to move towards the outside over the counter at some point with some version of something similar to the Stella in the US.

SPEAKER_00 28:03

Stella, yeah.

SPEAKER_01 28:04

Just in terms of of followers, just so that people are listening, because obviously, if you've got a young person, you're gonna want some followers, mum, dad, grandma, granddad, school, etc. So the G7, how many followers you can you have on that? Right.

SPEAKER_00 28:16

Right now it's up to 10. Okay. But I uh that may change.

SPEAKER_01 28:22

I mean, you don't you surely don't need more than 10. Who needs more than 10 followers? That is just ridiculous. If you've got more than 10 people, you've got people like completely over being over surveillance. If you've got more than 10 followers on telling you now, stop it. Yeah, that young kid, stop it. It's just it's not fair on them. Um but anyway, it's great to have more than 10, but 10's more than enough.

SPEAKER_00 28:43

More than enough. So yeah, you can have plenty of followers. Yeah, for me, like I say, if I'm talking about a a child, mum, dad, potentially a more than five's good because you might need schooling air and stuff like that.

SPEAKER_01 28:55

I guess more than ten if you absolutely need to, but and then the the one plus any followers on that situation? Exactly the same. All right, okay. So that's that's just got power to across there. Absolutely. Cool. So that's the G7 and OnePlus. Obviously, there's no integrations at the moment, that with anything else. That's kind of that's the whole point. It's like it's compact, it's in one place, it's just that's what it's there for, yeah.

SPEAKER_00 29:14

Yeah. Um again, probably watch this space around connected pens. That will probably go beyond G7. Okay. Because that that again makes a lot of sense in that OnePlus potential patient cohort. That's we could we'll be able to talk about that a lot more soon.

SPEAKER_01 29:31

Okay. And just just so I'm clear, because obviously what we really like on the G7 where where I work now is you can see instantaneously from Clarity, it pulls through your daily timing range, and you can look at your reports on the same app, which is massively important when you come to teaching, and you're trying to get that behaviour change, and you need you need a a week-long marker to kind of like pin to is so much easier now. Because before going on clarity was a bit of a pain in the ass, but now it's actually there. What's the situation on the OnePlus? Is that available too? Yeah. So you've got your clarity. Nice.

SPEAKER_00 29:59

So right as of right now, you've got your clarity card in both the DEXCOM G7 and the OnePlus app. Um, if it's not been released yet, it can be released imminently. The Clarity app essentially won't need to exist anymore. The whole of Clarity experience will be in your sensor app.

SPEAKER_01 30:18

That's that, yeah. I mean, I that's so important as for ownership as a person with diabetes. I'm sure it used to really annoy the families when they come back and they'd be like, how can you see that? And I can't see that, or you have to log on to here, like, I ain't doing that, should be in here. So that's good that that's now all being brought in-house. Okay, that's good. So that's all in one app now, all in the user experience. Okay, so we've I think that's covered off the majority of like what makes Dexcom Dexcom, what is that now? The two different options. So obviously, we've just both come back from the ATTD. Yes. Um, where there was a lot of information, education, different, all sorts of things out. And obviously, Dexcom have will have quite clearly released their I know there's the 15-day sensor in the States. We can talk about that a little bit, about at some point that will be over here. There's integrations with various different things. I'm gonna be front up and said I did a bit of party and I missed a lot of the sessions. So I need you to fill me in on what's what's new with DEXCOM in terms of currently in different places like the states, and then what's the sort of what was presented, what the future outlook might be for things to come.

SPEAKER_00 31:19

So what what's what's that saying? Absolutely. So yeah, we had a uh sponsored symposia at ATTD where the whole topic was essentially we were presenting our future roadmap. Okay. Um so there was lots on there. We were talking a lot about the as you say, so in the US right now, they've just released the G715 day, um, which is going really, really well. It's not just that we've made the sensor last longer. This has been part of a so yeah, what one of the great advantages advantages of working in medical technology is you're able to continually improve the product throughout its lifespan. So what we've done with G715 Day, it's also kind of come alongside a pretty big product update. Okay. So, you know, again, I I'm limited from a regs point of view.

SPEAKER_01 32:08

So Because obviously it's in the state. So I'm I'm presuming Al Canada. You've obviously changed some of the the the enzyme technology, you've probably changed some of the filament technology, probably changed some of the hardware technology.

SPEAKER_00 32:18

I can say definitely not that. Okay. So it's looking a lot more at the algorithm that converted.

