#954 Dexcom COO Jake Leach: G7, G6, Type 2 and your Questions

July 14, 2023Scott Benner

Dexcom COO Jake Leach is here to talk about G7, G6, Type 2 and answer listener questions.

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Scott Benner 0:00
Hello friends, welcome to episode 954 of the Juicebox Podcast.

Today, we welcome back a guest. That's been here quite a few times. Jake Leach. Jake is the Executive Vice President and Chief Operating Officer at Dexcom. He's going to answer your questions, a bunch of questions sent in by listeners, my questions, talk about a new product, a few other things that are on the horizon, and we're gonna find out if that Dexcom is ever going to go to your Apple Watch. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Big news kids that cozy Earth offer code juice box at checkout now saves you 40% On your entire purchase. Go to cozy earth.com Enter the offer code juice box at checkout and save 40% off your entire purchase. You'll get a free year's supply of vitamin D and five free travel packs with your first order at drink ag one.com forward slash juice box get a green drink drink it with me in the morning like virtually because I'm drinking it if you're drinking it, we're kind of doing it together. But I'll tell you about the advertisers and then we're getting right to Jake this episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter contour next.com forward slash juicebox. Check out the meters, the second chance test strips and everything else happening at contour next.com forward slash Juicebox Podcast is also sponsored today by us med us med.com forward slash juicebox. Now us med is the place where Arden gets her diabetes supplies from actually her Omni pod dash comes from there and her Dexcom g7. Yours good to you can get your free benefits check right now by calling 888-721-1514 or by going to my link us med.com forward slash juice box, type those links into a browser or click on them in the show notes of your podcast player or at juicebox podcast.com. When you use my links, you are supporting the production of this show. And keeping it free and plentiful for everybody. So you can get more stuff like this with Jake. Jake, how are you?

Unknown Speaker 2:37
I'm doing great. How are you doing?

Scott Benner 2:38
I'm well, thank you. It's nice to see you again.

Unknown Speaker 2:41
You too, man. It's been a little while. Yeah, well,

Scott Benner 2:43
there's a good, there's a good reason to get back together. So I'm excited. Yeah,

Jake Leach 2:47
yeah. g7 approval, I think was last time we chatted. Yeah,

Scott Benner 2:51
right. Right around that time. I have a couple of g7 questions for you. I'll hold off till later. Okay, cool. But I did want to find out what was going on. So it sounds like you guys are bringing some new products to light. And I wanted to hear about those.

Jake Leach 3:05
Yeah, yeah, we are. Absolutely. Yeah, we recently announced a exciting new product where we're looking at CGM for people who have diabetes, but not on insulin. So really, really focused on the needs of those users, which are different than, you know, many of the needs of folks who are taking insulin. You know, it's basically trying to build a product that's for, you know, there's about 25 million people in the US that have type two that aren't on insulin and don't have, you know, severe hypoglycemia events. So that there's really, you know, they could, they could use a CGM, like G six, or G seven. But we're really this idea here is let's design a product that really meets their needs. And it's something that, you know, they can really get engaged with.

Scott Benner 3:52
What is that a? Is that an easy timeline? Is it yours? Because the reason I'm asking my brother has typed too, he was just here visiting. And I may or may not have slipped him an old GE six transmitter and two sensors and put one on him while he was here. And inside of the first 10 days, he was already understanding what food was doing, that he never understood before, no matter how much a doctor tried to explain to him or I tried to help him. It wasn't until he saw it that it started to make sense. And then the next text I got from him was, do I put this next sensor on now? Or do I wait? Or like he already had that feeling of like, oh, no, I want this thing. So is this going to be like a long process FDA like that whole thing or? No? We have

Jake Leach 4:37
to get it approved by the FDA. But it's so a product we plan to launch next year? That's great. Yeah, so it's short term. It's built on the g7 hardware platform, and it has a totally different mobile app that goes with it.

Scott Benner 4:53
Okay. And you think insurance companies are gonna get behind it?

Jake Leach 4:57
You know, ultimately we have to show you But to generate enough evidence in this population of users to show the benefits, I mean, one of the most exciting things that ADA that just happened last month was there was quite a bit of data around use of CGM in this, this population that's not taking insulin, and looking at outcomes that can be generated there. And just like you mentioned, by your brother, it's like, that type of insight that you can get from wearing a CGM, it's, there's no, there's nothing, there's another tool that can give you that. And so that's why I really think this is something that it will be highly engaging for this group, it's something that they'll really find helpful.

Scott Benner 5:39
I would say not just the Insight either. But it provided a motivation for him that he couldn't find us anywhere else. And just he you know, he would call and say, Oh, eight this thing. And I saw what it did to my blood sugar. And that was the first context he had for it. He's like, I'm not gonna eat that anymore. And it of course, it's frustrating for me, because in my head, I don't know how many years ago I was talking to God, it might have been Kevin, and he said, I was wearing a sensor. And there's a couple of foods I've cut out of my diet because of that now, and it's just really valuable. Do you see it as something they would need forever? Or do you think it would be to help them adjust their lifestyle? Or do you think it might be different for different people?

