Continuous glucose monitoring company Dexcom has just launched a whole bunch of new features for its G6 mobile app, allowing more people to follow a user's data stream and introducing the long-awaited "Hey Siri, What's My Glucose?" audio feature. Plus, the Dexcom G6 is now OK'd for Canada and will likely be offered for Medicare beneficiaries in the U.S. before long. Exciting times!

Yet, as Dexcom marks its 20th birthday (since its founding in 1999), the California company is at a critical crossroads preparing for future growth and international expansion, not only for its current G6 model but its next-gen G7 technology expected to launch in late 2020. This has led to a corporate restructuring that impacts 13% of its employees, who will either be cut or moved around this year. That's 350 positions in customer service, sales, tech support and administrative functions being shifted or outsourced to third-party outfits or overseas -- all in the name of enabling expanded manufacturing and a better position to handle its CGM business going forward.

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Many loyal Dexcom users, who see the device as life-changing, are frustrated at the moment by order delays and long phone queue wait times. Some are also expressing concern over a Phillipines-based call center, which brings potential language barriers and reps not familiar enough with T1D or CGM.

To learn more, we spoke recently with Dexcom's CEO Kevin Sayer and Chief Technology Officer Jake Leach, who tell us that it's an exciting but transitional time at Dexcom as they prepare for the future and work to improve their services. But before we dig into that, let's run through the new app features just announced on Feb. 28.

 

New G6 Mobile App Features

The latest Dexcom G6 app updates hit the iOS store this past week:

  • “Hey Siri, what’s my glucose?” – You can now ask Siri to read Dexcom G6 glucose readings aloud and display graphs directly on the lock screen. Dexcom says this virtual assistant integration is a first-of-its-kind innovation in CGM, and that's true for the commercially-approved tech out there (though the #WeAreNotWaiting do-it-yourselfers have had this ability already). Dexcom says this is now possible thanks to the iOS 12 launched in Fall 2018. Through the Siri Extension, we're told you can actually turn this feature on and personalize it to however you want to phrase the question: "Siri, what's my number?," "Siri, where's my level at?" or "Siri, what's my happiness number?" and so on.
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  • More Followers – With an expanded Dexcom SHARE function, you can now share glucose readings with up to 10 people. This is a big update, as it's the first time Dexcom has expanded the number of followers beyond 5 since it first launched this data-sharing capability. This has been a long-awaited update, especially for pediatric patients and others who rely heavily on their family and support system (school nurses, teachers, grandparents, diabetes camp counselors, healthcare professionals, etc). We also hear Dexcom's exploring unlimited followers, too, but there's no ETA on that and right now it's being studied in some diabetes camps in the US.
  • 24-hour Sensor Expiration Reminder – The app now offers an automatic 24-hour reminder before it’s time to replace a sensor, in addition to the existing 2-hour and 6-hour reminders.
  • CLARITY App Right at Your Fingertips – You can now launch the Dexcom CLARITY app directly from the Dexcom G6 app for more retrospective glucose reports, rather than having to exit the G6 app and go into the separate CLARITY app.
  • Extra Integration – They've also added a feature allowing Google Fit to display Dexcom G6 data on a three-hour delay (this lag is a regulatory hurdle being discussed with FDA).
  • Apple Watch Feature – Users can also add an icon to check their glucose level when customizing the face of their Apple Watch Series 4. Unfortunately, Dexcom doesn't yet allow for direct-to-watch functionality; you still need the smartphone as the middleman between the CGM and Apple Watch. Dexcom says it expects to launch that functionality by year's end, but it will initially require users to get a new G6 transmitter because of the differences in Bluetooth. Following that launch, the company will of course begin shipping transmitters already fitted for the integration.
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At the moment, all these new G6 app features are specific to iOS in the Apple store, but Android is "coming soon," Dexcom tells us. The reason for the delay is that Apple apps are universal to the iPhone platform, while Android requires different developments and regulatory review for each phone model -- meaning it takes more time, and not all Android phones types will be compatible. While it's frustrating for Android users, that's just a limitation of the technosphere at this point.

 

Dexcom's Hot Technology Pipeline

Beyond the G6 app updates, we have a lot to be excited from Dexcom. At the recent Advanced Technologies and Treatments for Diabetes (ATTD) conference in Berlin, the company previewed more new mobile app features, its next-gen G7 tech anticipated in late 2020, and more.

Tandem Control-IQ Hybrid Closed Loop: Dexcom partner Tandem Diabetes Care launched its Basal-IQ product in mid-2018, which automatically suspends basal insulin when a Low glucose is predicted, using the G6-integrated t:slim X2 device. While that's exciting all on its own, Tandem plans to launch its next version in late 2019 -- the Control-IQ, which will add auto insulin-dosing for High glucose levels, too, making it just the second-ever "hybrid closed loop" system on the market but offering more than the current Medtronic Minimed 670G available now.

Updated, Lower-cost Transmitter: It's already FDA-approved and is expected by the end of 2019, the new transmitter will have the same G6 form factor and wear-time, but with improved electronics, and will include some other yet-to-be-announced features. Specifically and most notably, this will include the capability to actually communicate directly with Apple Watch so a smartphone isn't needed as a go-between. CEO Sayer says he expects this will come in at a lower cost than the existing G6 transmitter (currently $237 cash price from Dexcom).

The G6 Pro:FDA cleared in late 2018, the Pro Q is Dexcom's "professional CGM" that allows healthcare professionals to monitor their patient's glucose and analyze trends for them. This includes a fully-disposable G6 transmitter and factory-calibrated 10-day sensor, and has the ability to use either "blinded" (where only the healthcare professional can see the data) or with real-time, patient-visible data monitoring through the G6 mobile app. This is a big advance over the G4 professional version that's been available, and it seems especially important for T2s who may want to try CGM or get a quick medical assessment in clinic only.