SPEAKER_01 32:26

This is a really important point here, because I want to make this point. And I also think it's important for systems and companies that have been around for a long time, and this includes Medtronic, because I used to work for Medtronic. The advantage of being in the game for such a long period of time is you amass a huge amount of data around how your product performs, where the blind spots are, and also where the opportunities are, but also a whole load of information to test new algorithms and products. You only get that by being in the game for a long, long period of time, which means that in the future, when you do something new, you don't make the same mistakes that you made on the previous three or four iterations, and actually you're forward-looking, but you've also got a very solid base. And the reason why I say that is because there's obviously a lot of new CGM companies coming to the market. Yeah. And one thing for them that they the big hurdle that they have to get over is how are they going to train their algorithm for their sensor based on their input and the actual hardware and software that they have, specific in the limitations to that, and learning, they'll have to learn quickly and iterate fast, and they've only got so much kind of money to do it. And if they can do it, then great, that's absolutely brilliant. But at the same time, it's also important for the people out there who are kind of thinking, like, oh, you know, why would I think about one rather than another? You have to think about the learning that's gone over a 20 to 30 year period to be able to develop technologies and improve on them and not make the same mistakes. And that is one benefit of being a product that has been around and trusted for such a long period of time. So I'm not just saying that because I'll say that when we have the Medtronic people on here, I'll say it when we have the Abbott people on here. It'll also be a challenge to some of the others that don't have that legacy, is kind of like, you know, how do you protect against that? Because those are serious questions, you know, to answer. So, yeah, obviously, I'll say that for you, but that obviously is part of what is built into the new algorithm, is a lot of learning over a 20-year period.

SPEAKER_00 34:17

Without a doubt. You know, and we're not afraid of competition because of that, because we can go back and we can start really right now. What can we do better than company X, Company Y, Company, yeah, whatever. You know, what what can our sensor do better and not just to be better than them, to have a better product for our patients? That's what we're better than the previous, better than our previous, and that's where 15 day cake is is coming with lots of really kind of uh big changes that that will come. Um plans for for Europe haven't been released yet. Um and I'm probably not important enough to be able to give you a heads up. Um we'll have to get Jake Leech on here.

SPEAKER_01 34:59

We'll get Jake Leech on it.

SPEAKER_00 35:00

Absolutely, yeah, absolutely.

SPEAKER_01 35:02

If you're listening, if you're listening, it is a community.

SPEAKER_00 35:04

Oh, yeah. I hope you're gonna do it.

SPEAKER_01 35:06

Okay, while you're at it, give Adam a raise as well. He deserves at least a 50% raise. He's doing a great job.

SPEAKER_00 35:12

Easy. Um so yeah, listen, we we know it's likely to come. It makes a lot of sense to everybody. Um the one thing to note is in the US it does, it's only indicated for adults, 18 people. Okay.

SPEAKER_01 35:28

Well, they'll be they'll be doing the pediatric studies right now, won't they? And hopefully by the time it comes in Europe, the data will be there. And we hope we all know CE marking is not quite as difficult as FDAICGM. So I don't think that I don't think there'll be too many problems in getting it through Europe. If you say that, I'm saying that.

SPEAKER_00 35:44

You could say that. Okay as a company, it it it it you know, we wouldn't release it if it wasn't good enough. Yeah, of course. You know, there'd be no that we we wouldn't want to do that. Um so yeah, we wouldn't.

SPEAKER_01 35:55

Uh so the the the 15-day obviously updates at the moment, adults own label the studies we've done to children, but at some point in the future we'll be getting that over here. And obviously that gives time for the integrations as well with the new systems because that's one thing with this whole interoperability piece is like if someone upgrades one piece of kit, you haven't just got to update it for your like app, you've also got to now do an integration with four or five different software things and make sure that these all fits within like the interoperability criteria and manifestos of the different things, so it's not quite as simple as we just do a new one and we let it go. You have to actually, you've got a whole load of nuances to manage as well. Okay, that makes sense. So I've passed the the the 15 day, is it anything else on the roadmap that was that was discussed? Right.

SPEAKER_00 36:35

We did speak about our next generation sensor. The the G A? Is that gonna be the G A? You would hope so. It would seem to be sensical, but it's it was on the slide, it's our next generation sensor. Okay. And that's really starting to think I think we're calling it that because I think this, you know, this this it this iteration, this generation of DEXCOM sensors is our first where the sensor technology has gone across three products. So G7, OnePlus, and Stello are all essential. So our next generation will be the next iterations of all three. So yes, it might be. It might be named G8. Our marketing department might decide to call it something different. Who knows? But yeah, so yeah, talked a little bit about that. Um there's gonna be a complete, that's where there is gonna be a complete filament redesign, which is looking really, really positive. We are looking at different analytes. Obviously, ketones was the big buzzword at ATTD. I'm sure it will be on the list. It might have been for you. It wasn't obviously not for me.