Jake Leach 6:18
You know, I think it's gonna be different for different people. I mean, we did you know, there was a study that we saw, you know, greater than 90% utilization of CGM in this population, we basically looked at a group of about 7200. People, they're using G six, and in that population that was greater than 90%. Were so that was a strong signal to us. It says, Okay, I think people are gonna like this. I, you know, it's the real time feedback. That's the key. Like you mentioned, the motivation factor, it's hard to get motivated when you get an A one see every six months. But when you get that live feedback right away that says, This is how, you know, either that food choice or, you know, activity, stress. did sleep a lot. You can see how that impacts you.

Scott Benner 7:01
Yeah. 100%. Okay. So that you're shooting for for next year? Yes, absolutely. All right. Anything else coming?

Jake Leach 7:10
We got We got lots government, I mean, even just the g7 platform, you know, we just launched it last year, we've got lots of things going into that we've had, if you've noticed, but there's been a pretty steady cadence of app releases, as we've after we launched G seven. Some of that's, you know, small bug fixes, but all bunch of it was pretty significant functionality, you can now verify an account or get lost passwords using a text message code instead of going into the email. So that, you know, much faster we enabled silence all sound saw wasn't in the original g7 is now in there. And then we just released some updates for the widget on iOS to to make that update more frequently and be more functional for users. So it's been been about five releases. Since we launched in, there's a bunch more coming. One thing that we talked about, recently, around the time, VDA is the director watch is finally coming. And so we're very excited to put that into the product. We're shooting for getting it in by the end of this year.

Scott Benner 8:14
Wow. Okay, so you're gonna, you think, Well, let me ask my question a different way. I feel like I've noticed, because I've been around for a number of different releases, that when the device first comes out, it comes out as is. And then there are things I feel like I'm seeing in its functionality, like not just stuff you can see, right, but like, you know, a screen or something like that. But I feel like things like connectivity, even you know how accuracy works. I feel like you guys are tweaking that in the background. Is that happening? And does that happen with all new stuff?

Jake Leach 8:50
It does, we're always looking to improve the product, we get lots of feedback, right? That's one of the number one things we do is listen to feedback from users, about new products, but also about current products. And so you know, working on Bluetooth connectivity, further enhancing that adhesives, you know, the performance is all of those pieces we're always working on in terms of improvement. We did it with G six, right over the number of years that it's been out there, we've continued to improve it. We're gonna keep doing that with G seven for all of our current and future customers.

Scott Benner 9:23
Some people are asking me, Is there a difference in Bluetooth distance for G six for NG seven from the phone to the device?

Jake Leach 9:31
Not so when we did all of our testing? We haven't seen that. But we have had certain users that have run into that. They say, hey, look, my G six worked a little bit stronger than my G seven. So we've been analyzing that and take determining if there's anything more we can do to further enhance the Bluetooth. One thing we do know is that as we looked at the every time a new phone model comes out, we do quite a bit of work on the analyzing the way that the phone connects to our on our device we get, but we get very consistent performance with our receivers and our pump users. But on the mobile app, sometimes there is, you know, phone will come out. And we do make changes, to ensure the product connects better to different phones. And so we're always kind of doing that in the background. And so you know, anybody's having that type of an experience with GS seven, I'd say definitely call us and see, we've got lots of tips and tricks to help ensure that you get good connectivity. But we're also making improvements along the way here.

Scott Benner 10:29
It's confusing for me when people ask because Arden has been using it now, G seven, I don't know for a number of months. And I haven't seen like a disconnection of data more than more, more or less than I saw it before. But she's also 19. And I'm assuming her phone is like, glued to her somehow. So I don't know if that's the case. Because I mean, fair enough. I've seen her walk from one room to another, stay out there and come back. Now what I'll say is that when she does come back into the room, I see it pick it back up much faster than G six, like, that's my, you know, but my, my experience at least. But how much of it has to do with people's phones? Like, I mean, is it newer phones, stronger Bluetooth in some phones and other phones? Is that Is

Jake Leach 11:16
it you know, all each case is different. But what does happen? Sometimes it's just basically how people have their phones configured. I've even had experiences where, you know, I have like rock solid connectivity, and all sudden, I'm starting reading some issues. And I'll cycle the Bluetooth but also cycle the Wi Fi. And what I found is, you know, a lot of our mobile phones, the Wi Fi radio on the Bluetooth radio, often the same silicon the same chipset. And so sometimes, you know, if something gets hung, there's tons of software in our in our phones, right? And so, you know, there's always that, turn it off and turn back on to help connectivity. But I think, you know, it's it's can be unique to, I don't think it's necessarily the full models. It's more around just how phones are set up and how they're used. But, you know, like with any new product, we're going to keep learning. We you know, all of the data that we get back, we analyze for performance of the phones and Bluetooth and sensors and everything else. We do make enhancements based on that feedback.

