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Innovating Healthcare with CGM: Insights from Dexcom · Becker’s Healthcare Digital Health + Health IT

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  Hello, everyone, and thank you for tuning to
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  the Becker's Health Care podcast. I'm Molly Gamble
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  with Becker's and thrilled today to be joined
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  by Scott Odgers, senior director of key accounts
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  and health system innovation with Dexcom.
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  Scott, thank you so much for joining me
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  today. Hi, Molly. Thank you for having me.
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  Well, we've got a lot to dig into,
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  Scott. 1st, can you just introduce yourself a
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  bit more, provide an overview of your work
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  with Dexcom? What do you do? Absolutely. Thank
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  you for asking. So I've been with Dexcom
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  nearly 11 years. And so when I started
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  with Dexcom, that was very much in the
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  beginning of CGM development. In fact, it wasn't
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  even approved for pediatric use yet.
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  So so that's that's where I work. And
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  then I've,
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  I started there working more in the payer
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  insurance side because there really wasn't much reimbursement
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  for it.
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  So we worked through commercial insurers, through Medicaid
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  and Medicare, and now all of the above
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  cover it. And there's even cash options. So
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  it has really, really, expanded in terms of
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  the access for CGM, as well as the
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  technology itself has has evolved quite a bit
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  over time. Well, more evolution we're gonna touch
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  on in just a moment. Yes. CGM and
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  listeners, continuous glucose monitoring.
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  For those, Scott, who might be less familiar
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  with CGM,
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  can you give an overview of it? And
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  then also
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  talk a little bit, if you will, about
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  how it works, these devices, and then who
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  benefits from them? Yeah. So it's it's I'm
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  from Wisconsin.
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  And ironically, it was invented in Wisconsin at
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  the University of Wisconsin
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  in 1983.
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  So kind of a neat connection, and that's
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  right where I work.
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  But fast forward a little, and Dexcom was
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  founded in 1999,
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  and has been the leader in CGM advancement
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  ever since.
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  In terms of how continuous glucose monitoring technology
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  works, there's a sensor that resides just under
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  the skin in the interstitial fluid.
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  So think of, like, a fish line and
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  maybe an eighth of an inch long. That's
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  that's what it looks like that resides under
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  the skin. And then there's an algorithm that
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  converts the data into a glucose value that
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  is displayed on a smartphone or a receiver.
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  So there's both options.
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  And it shows the current glucose level as
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  well as where it is going and how
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  fast.
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  And I would be remissed recently we got
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  approved for smartwatches. So now you can see
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  it on like Apple Watch, things like that
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  too. And so a little bit more about
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  the technology though, but so what it does
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  show is your current glucose level, but it
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  also shows where it's going. So I think
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  of GPS. So not only do you see
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  where you are presently, you get to see
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  where you're going, what turns, and what's happening
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  if there's construction and things you have to
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  account for. It monitors glucose in much a
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  similar way in terms of
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  whether you're stressed, whether you just ate, exercise.
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  It shows where you are currently, but then
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  there's an arrow that is either up, down,
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  straight across, or somewhere in between, and that
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  tells you how fast you're going in a
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  certain direction. So for people that, especially people
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  that are on insulin, that's incredibly important so
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  that they can manage their diabetes in a
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  healthy way.
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  Who benefits? Is it primarily children? Is it
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  adults? Is there one patient population that has
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  the best or, like, the most use of
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  this device? Yeah. It's evolved. So yes. Another
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  great question. So it was first developed for
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  people with type 1 diabetes taking insulin.
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  And while insulin is one of the most
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  beneficial drugs that there that exist today, it
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  can also be life or death situation in
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  terms of how it's used, how it's dosed
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  for people that are dependent on it.
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  And this is where CGM has made a
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  profound difference in helping people at risk of
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  hypoglycemia,
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  which is low blood sugar, or hyperglycemia,
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  which is high blood sugar, and everywhere in
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  between. It's really a guide for how to
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  manage their insulin, their food intake,
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  exercise, stress, illness,
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  and overall lifestyle. It's it really does relate
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  to every aspect of their life and how
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  it affects their blood glucose.