Smart Insulin Pens: At ATTD, CTO Leach announced officially for the first time that Dexcom is ready to allow "smart insulin pens" send data directly to the G6 app and onto its CLARITY platform. This is a huge benefit for those on Multiple Daily Injections (MDI) rather than insulin pumps. On the pen front, Dexcom is partnered with both Eli Lilly and Novo Nordisk, and we hope to see that integration available in the coming year. 

G7 (Formerly Known as Verily Project): Remember that Dexcom partnered with Verily, formerly known as Google Life Sciences, back in 2015 to develop a low-cost, miniaturized CGM system? That work is ongoing, and Leach now says the 2nd gen product will likely be ready by late 2020 with a limited launch then and a broader rollout in 2021.

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More Follow App Features: Dexcom's also planning to update its Follow app before long, adding improved graphics and a "Night" button to dim the screen in the dark, and allowing up to 10 followers directly from the Follow app (as opposed to going through the G6 app).

Go, You! Also shown on a slide at ATTD was Dexcom's plan to soon launch other new features on its mobile app and CLARITY, such as an "On the Bright Side" notification -- an automated message generated when the app identifies days and patterns where CGM users achieve their glucose goals and encourages them. This type of positive reinforcement has been discussed for several years now, so it's nice to see it becoming reality.

TypeZero Advances: We also hear from Dexcom execs that thanks to its acquisition of TypeZero Technologies in 2018, the company will be weaving in more features using those algorithms. That includes an On-Demand Sleep function and an Exercise Feature that allows for insulin dosing; as well as a CGM-based bolus calculator. There's no exact timing on that, though studies are underway.

Longer Wear-Time: A 14-day wear sensor remains a goal, but there's no ETA yet. Dexcom's Sayer says they'll be conducting studies on that this year, while carefully working to comply with new regulatory requirements on the "iCGM" designation for interoperability, which the FDA created in 2018 with the approval of Dexcom's G6 model. We'll see if this materializes in a future iteration of G6 or if it'll be introduced with the G7.

Exciting stuff, no?

And yet, this brings us to the issue of Dexcom's recent announcement, showing that the company needed to rethink how it operates.

 

Dexcom Company Restructuring

In its earnings call on Feb. 21, Dexcom announced it had a record-breaking year, pulling in $1 billion in revenue for the first time. According to Sayer, “Our growth in 2018 was far beyond anything we ever thought we’d achieve when we started the year, so it’s really turned out to be a remarkable year of accomplishment for us.”

Reflecting on the growing pains from their G5 launch and evolving Medicare coverage, leading up to the G6 approval that came much sooner than Dexcom expected in 2018, Sayer says the company has learned lessons that have led to the need to restructure. Details of that were announced during the recent earnings call and confirmed in an SEC filing.

Sayers says that frankly, the company must be better prepared for its next launch than it was for G6. After receiving an FDA approval on the G6 in just three months, the company decided to launch directly in June 2018 rather than waiting for September, when it could have first built up inventory and upscaled its manufacturing and customer support infrastructure.

This is also what plays into Medicare coverage and offering of the latest G6, which Dexcom currently says is planned to begin being offered to Medicare beneficiaries in the second half of this year (later than first announced last Fall). Without the inventory to meet the manufacturing (along with that added service demand), Dexcom's G6 growth for Medicare and now-approved Canada is taking longer to build up that infrastructure.

“We’re not going to go through these type of issues again, we’re going to plan more. That means getting our factory set up, including doubling our G6 manufacturing capabilities before the end of this year. On top of that, we’re building the additional lines and infrastructure for the next product," Sayer says.

He points out how the company didn't use its Phoenix-area manufacturing facility as was first planned when announced in 2016. Instead, they initially leased a location in Mesa, AZ, for tech manufacturing and then later in 2017 added on hundreds of jobs and turned it into a call center when that need arose.

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Photo Source: Phoenix Business Journal

"We opportunistically solved problems with people and assets that we had, rather than stepping back and determining what we actually needed and what it would look like for the best customer experience," Sayer said. "The message we need to convey better now is that we think we can more efficiently and better take care of our customers by restructuring the way we do things. Some of our functions will be outsourced to third-party entities, some will move to our Dexcom-Phillipines global business services in Manila, and some will be consolidated at Dexcom-San Diego from what was based in Arizona."

While there will be job losses in both Arizona and San Diego this year, Sayer says that after the restructuring there will be more employees in those locations than previously -- those employees will just be doing different things.

Sayer told us no one at Dexcom has been fired or "walked out the door," and that those notified of layoffs have (by federal law) at least 60 days left at the company. Many will be asked to stay longer, and he says more people will be manning the phones for the next 5-6 months, to make sure the transition goes as smoothly as possible.

"I look out at the tower we have in Manila and see the signs and names of all our competitors displayed. This is not unique to Dexcom, as there are literally 1.3 million people in Manila who work at these call centers for U.S.-based companies," he said. "This is a market where we see (all the resources) out our window already. We really need to focus and give our customers the best we can."

Sayer added that it comes down to "better results than what we can do and how we’re doing it now."

"It’s all about taking care of our CGM customers and the company. I think that outcome, a year from now, will be positive. Sure, there will be hiccups; there always are and we see them now without doing this. But it’s not a decision we took lightly. We believe it’s what is best for our business and customers."

Here at the 'Mine, we're of course sad to see job losses, but the fact is that Dexcom is all grown up now. Their customer base is expanding hugely, and they need to remake themselves to properly handle that. So while delayed orders and long wait times are annoying at the moment, no doubt those issues will be fixed soon.

Meanwhile, we remain excited about how Dexcom is changing the diabetes technology landscape for the better.