Scott Benner 12:14
That's great. Okay, can I jump to some questions? Let's do it. Yeah, absolutely. I'm gonna, I'm going to, I'm going to hit some miscellaneous ones first and then go to stuff that's kind of grouped together. Can you help me dispel the myth that a G SIX sensor with the code 9117 is somehow not as good as a sensor with another code on it? I love a CGM just like the next fella. But you also need a really accurate blood glucose meter contour next.com forward slash juicebox. You will love the line of meters from contour Arden is using the Contour Next One, the contour next gen is brand new, they are all incredibly accurate. They featured Second Chance test strips, meaning that if you for some reason don't get the right amount of blood the first time you can go right back, get more and it will not affect the accuracy of the test or ruin the strip in our lovely. So you don't have to be perfect to get a great result. Contour next one.com forward slash juicebox. It is possible, it's incredibly possible that the meters and test strips may cost less in cash than you are paying right now. For a possibly inferior product through your insurance. Isn't that crazy? Go to the link contour next.com forward slash juice box when you get there. Hit the button that says buy now you understand I'm typing into the browser right now the browser that's how the kids talk I say browse by now big orange button you click on it. What it'll show you is that you can get these supplies@walmart.com Amazon Walgreens CVS Pharmacy online, Meijer, Kroger target Rite Aid, these are all online links clicky Clicky. Right there you're buying. Go take a look. Why don't you you can save time and money by buying contour next products from the convenience of your home with my link contour next one.com forward slash juicebox. And if you want to dig down deep into your data, dig down deep into your data. Wow, there's a lot of these. If you want to do that, use the free app that comes with the contour meter, put it on your phone, bing, bang, boom, all of a sudden you're keeping track of things stuff makes more sense. You can make better decisions. Check it out, get started today. Use the link. It's in the show notes of the podcast player that you're looking at right now. Or it's at juicebox podcast.com. And of course you can just type it into a browser. Here's something else you could type into the browser. Us med.com forward slash juice box and A plus rating with the Better Business Bureau. They accept Medicare news nationwide and abroad, broad swath over 800 In fact, big big bunch of private insurers What am I saying your insurance is probably accepted by us med give them a call and find out or go on the link 888-721-1514 or us med.com forward slash juice box. Now Scott What am I gonna get us Matt how about this US med carries everything from insulin pumps, and diabetes testing supplies the latest and CGM. They've got the libre two and the libre three they ever got the Dexcom G six and the Dexcom g7 Omnipod five Omnipod dash t slim baby. They got it over there. In fact, the number one fastest growing tandem distributor nationwide. And how about this? Because we're talking about Dexcom today, how about the number one rated distributor in Dexcom customer satisfaction surveys art and gets her supplies from us Med and you could to get your free benefits check today and see what US med means when they say they want to give you white glove treatment, better service and better care. That's what US med is offering you us med.com forward slash juicebox 8887 to 11514. Hey, I appreciate all you guys listen to the ads, I do my best to make them fun and jazzy and informative. Now let's get back to Jake and find out the answer to my question about the code 91170. No, not the 9117.

That a G SIX sensor with the code 9117 is somehow not as good as a sensor with another code on it.

Jake Leach 16:52
So that is a very common code. It's one of the more common codes towards the center of the distribution. So it's no that just I think it's a more common code. It the other thing I've noticed too, is when people do have issues, you always trying to find something to associate it with whether it's sometimes it's just the difference between new products and an old product. Or maybe it's that they've seen that code frequently. That is one of the more frequent sensor codes because it's in the middle of our calibration distribution.

Scott Benner 17:19
I just wanted somebody besides me to say it. So yeah, sure, I get tired.

Jake Leach 17:24
I'll tell you a funny story. In the old days when we were read in sensors, and before we had the the calibration stuff all figured out. I would just type in 999117 was my normal code that I type in that it would take. So

Scott Benner 17:37
are you guys working on getting approval for in hospital use of a Dexcom? Yeah, actually, we are.

Jake Leach 17:45
Yeah, yeah, the, you know, the current CGM CGM aren't basically approved for use in the hospital. But one of the things that we during COVID was there was an emergency authorization that the FDA gave us to allow us to allow Basal hospitals to use our product, and they could buy it from us. And so we had many hospitals come and ask for the product. They put it on patients, you know, during the time when they had a lot of patients COVID And it helped them, you know, they weren't utilizing as much of the protective gear because they weren't having to go fingerstick the patients often they could put it on someone, they were worried about glucose excursions on that. So they could basically I mean, G six, this was G six timeframe, it was a great product, it's a great product. But you know, for a hospital workflow, they basically had the phones like sitting outside the room, or sometimes they use receivers, some set up their own follow networks, to be able to follow the data. So you know, they were kind of using it, it was a super beneficial tool to help them manage blood sugars during during while people were in the hospital. But what we're doing now is taking the product, taking the substance sensor technology and designing a product that specific ly designed to fit into the workflow in the hospital. Think like connectivity data data display. That's a big part of the product development. The other thing we're doing is we're running clinical studies that show the performance of a subcutaneous sensor in the hospital, basically showing we're seeing really good performance from these studies. But they're a little bit longer because you have to enrolled people who are actually in the hospital. The FDA wants to see the sensor in that intended use environment just because it's such a critical place to make sure your sensors performing well, drugs, your parents is all that stuff that can happen in a hospital is what we're basically doing the study to show that the sensors are great there

Scott Benner 19:36
is the idea of sort of, when you're done with it, a nurse would be able to look up the same place where the blood pressure is and see the blood glucose.

Jake Leach 19:44
That's the That's the vision. It's the you know, glucose, the fifth vital sign so that's really important. You know what, you know, we've worked in the hospital for many years. In the past we had a program that we were focused on more of a intravenous sensor but the thing that I took away from that was that I spent a lot of time in ICUs and in the hospital environment and just saw the the teams there need better tools to manage people's diabetes or blood sugar's even a lot of people have blood sugar issues from stress, stress induced hyperglycemia. That's not they don't even have diabetes, but they're just the tools are not good. The finger stick is so you know, to get actual frequent measurements, you go in and prick and someone's finger every hour was the kind of the protocols that I saw in the ICU. So yeah, a continuous monitor makes perfect sense for that environment.