SPEAKER_01 37:45

I want to see I want I I want to see lactate in a sensor. That's what I want to see. I want to see for people pre-diabetes, people in that space where the glucose doesn't move enough to get a big enough signal. I want to see lactate in a sensor. That's that's what I want to see.

SPEAKER_00 37:57

I'm sure it's on the list, like I say, for the buffers in San Diego. So yeah, there's there's we it's going to have that ability. Uh it's improved chip, smaller size on the body, uh, obviously at least 15 days. So yeah, that's coming. That's in the future. There's going to be updates to clarity, perhaps a bit closer, a bit more immediate future. Population health. So actually really the HCPs that you can look at. Yeah, I mean, just so people are listening.

SPEAKER_01 38:27

If you're a healthcare professional, this is the bit where you log into your clarity at the moment, you just see a load of names and numbers. You'll be able to sort it by time in range, time below range, hopefully be able to set up some kind of report, some filters that allows you to identify who are the people between clinic who really need your help and need your help quickly rather than it being a retrospective service, it will be more of a proactive outlook. And we've we're doing a little bit of that now with Gluco and trying some sort of text message style nudges to see whether between clinic we can get there. So presumably that that will be interesting. So when it when it does, then give us let us know when it's coming because obviously we've got so many people on Dexcom, we we'd be quite keen to have a look at that for sure. Absolutely. G8, we've got a bit of clarity update with some population health. Is there anything else on the menu on the roadmap?

SPEAKER_00 39:14

EHR integration, again, for the CPs listening. And so electronic healthcare records becoming a much bigger thing. You know, most hospitals now will have, will generally, you don't have paper notes anymore, everything on the Well, we've just gone across to Epic, and it's been a huge, huge learning curve.

SPEAKER_01 39:33

Um, and quite overwhelming for a lot of people. But one of the gripes with every diabetes centre is like, I've got an open gluco and clarity and LibreView, and then now tandem source and something else. It's like, oh my god, can we not just get like these things plugged into one platform? And I know in Scotland they have an amazing thing, uh it's called diabetes sky or something like that, where they've got everything that kind of like filters in in one place, which if they've done well with that. Um, I think it'd just be particularly helpful and easier to have the information there to plug into your record so the note keeping becomes easier.

SPEAKER_00 40:07

And the wonderful news there then is you're an epic site. Okay. Oh, okay. Dexcom clarity data can actually almost you can see, so you can personalize it, each center can personalise how what they want to pull through to Epic Healthcare records. And but yeah, you can essentially see AGPs.

SPEAKER_01 40:29

So if you're a researcher, that's massive because you've got HBA1Cs and you've got um CGM data on the same thing. So if you want to have a look at things like the match between GMI and HBO and C, if you want to have a look at, you know, some of the work that I've been involved in is that some CGMs measure the glucose level very closely to what the actual glucose level one, which is obviously what DEXCOM is, and some measure underneath. But that becomes very, very clear when you have matched CGM and um HBO and C records, and you'd be able to run reports to see, you know, kind of which your patients are maybe on a sensor that's under reporting, yeah, or reporting in the range. So that that sort of information would be a bit clearer to see. So yeah, that that'll be good. Yeah. If you're in the if you're in the world of research and boring stats like me.

SPEAKER_00 41:10

Yeah. So that's all coming. In primary care, we do integration with EHR a little bit differently. We do it through an NHS approved partner. But yeah, the epic one is is for me. Yeah, that's actually potentially very exciting. And moving to inpatients and that kind of thing, actually, if you've got an inpatient who may or may not be using a CGM to be able to see that in their epic healthcare record, um, is really interesting. So, yeah, that's the future. Integration and really looking at how we can utilize things like AI, generative AI is already in the stello product in the US. How can we get more of that into our other product to help people help themselves? You know, that's always the best on.

SPEAKER_01 41:58

So it sounds like the roadmap that was presented, something sooner rather than later is going to be the 15 day. And then we've got the G8 that's on the horizon, which is the right rather rather than rather than just a facelift, it's getting a tummy tuck, it's getting a Brazilian butt lift, it's getting the whole Shibani. So that'll be that'll be good to see. Then you obviously got the integration pieces um and the clarity pieces, and maybe some um decision support, some behavioural support and behavioural nudges with generative II and maybe learning over time. So it's kind of like really building on a really solid portfolio, an accurate sensor, and then as the information technology is moving forward and the connectivity is picking up, is what else can we put into just being a really good sensor? How can we change that into now being a situation where you've got a compact thing which is very useful for behaviour change? And then so that kind of puts it about right?