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  I guess what impresses me from what you
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  shared so far, Scott, is that you mentioned
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  this was developed in the 19 seventies at
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  University of Wisconsin. This was almost like a
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  wearable before I,
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  my concept of wearables was a thing. Right?
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  Is that accurate? So it wasn't a wearable
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  then. In 1983, the technology
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  was developed where you could monitor it. And
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  I believe it was, actually had to be
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  inserted under the skin and left there. But
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  since then, it's now it's like a little
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  patch that resides on the skin with that
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  little interstitial
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  little filament, if you will, and that's where
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  it's evolved to. So, yeah, initially and it
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  was kinda clunky. It wasn't very accurate.
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  And that's something else that Dexcom has really
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  pushed the boundaries for is to increase the
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  accuracy.
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  So now it applies and that's that was
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  critical for the pediatric indication, which happened shortly
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  after I joined Dexcom. So it used to
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  be 25 and older.
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  And we got the first indication for pediatrics,
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  and it went down to 2 years old.
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  So that was tremendous for those kiddos out
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  there living with diabetes that and then think
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  about the parents in schools and everywhere else
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  in terms of now they had access to
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  this technology in a reliable and accurate way.
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  So that was a tremendous breakthrough.
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  But it really has evolved beyond people, with
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  just type 1 diabetes, but to people with
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  type 2 diabetes that may or may not
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  be on rapid acting insulin, but, basal insulin
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  and really any drug or treatment that would
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  cause hypoglycemia.
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  So it's it's it's really Medicare covers for
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  anyone on basal insulin
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  or any type of insulin, whether you're type
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  1 or type 2 have type 1 or
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  type 2 by diabetes.
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  Can you talk about that with the evolution
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  in mind, listeners? Can you talk about, Scott,
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  how these CGM devices are meeting patients'
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  expectations now for just more streamlined,
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  more digitally attuned,
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  and health care experiences and also information? Yeah.
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  Excited to answer that question because that's where
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  the innovation is really cool to see what's
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  happening. But,
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  in CGM's first iteration, it was required to
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  use a receiver.
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  And going back to g 5 mobile, which
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  would have been around 2016, 2017,
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  that was the first CGM that could go
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  to a smartphone,
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  which was
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  which really a game changer for people. So
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  they didn't have to look like this medical
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  device and now could look like a consumer
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  product.
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  So people didn't have to feel self conscious
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  because they're looking at their phone all the
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  time anyway, but now they can see their
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  glucose level there. So that that was a
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  big, change.
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  And then we we, are very active in
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  our partnerships. So we look at data integration.
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  We do have public APIs where we have
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  100 of partners that
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  ingest our data and then use it whether
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  it's a chronic condition management program, maybe a
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  post acute care program, diabetes management,
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  program,
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  and a number of others. But they take
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  our data and use it towards all kinds
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  of means. So we have partnered with automatic
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  insulin delivery systems, like, think of a insulin
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  pump or a, like, a patch pump or
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  smart pens, that have the ability to dose
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  based on the Bluetooth connectivity with our product.
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  And then we're even doing it with, lifestyle,
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  like, apps and things like that. So people
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  that are are using it for, you know,
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  reminders of different sorts, but how it works
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  into their life. So, again, hundreds of apps
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  that can ingest our data,
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  and then, again, provide that person or that
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  patient data in a way that's meaningful and
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  helpful to them.
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  That's terrific. And I know too in March
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  this year, so not that long ago from
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  when you and I are sitting down now,
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  Scott, the FDA approved
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  the first over the counter CGM device that
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  does not require a prescription.
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  That was big news at the time. I
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  wanted to touch on that. Can you expand
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  on how you see that
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  move helping to enable greater access for patients?
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  Yes. That actually at the conference here has
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  been one of the key questions we've been
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  getting, like, day in and day out. So
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  it's really exciting. Yes. The name of the
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  product is Stello, s t e l o,
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  and it's the first glucose biosensor
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  approved back in March and became available to
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  consumers online,
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  through consumer purchase this past August. And it
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  is available without a prescription because it is
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  intended for anyone 18 and older not on
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  insulin or at risk of hypoglycemia.
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  So think anyone with type 2 diabetes not
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  on insulin or hypoglycemic
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  risk,
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  or people newly diagnosed with type 2 diabetes,
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  you know, that may be just on lifestyle
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  management protocols.