Scott Benner 20:32
I think anybody who has been through it knows that makes sense. Obviously, the work has to happen with the FDA, but Arden had an exploratory surgery once I explained the loop to them in in the pre op, and the doctor was like here, put that in a bag, leave that under the table. He wanted her algorithm to run during a surgery. And I only heard about it 30 minutes before and he was like, Yeah, we're good with that. So yeah, yeah, hopefully, hopefully

Jake Leach 20:54
that works out. Alright, one less thing to worry about. Yeah, exactly.

Scott Benner 20:58
All right, here's the scary one, you made a new thing. So everybody's worried you're gonna stop supporting the old thing. So Oh, yeah, G six is that

Jake Leach 21:08
it's we're gonna so we're building G six now. And serving all the customers ng six particular AI D users. Quite a few of our customers use automated insulin delivery systems. And those are still working on their G seven integrations. So now we're not taking g six away. We are encouraging people, though, to upgrade to G seven. So you continue to get the latest updates and technology. But we'll support GE six for quite a while until everybody's got got the upgrade. You know, upgrade timing is different for everybody. So we got to work through that. But yeah, G 16 is running great, super happy with the output that we're seeing. So yeah, the other point that I'd like to make too, is that, you know, we are, you know, we've got our g7 we've got this new product for non insulin users. But we're still very focused on innovating in the ad space and in the sensor space, and you know, automated insulin delivery, MDI, multiple daily injection, we're focused on continuing to innovate there, we've been the innovation leaders there, and we are going to remain that. So just because we are launching new products that benefit more people. We're not taking off our current customers.

Scott Benner 22:17
Yeah, I mean, is the company. I mean, you guys, are you sticking fingers out in a lot of directions? Is the company growing? Are you taking more staff on? Or is this something that you're able to do with your, your current workforce?

Jake Leach 22:27
We know we do we, we grow our r&d, Greg, kind of team and all the folks that work on product development that that has grown over time, it's actually been an exciting, fun kind of process of going from developing just one thing right now developing multiple different products that utilize the core CGM technology, but you'll have different embodiments of the of the physical product. And so the team has grown. We continue to, you know, grow revenue and the customer base. We're also kind of we don't grow our expenses at the same rate, as we bring on new customers. So we are we find efficiencies and how we work. But yeah, we make really healthy r&d investment. And that's a really important part of our growth story. And also ensuring that as many people can benefit from CGM, there's still you know, hundreds of millions of people out there that could benefit that don't have access to the product you know, they either can't afford it. They don't have an insurance coverage. It's not available in their country. There's there's all those things that we got to get after.

Scott Benner 23:27
Yeah. Oh, please. The bottom my list here, India, Australia, Japan, those are the three people are like, When can I get g7 is so that's not lost on me at all, that there's stuff to do still, you know, you you hear from people all the time, especially now the world's opened up, people are more aware of what they don't have, and the benefits of it. And I think it's hard to hear about the benefit of something like that and then not be able to put your hands on it. I mean, really frustrating, especially around health, you know, and I made myself laugh and you said you're growing and bringing in new customers with I forget exactly how you said it because when I thought my head was the ads on the podcast are very affordable. I was giving myself credit and my love it. No

Jake Leach 24:12
awareness. You know, awareness for CGM is so much greater now than it was even a year or two ago. But there's still people I meet that have never that have diabetes that ever heard of the CGM. So? Yeah, well, you know, actually, I was at South by Southwest doing a panel, and we actually asked the audience, you know, it's about 2000 people who here knows someone with diabetes, almost every hand raises. Then I asked him, Okay, who knows what a continuous glucose monitor is, and it was a very small fraction less way less than 10% raise their hands. So it's like there is, you know, awareness around technology that can benefit that we started to work

Scott Benner 24:47
on I did a talk in front of 200 couples, adult couples, at least one person in the couple had type one. And I started a, an uproar when I asked about if everyone had glucagon in their home and It was fascinating how few people knew what glucagon was, or understood how dangerous insulin could be. And these were not like newly diagnosed people, for the most part, it was really, like fascinating, kind of stunning, actually. So I think the work is always there to try to get the word out to people. Yeah, a 12 year old boy wants to know if they'll ever be a poke free sensor.

Jake Leach 25:24
Well, I, in the time period that I've been doing this, which is, well, north of 20 years, I've never seen a technology that works non invasively, meaning you don't have any sensor. But what I would say is, if you looked at what, you know, she, she she for, and some of the previous generations started with that manual applicator, which you're familiar with Scott, and now where we are with G seven, with a much smaller sensor, very quick insertion. Most most of the time, you don't even feel it. So that's, that's our focus is on making, you know, sensing technology that is as minimally invasive as possible.

Scott Benner 25:59
I have to tell you that every time I see somebody put up one of those like, I don't know, a picture of a watch, and they say it's going to tell you a glucose, I think that's not gonna work. I mean, I'm not an engineer. But that seems like that's not going to work, not with current technology, right? Like, it's not to say that in the future, we don't figure something out. But at the moment, you what you do is is the best way to do it at this point.