SPEAKER_00 42:48

Yeah, absolutely. It's making sure the sensor is the foundation of everything we do. If we stop building a good sensor, we've got to recognise the house on top falls down. So that's our foundation, but everything else on top is what's going to make it beyond a a glucose monitoring solution into a health solution. Yeah. Something that's going to keep people healthy.

SPEAKER_01 43:12

Well, that has been extremely insightful. And I know that the people who are listening, um, as I said before, we'd already covered off that this is a very accurate centre, and it's a company that's been in the game, that's got um a good uh history and will continue to be a serious player in this market, but also most importantly to the people with diabetes, we've covered off why they may think about uh uh a G7 or a OnePlus, what's to come in terms of the future integrations, um, and obviously that now the game is kind of finding how we can provide extra support to people beyond a very, very good foundation of a centre. So I think it's that's pretty clear for most of the people. Yeah, no, so I can't let you go without obviously having a conversation um about some of the recent events. So I'll just sort of set the scene here a little bit about the whole infrastructure, apart from not talking text from in general, but sort of the whole portfolio. So now we have a market or a potential market which is very lucrative both in the diabetes space and the non-diabetes space moving forward. Like CGM and wearables is going to be and already is huge and it's going to be even bigger because it is a metric that is well recognised, well respected, and has of great value to the peer to the people who receive those readings. So within that you've obviously currently got probably three main players. You've got Abbott, you've got Dexcom, you've got Medtronic, and then you've got lots of other people buying to come into the place. So as that happens, just so people are listening, as a market becomes mature and as people enter the market, there is a risk or there is a big push to commoditize the market, which basically means there's a lot of money to be gained. So what you do is you come in with a product which looks like the same but is cheaper. Therefore to the person who's purchasing said device, it's kind of like these are the same. So we're going to go for the cheaper one because it's a commodities market. So I'm here to say for people with type 1 diabetes and people with type 2 who are making insulin decisions, you can never commoditize a market where you're adjusting insulin which has potentially one of the most dangerous self-administered drugs. It's not a commodities market. It's a market of good quality high quality products. Now outside of the insulin dosing realm it changes because the risk of a few bad readings of making well I'm not going to eat an apple anymore because it makes me go high when you weren't ready to go high or oh it said I was low and it wasn't low. It's annoying but it isn't serious serious as taking insulin. So I just want to make that clear when people are listening insulin dosing is not a commodities market. So cost in some ways you get what you pay for number one. So just to kind of put that frame out there because what happens then is when you're distributing a huge number of sensors across the world the chances are there will be for any said company going to be glitches within manufacturing processes and X, Y, and Z, because it's impossible there. That is why CGM will always come with the caveat of always have a finger pricker with you because although it's amazing 1% of the time the readings will be outside 40-40 and for anyone listening to that that's a reading which will lead to an insulin dosing error or an incorrect hypo treatment. That's as good as it will ever get. So it always means you'll always need a finger pricker as a backup just in case you feel like it's off you do your finger pricker. But that also protects you against manufacturing issues because they are going to happen. Yeah. You are going to get dodgy sensors. You are going to get a dodgy batch of sensors because it's impossible to manufacture so many and not make a small mistake in an occasional batch. So as people are listening if they're ever expecting a day where every center that they will get will be absolutely perfect. They are waiting for the wrong thing. We've got an amazing piece of technology which is always going to have limitations understand that and always have a finger pricker with you. So that being said there's obviously been the high profile mention with one of your competitors and then a little bit back in the US there was a bit of a mention of some manufacturing issues in the sort of main plant in in um San Diego where the FDA wrote some notes and some letters and obviously those things have been addressed. So obviously the people who are listening will kind of want to know what was that all about importantly what lessons were learned what's being done and what's the message that you would like to convey as kind of a company as to sort of what that situation was. Because obviously I'm I've got a good understanding from the outside you'll obviously only be able to say a certain amount of things but I think people would be interested to hear a sort of grounded but honest opinion from someone who works within DEXCOM as to kind of what the situation was and what's happening.