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  People with prediabetes
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  and even health and wellness, is everyone is
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  becoming more aware of glucose, carb counting, and
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  all those things, you know, that you you
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  read about on every different health app or
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  news article around, glucose and diabetes, that we
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  see out in the public.
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  Scott, we've really had a vibrant discussion about
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  CGM. Is there anything that you didn't share
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  or I didn't ask you that we'd be
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  remiss to not touch on for our listeners?
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  Yes. Thank you for asking. A few things.
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  So one is, especially thinking about health systems
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  that may be involved with Becker's.
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  Recently, NCQA
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  when I say recently, January 1st, they adopted
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  GMI, which is glucose management
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  indicator,
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  which can be used instead of an a
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  one c for for basically how people are
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  doing with managing their diabetes. And it requires
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  CGM to be worn with that. So that
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  is significant because we're working with a number
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  of health systems in terms of not only
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  explaining what that means,
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  and how they can use it, but also
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  how they can take that data in across
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  for not just an individual patient, but for
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  population health management.
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  So this can raise the quality scores for
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  any health system that's looking at doing this
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  because
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  a one c, while it's a 3 month
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  average, you don't know what's happening. Over 3
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  months, your blood glucose can go all over
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  the place. The GMI indicator is a much
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  tighter, much closer measurement that gives a a
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  provider and then a health system much better
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  access to information, again, across an individual patient
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  and even across populations.
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  Couple other things I think are are I
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  really wanna make sure I mention, and and
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  that is that, I mentioned Dexcom's first. So
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  just I'll mention a couple of those and
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  how Dexcom is trailblazing in the CGM,
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  category.
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  I mentioned the 1st pediatric indication. We're also
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  the 1st CGM indicated for pregnancy.
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  The 1st direct to phone as we had
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  talked about, 1st direct to watch, 1st to
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  gain reimbursement from Medicare.
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  And then we also had the 1st share
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  follow, which is one I forgot to mention
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  earlier. And that's where an individual living with
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  IVs or using a Dexcom can share their
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  data with a loved one, a friend, a
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  teacher,
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  up to 10 people that they want to
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  see their data. And we've heard literally stories,
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  say, a college student maybe,
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  went low some night. A parent can see
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  that, call them, or call their roommate and
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  have them woke up to see if there's
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  something wrong with that person, or even call
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  91 if needed from, you know, from distance.
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  So it's really neat to see where that's
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  gone. And I'd be remiss, of course, if
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  I didn't mention again, STELLO, the first OTC
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  glucose biosensor. So those are just naming a
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  few. But what's really exciting is that I
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  know there's more to come, just in a
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  in a short, short amount of time coming
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  up here.
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  Scott, I wanna thank you for your time
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  and your insights today. This has been a
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  really interesting discussion about CGM, where it's been,
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  and where it's going. If listeners wanna learn
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  more, where where should they find you? No.
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  Yes. Thank you for asking, Molly.
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  So a couple different ways they can reach
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  out to us. Probably the main way is
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  key accounts, so key
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  accounts at dexcom.com.
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  That will reach me and my team. And
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  then what we do is evaluate what the
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  requests are. And some some some areas health
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  systems may wanna reach out to us for
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  is we have some programs. For example, we
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  have an adult hospital discharge program where we
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  provide both education and actual Dexcom product that
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  they can then provide to their patients that
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  are being discharged. Maybe they're newly diagnosed or
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  had a hypoglycemic
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  event.
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  We have a pediatric discharge program, so thinking
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  of pediatric hospitals.
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  We have well developed education and resources for
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  them, so they can help, put patients on
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  CGM that need it. And then 3rd is
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  a little bit broader category, but we can
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  help with data integration, whether that's direct into
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  an EHR integration
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  or it's even like a chronic condition management
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  program or post acute care management program. And,
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  again, they can reach us at key accounts
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  at dexcom.com,
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  and we can help them with any kind
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  of requests or needs that they might have.
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  Thank you, Scott. And my thanks too to
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  Dexcom for sponsoring today's content. To our listeners,
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  thank you for joining us today, and please
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  be sure to check out other Becker's podcasts.
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  Have a wonderful rest of your day.