Jake Leach 26:21
Yeah, basically, there hasn't been a technology, you know, there's a lot of light, you know, infrared light, radio frequencies, all kinds of different techniques have been tried to send a signal into the body and then get a signal back that somehow represents glucose, it just, glucose is a particularly challenging molecule to measure. It's not like oxygen, right, where you can put a pulse ox on somebody's finger, and get their oxygen level in their blood, from a light shining through their their skin, it's just It doesn't work that way for glucose. And so having the sensor probe actually in contact with the glucose in your body is one of the ways that we make the sensors as accurate as they are

Scott Benner 26:56
number of times that I've spoken with different people from Dexcom. It's been brought up that the data that you guys are able to see that maybe one day it would help people make decisions about insulin. Is that still something you think about? And are you working on it?

Jake Leach 27:11
Yeah, 100% in a couple of different avenues, right, one of the avenues we're working on is, you know, we use data to tune our automated insulin delivery algorithms. So you know, our first generation we algorithm we launched with tandem and their control IQ, we have another generation algorithm that we're working on, that we talked a little bit about at attd. This this year, and it was really around full automated control. So actually doing boluses and controlling correction Bolus isn't everything, Basal everything with just an algorithm. And so we in that we've used quite a bit of the kind of glucose dynamics that we see in our in our data, to to help develop that algorithm. We also see kind of you think about Basal insulin users, you think about MDI users, there's a lot of things we can do, to provide further insight to help them you know, make make the disease easier to manage. And so they'll they'll be predicted, as we've started to kind of build out our software capabilities, you're seeing g7, we're launching more more frequent releases to the mobile app, you're gonna see some more stuff there in the future on insulin as well.

Scott Benner 28:25
So I have a couple of questions here about in pen and why it's not real time, like it used to be. But my my guess is, it's because Medtronic bought in pen, and they probably would prefer if their users use their sensor. Is that is that the reason? Or what is the reason that happens?

Jake Leach 28:41
No. So so the in pen is, you know, it was purchased by Medtronic, but we still support connectivity to it. And we're working with Medtronic to continue to provide that support and maybe even expand it will see, but no, I think, you know, for my perspective, is that, you know, Medtronic, you know, it's a great pen for people who are using it, and we make a fantastic sensor and why why shouldn't those two go together?

Scott Benner 29:06
That's great. Because it is a it's a really important device. And even people who only use it for a time before they go to a pump, talk about how valuable what they learned is from it, so Okay, well, I'm glad to hear that I just that was me, I was being cynical. I just assumed they were like,

Jake Leach 29:19
well, you know, it's I mean, thinking about you, technically, competitors were working together, but it happens all over and definitely something that we're comfortable with.

Scott Benner 29:27
Okay, cool. g7 questions specific? What's the difference between entering a blood glucose versus calibrating? Like, why would I enter one but not use it as a calibration?

Jake Leach 29:38
Maybe you want it to show up in your data reports, but you don't want to use it as calibration. It was it was I don't know how many users actually use that. But it was definitely something that came back in user feedback where they wanted to be able to track glucose but not with a finger stick meter but not always use it to calibrate okay.

Scott Benner 29:56
I also saw this question enough that I want to ask it of you. I don't have any personal no experience with it. People say they're traveling internationally and having trouble restarting new sensors because it feels like the app is like geo locked or something like that. Is that real? Or is that?

Jake Leach 30:10
Well, there's, well, there is there is basically an important component here. But it can get confusing, so I'll explain it. So yeah, I think users, what happens is, the important thing to know is that every country that you go to, and you set up your phone in that country, they all have different app stores. So if I take my US phone, and I leave it is, you know, it's my account, my my, you know, I'm an Android user. But for the Apple account to when I traveled to the UK, and I looked at the App Store, I'm still looking at the US App Store, even though I'm physically in the UK, I'm looking at the US App Store, I can download a US App. One of the things that happens though, is if you start using a UK phone that UK based, like you picked up a phone at a store, there's something that phone will go to unless you like entering all your us information, it's gonna go to the UK App Store, and download the UK app, which is different functionality than what you have in the US. And so when you basically are traveling, you need to use the phone that you you know, your normal phone and your normal account, and everything should work just fine. Okay, the sensors aren't different. They're not the sensors don't function different. But there is differences in the in, you can't take a US account and say, I'm in I'm in the UK now. And unless you want to call tech support, we can actually correct that on the back end. But the idea there is that, because we have one global app that configures itself to the functionality of each of the countries of which you purchase your sensors and reside. So it's basically locked into your account and where you live normally,

Scott Benner 31:46
but it wouldn't be necessary for like, like when I have to call my credit union and tell them I might want to use my ATM card in another country. I don't have to call.

Jake Leach 31:54
You'll be fine. Yeah, yeah. And it's still the follow network in the share network. It's actually one of the interesting things where we've got a US person and someone owe us wants to follow them. That owe us person has to download the US follow up. The Oh us follow up won't connect to a USF data privacy, all kinds of, you know, back end stuff there.

Scott Benner 32:13
So I don't know how specific you can be about this. But I'll just go in order that it's written here. g7 compatibility with I let any idea how long that will take.

Jake Leach 32:25
That's a really up to beta bionics. You know, I think they're just getting going with the eyelid ng six, which has been super exciting. So Ada saw a couple of people wearing it saw some great time and range numbers from those folks. And so, you know, it's a great product, and we're ready to support them on g7 as fast as they can move, but

Scott Benner 32:46
you know, they're just brand new coming to the market. So I don't actually know the specific timing. Okay, but I would assume there's a window in your head to where g six is going to be gone? Even if it's Yeah, even if it's a couple of years from now. So it's got to be at least in that window. Yeah, you got it. What about on the pod five?