SPEAKER_00 47:26

Absolutely so so as you put it um this is kind of one of the issues of maybe iterating product development a little bit too quickly. So the problem was identified by the FDA that some of our manufacturing didn't match some of our designs. Which is not what we ever hoped to do. And it's just a case you know we iterate we develop we get better hopefully and I think in this in this scenario you know we didn't really meet our own expectations. And that was what was for me that was potentially the most refreshing thing about knowing I'm working in the right place. Because instead of yeah feeling like a a really down place to work this was viewed as an amazing opportunity to actually write this is our chance go back to the drawing board we've got FDA in let's make sure our processes are better than they've ever been before so there's been a huge amount of work going on in our US plants and they've really gone back to the drawing board to make sure that as far as we are able John bear in mind exactly what you've just said but as far as we are able every centre that comes off the line we're comfortable it going into somebody living with type 1 diabetes. So that's really what we aimed for. That's our North Star and obviously we've got the new factory being built in Ireland first factory in Europe for DEXCOM and that is being built from those principles ground up. So we're really really excited. You know we've had a few G7 was our first 90 degree sensor. I would have been surprised if we didn't have any issues I'm also bearing in mind what I do for a living very happy that we are at the back end of those issues. We are back to where DEXCOM should be right at the very top of our game creating the very best sensors for people living with type 1 and type 2 diabetes.

SPEAKER_01 49:18

Yeah I mean there's a couple of reflections I will have on that and the first one is and this is really important to people think about CE marking and companies coming to Europe is one thing about the FDA is they they run a tight ship over there. Which means if something's going on there's a good chance they will find it which is very very comforting as a person with diabetes or a person who puts other people on a sense technology because that postmarket surveillance and the auditing of manufacturing things is the things that you would like to think that all companies are playing by the rules that makes you play by the rules it makes you accountable. Now the postmarket surveillance via CE marking and the auditing of manufacturing is not at the same level. I mean I don't know what it is but it's it's not even close to the same level. So what I would say is that's one thing about having a sensor that's under the FDA's watchful eye is these things get picked up and it means there's an opportunity so hold your hands up and go forward. And as you said there's some um issues at the beginning with G7 like with different algorithms and different bits and pieces and you're now at a position where you're past that and I think for maybe people and I would say I'm one of these so I've just switched to the G7 I was sticking on the G6 for the rest of time. Because I tried the G7 for a bit didn't really work for me just didn't get the same results I got on the G6. But I have to say I tried I've gone back oh well I've moved actually moved to the G7 now over the last couple of months as we started migrating people across we could tell the difference because when we first started migrating people to the G7 at the start we was like no we need to hang off here and just hold back. We need to hold back because with the reports we're getting back ain't good. But since we've reinitiated this since sort of January February we haven't had the same thing everyone's been loving it. So maybe if you're listening and you had the same experience that I had I'm not saying you'll have the same experience going forward or our children but it's maybe worth revisiting now because it might be a slightly different sensor and situation than you first encountered a while back. Which is not ideal for your I guess the the image of the G7 from the beginning part you would have rather been here but life is life you are what you're at and this is where this is where the cards are now so let's go and play them and you'll sort of see where we listen we were super excited.

SPEAKER_00 51:21

So the UK and Ireland was actually the first the first two countries in the world that launched G7. So always always the danger being first yeah I think if San Diego asked us again we'll just hang on.

SPEAKER_01 51:36

We'll hang on let those guys go first.

SPEAKER_00 51:38

Let those guys go first yeah um but no you know these things happen you know and and for me it's exactly like you say on a on a kind of a macro level micro level it it's you know you've got to prepare for when these things happen. It's it it's less about the thing happening to that how you respond. And that's what's made me and I'm going to sound very American and it makes me cringe just thinking it but that is what makes me proud to work for somebody like Dexcom because actually it is you do we you could see rather than hiding from it how can we learn from this how can how does this make us at our mission?

SPEAKER_01 52:15

That came with the with the tw yeah next time I'll see you have a deck you'll have a Dexcom stamp on your forehead. That's it getting the tattoo on but yeah but but it's true it's really true.

SPEAKER_00 52:25

And it is it's it's um it's great and and that's where when things go wrong that's the measure of a person or an organization is how do you manage how do you deal with things when things don't go to plan and and that's been yeah like I say it's been really illuminating at Dexcom to see that passion for get it right and now we're going to get it right first time moving forward.

SPEAKER_01 52:46

As long as you don't go first on the launch. Exactly so I well first of all I want to be respectful of your time I want to say thank you on a Friday afternoon for uh giving an hour of your time. I'm sure the people who are listening are now pretty clear on what the Dexcrum G701 plus have to offer now. Have a little bit of a look at the roadmap obviously have an understanding what it takes to deliver a centre internationally and some of the challenges that can come with that and obviously the lessons that can be learned from from before and after. And that sounds like some exciting things to come as well. So yeah I just want to say thank you for your time um and I think I'm sure people have got a lot out of this and wish you uh a lovely weekend. Thank you very much.

SPEAKER_00 53:23

Thanks for the invite it it's it's always great chatting with you. Thank you very much. See you soon. Take care