Jake Leach 33:05
So they're, they're working hard. I mean, it's been a while I've seen quite a few, you know, open systems up and running on the development side. So I they haven't made public comments about when, when their timing is, but you know, I know they're working hard on it, and we're ready to support him when it comes out.

Scott Benner 33:20
I'm sorry, I'm gonna just ask for about tandem to say they all about the same answer or because Play Doh

Jake Leach 33:26
no tandems actually tandem said publicly that they're planning to launch a around quarter three of this year. So that's pretty soon, right. We're already in cute quarter three with the July. So you know, in that timeframe there. And, you know, I had to I mean, reasonably, they're not on track.

Scott Benner 33:45
So I have to I have two questions about watches. The first one is, you mentioned, you mentioned the Apple Watch, but we didn't talk about other, like watches the integration for other kinds of wearables to

Jake Leach 33:55
Yeah, so right now we support the same things. We did ng six, with the Android Wear platform. And we also support the iOS, the Apple Watch, when we go, excuse me, we go to direct to watch. The initial foray there is on the Apple Watch. That's what we spent quite a bit of time working through making an Apple watch a full functional receiver, because that's what we have to do to ensure that you get the right alerts, and alarms and all the things that are really important from a safety perspective, that those are always reliable on the watch platform. And that was basically what we've been working on for a number of years with our team and also the team at Apple on the watch OS to ensure that you can reliably get those alerts because that's the you know, if you think about you know CGM it's one of the most important things it does is give you alerts when you're out of range,

Scott Benner 34:47
the first time that it's available for the Apple Watch, I'm going to find out where you are and send you flowers because I'm going to be super excited that we're never going to talk about this. Like

Jake Leach 34:57
there's a there's a large team that's very excited that this is finally coming to fruition. They've been working on it for a long time. Yeah.

Scott Benner 35:04
Somebody told me that the Apple Watch question with XCOM is like asking Elon Musk when the cars are gonna drive themselves. Like, oh, it's happening next month, don't worry.

Jake Leach 35:15
I like I like that analogy. It's one of those like, it's gonna happen as fast as it can, yeah, put a finger on it. But yeah, we're feeling really good about where it is now.

Scott Benner 35:22
Nice. So I'm going to just say, for me, personally, of all the things that I wanted you to do, that didn't happen? I am probably most disappointed, I guess I'll say about there not being Delta. I knew you're gonna say that. That would that would make me a little snippy. I got a little sad when I saw it, wasn't there? Is there a reason it didn't happen? Or is it coming in the future?

Jake Leach 35:48
It's one of the things on the on the priority list. I don't exactly know where it ranks, but I know it's on there. So like I said, with the faster app releases for G seven, you know, we we've already, you know, released more functionality into G seven, within a short period time has been available than we do with G six last year. And so you'll see more and more app releases, we're kind of targeting the teams, we're targeting almost one and one every six weeks. So new functionality each time

Scott Benner 36:14
I saw the app, and I thought I hold no sway at all, I Dexcom.

Jake Leach 36:19
I wouldn't say that. I didn't

Scott Benner 36:21
think I did. But I was I was like, Oh, I definitely don't. People are asking about the graph looking jumpier I don't know another word to use, is there something you can explain about that?

Jake Leach 36:33
So it is that so there's there's less smoothing in g7 than what was ng six. And a lot of that has to do with trying to heighten the performance of the sensor. And its ability to detect glucose, and what kind of changes and turnaround and rapid rates of change and all those things. And so with the performance of the sensor being better than G six, we turn down the filtering. And so you're gonna see a little bit more jitter there's no reason to think that it's less, it's actually, you know, we know G seven, we studied it, it's more accurate than G six. But the perception of the I've had multiple people ask me, Hey, my lines, kind of, you know, it's not as smooth as it was on G six, is that a problem? And it's like, no, no, it's actually measuring glucose quite accurately.

Scott Benner 37:16
Okay. Speaking of accuracy, before I go back to my next question, is there are we at the ceiling? Or is there more? Do you there's more to go? There's more to go?

Jake Leach 37:25
There's more to go? Yeah, I mean, I want to continue to tackle, you know, sensors that, you know, every so often you'll get a wonky sensor, right. And it there's a lot that cause can cause different things to happen. But my goal is every sensor works 100% of time, I think there's still improvements can be made on the first day of where, right, sometimes first days is more variable than the rest of the where, and also on those latter days, you know, as we continue to extend the life of the sensor, you know, ensuring that you've got good performance all the way to that last day is there. There's plenty more to innovate there. From both the sensor technology as well as the algorithm that powers it.

Scott Benner 38:06
Arden got up yesterday morning. It was my birthday yesterday. So we had a whole big day planned. My son was home and we were all doing stuff together, right? And she got up and she said, hey, my Dexcom is going to expire in like eight or nine hours. And I was like, oh, put a new one on now. And you know, like, so she's just home from college. She's like, is this the thing you were trying to tell me in college? I'm like, yeah, like, I'm like, put the new one on now. And then she wore it for, I don't know, five, six hours. And then when there was a lull, I said, Okay, now, you know, disconnect the other one and put the new one on. And I'll tell you, man, it just popped back on it read exactly where the other one was. And I was like, This is amazing. Like, I love it. Everyone should be trying to accomplish that if they can. Really fantastic. More on g7. Is there a right and wrong way to do the insertion? And people want to know, why is it only cleared for arms?

Jake Leach 38:57
Okay, yeah, so two great questions. You know, I know that there's no right or wrong way to insert it, you basically just have to push it down hard enough so that the little safety guard is you know, ensures is pressed up against your skin and the press the button you know, when I've worked way where sensors, I wear them farther on the back of my arm than on the side because you know on the side sometimes you'd run into things, you see belts, whatever so I like kind of like it on the back. I find it's more protective back there. And then from arm in wherever it is abdomen where basically when we did this study that we saw the best performance in the arm and so that's what we got cleared by the FDA but if you look outside the US our labeling has both arm and abdomen in the US based on the way the study went in the way we wanted to get the product approved through the regulatory course and also the performance we just we settled on let's let's go with arm

Scott Benner 39:48
I'm going to save 30 seconds at the end of this to tell you a funny story that I don't think I can record but I'm gonna make myself a note. It's about something Arden said that cracked me up.

Jake Leach 39:56
I can't wait to hear. Happy birthday by the way. Oh, thank

Scott Benner 40:00
you. I'm 52. So I'm feeling pretty old. But my hairs stand dark. So I feel like I'm ahead of something. Also,

Jake Leach 40:08
you're ahead of me for sure. Check that out. Check your handsome man. And

Scott Benner 40:11
there's no reason for you to say that. I, I found that we go via about four months ago, so my life is getting much better. It's crazy. I swear, I just got nothing to do with our conversation, but 25 pounds in four months.

Jake Leach 40:25
Congratulations. But it's it's a fantastic therapy. Yeah, it

Scott Benner 40:29
really is. And I'm starting to see people use it with type one and watching their insulin resistance, or not just resistance maybe, but their insulin needs are dropping, which is really fantastic. I really feel like you're gonna see the the semaglutide maybe get okayed for type ones in the next couple of years. Anyway, I'm sorry, I got off track there. Okay, here's some half like, conspiracy theory stuff. Did you start using but I don't even know what I'm saying here. Did you start using less dielectric grease on the g7 than you did on the G six? Because I'm seeing something wonky when I take a shower.

Jake Leach 41:07
Oh, interesting. No, the, that's interesting. That's a person who's into the details on the on the ceiling system. The ceiling system for G seven is totally different than G six. So it doesn't use that those same components. So it you know, G seven is, you know, from a waterproof perspective, you know, meets the same standards G six very waterproof. So when taking a shower, if they're seeing something wonky, the only thing I've seen is like really hot temperatures sometimes can make a little bobble in the signal, but it depends on what they're seeing. I don't know what what they're experiencing. But know it the waterproofness is great. You can swim with it and go underwater, reconstruct koozie Yeah, all good.

Scott Benner 41:49
I mean, Arden's blood sugar jumps naturally, when she gets in the shower, and some people's fall, I didn't know if maybe they're just, I don't know, seeing that I couldn't tell. But I was like, well, some engineer, that anyway, I thought I would could help quell your internet rumors. So there was one for that. I know this is never going to end, but you guys made a change to the adhesive. I think it works terrific. I'm not seeing any trouble with art. And she is wearing the little over patch that she sent. If I can give a personal bit of feedback, it would be nice if they were a little stiffer, because I end up sticking them to themselves a lot. I agree. I totally agree. IVs, big X square fingers. And my hands are huge and are just like leave it alone. Like you're gonna, it's stuck to itself. And I'm like, I know, I'm sorry. But anyway, that's that. Some people are saying, could the patch be larger that comes with a Dexcom? Is that something you're evaluating? Are you happy with where it is?

Jake Leach 42:42
No, no, we're evaluating I mean, we're always looking at new patch technologies. And there's quite a bit going on in that space with the different patch manufacturers. And so now we're always looking at making it you're better with the balance of ensuring it doesn't cause skin reactions, right? We we made a number of enhancements to G six over time that reduced some people have sensitivities to medical grade adhesive. And so we made a bunch of changes over time to G six to improve that those changes are you know, that learning went into G seven. And so but now we're still we're always looking at how do you improve it, that it's I think it's gonna be less about the size of the patch and more about this specific materials that are in there. But yeah, you'll you'll see enhancements come out over time on G seven for the patch.

Scott Benner 43:29
Art was it removed? The countdown on the on the caregivers side? But that's not different. Is it? Because I don't

Jake Leach 43:38
know. I don't think so. I don't I don't even on the follow side.

Scott Benner 43:42
Yeah. Let's see. Is there any plans to add a time since updated? clock on the g7? Mobile App? Okay, so

Jake Leach 43:49
Oh, I don't know. Yeah, no, I get it to get because we have that on the follow up, right? I don't think so. But I can I can double check and look,

Scott Benner 43:59
in that same vein, a number of people asked if why they can't ping the sensor. Why do they have to wait the full five minutes if they I think it's a lot of parents who are like, stand here for two minutes until I see what this does. And then you can like go away? Is there? I mean,

Jake Leach 44:16
yeah, the current design community, it only communicates every five minutes. So depending on where you catch it, right, it could be as short as a minute. But it's basically five minutes in between the communication cycles. But that's another thing that we're looking at in terms of for reliability, and ensuring you get the connection back faster. Enhance hands there.

Scott Benner 44:38
A lot of people are asking for a lot of the management stuff that you can see in your your app if you're the user, but on the on the follow side, time to expiration like things that really helped with management. And I know we've talked about the app a number of times it feels like you're working towards it, but we are

Jake Leach 44:56
you know, we spent a lot of effort the sovereignty He was super focused on getting g7 out and getting it internationalized across all these different countries. And we're still continuing to launch new countries around the globe with g7. But we also, we built a lot of software capacity to do that. And we also do one, the Dexcom, one product that's available outside the US same thing, added a bunch more software resources to drive software development forward. And the teams do kind of inter interchange, we don't use, it's not like there's a dedicated g7 team that's totally separate from Dexcom. One, there's a lot of common software. And so follow, I'm excited to bring follow into that fold and start making more enhancements to follow. Because it's, you know, it's time we do that we haven't we've ensured it stayed compatible and made some small changes, but it's time to make some of those changes that users are asking for because it follows a really important part of the system. And we need to put more attention into it. Yeah.

Scott Benner 45:53
I'm glad to hear you say that. I have a question I hope doesn't seem difficult, but I feel like I've known you for long enough. When do you hit enough scale that you can bring the price down? For for cash options? Like did you know what I mean? Like the idea in business like we can sell a few expensive things? Or a lot of inexpensive things? Like is there a tipping point where that can happen? So that so that instead of you and I having this conversation, and a lot of nice, middle class people hearing it like when can everybody use one of these that needs it?

Jake Leach 46:26
Yeah, I think so. You know, the price of CGM has come down quite a bit over the over the period of time that it's been available. The average selling price of CGM is quite a bit less than it was even four years ago. But there's still more room to go and I there, there is a time period where we're getting to a point where it's, it's very affordable for people to access it. Now, different products, maybe a different price points based on functionality. You know, you think about it from the perspective of like an automated some delivery system, and all of the functionality that's required there, that may be a different price point than someone you know, who doesn't use automated insulin, they're not using insulin, they don't have the alerts alarms, not using ShareFile. So I mean, there's there's different feature sets for users. But you know, I think we're it's one of our focuses is always to innovate on the cost side of the product. G seven was a big step for us, in terms of, you know, continuing to reduce the cost, it takes us to manufacture now we're not there, because your G seven volumes aren't, you know, completely, it's not the whole base hasn't shifted over and all the new customers that are coming in, but as the g7, volume ramps, and we just, you know, our factory in Malaysia just just started up at the beginning of the month of June. And so we're really excited to have that factory now running. And that's a big part of our cost to serve and being able to reduce the overall cost of the product.

Scott Benner 47:50
Is it possible that the business on the non insulin using type two side could help to buoy the other side at some point,

Jake Leach 47:57
volume volume, in all cases helps, right. And there are a lot of common components to the systems. And so you know what the nice thing about having, you know, kind of the product built around a particular hardware platform like G seven is that as scale continues to grow, and your volumes grow, you can take advantage of that. And so absolutely the more volumes that we grow in all the different patient segments, the better. Okay,

Scott Benner 48:19
here's my last question. And it's very Nishi. I think four people are going to understand it when I say it. Is John Welsh, still with the company? And can I interview him again, because people loved him.

Jake Leach 48:29
John Wells has tested absolutely still with the company. He actually is one of our main medical writers and has published a lot of recent data. Actually, that's some of the data I was talking about. With the type two users that aren't on insulin, some of the outcome data we saw there. That was all, John was one of the authors. So yeah, he still is

Scott Benner 48:48
he's maybe without a doubt in the top five. I don't know if you call it gi here. Dorcy diabetes, people who have been on people love the I mean, we talked at length about standard deviation and things that I just think most people might not even understand or care about. And man, people loved it. It was. So I'm glad to hear that I'm gonna reach back out and get them on the show again. Which is on the lock screen that's still there for g7

Jake Leach 49:13
Yeah, I believe so. Yeah, we actually just yeah, we just made a bunch of updates for the widget in the last version. So if if it wasn't that I'm assuming it's there now. Okay, great. Jake,

Scott Benner 49:23
I appreciate this very much. And I am cutting it two minutes short, because I'm going to tell you this very silly story. So I'm gonna say goodbye to you. I'm gonna hit stop. So you know, you're not being recorded anymore. I appreciate you being here.

Jake Leach 49:31
Awesome. Pleasure.

Scott Benner 49:37
A huge thanks to Jake leech and Dexcom for coming on the show and answering all of your questions. And thanks to you guys, of course, for sending in those questions. Check out us med at us med.com forward slash juicebox or call 888721151 for better service and better care. That's what you're gonna get hate us med. The podcast was is also sponsored today by the contour next gen blood glucose meter. And I'd like to remind you to head over to contour next one.com forward slash juice box to learn more, and maybe buy yourself one. If you're looking for community around diabetes, please check out the private Facebook group Juicebox Podcast type one diabetes, if you have type one, type two pre diabetes, gestational, everyone's welcome. It's a private group with over 40,000 members. There's a conversation happening there right now that you would be interested in. Or let me say this, maybe you'd have something to add to that conversation. Maybe you just want to work doesn't matter to us. Come on over. Everyone's welcome. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.