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Making CGM Systems Available To Hospitals: What You Need To Know

Diabetes Connections with Stacey Simms Type 1 Diabetes

Release Date: 04/16/2020

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More Episodes

This week.. making CGM available to hospitals.. something new because of the healthcare crisis caused by COVID 19. We talk to Dexcom’s CEO about training and more. Kevin Sayer explains how the program came about, why it’s needed and how he hopes it will help people with all types of diabetes in hospitals. We also talk about other Dexcom news, financial issues and more.

More about Abbot & Dexcom in hospitals from DiaTribe

In TMSG – taking flight.. finally and a birthday, a diaversary and a family of healthcare heroes.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Check out Stacey's new book: The World's Worst Diabetes Mom!

Insulin assistance due to COVID19 crisis:

NovoNordisk 90 day no cost 

Lilly Diabetes $35 copay

The first pilot with T1D gets FAA clearance for commercial flights

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Episode transcript: 

Stacey Simms  0:01

Kevin, let me let me start by asking how are you doing everybody staying safe and staying home as much as possible?

 

Kevin Sayer  0:09

I am staying home and staying safe as much as possible I since the office is deserted quite frankly, it's safer than home is respect because there's no one in the neighborhood. So we're I've just been going in maybe once once a week for a little while to take a couple of calls and then working from home I have learned I have learned a lot of things about work at home tools that I that I need, like I needed a better camera on my computer and some better it's interesting as you go through this and realize just little things. Our company. So me personally, my kids are all great. So that's good.

Our company Stacey  we have done absolutely everything we possibly can to to take care of our people and our employees. We you know, mid March when we Send everybody home. We were definitely the first in our area one of the first in our area. I think Illumina might have been a little bit ahead of us, but we were very quick there and we have work from home tools that we put in place. Our IT team has just been tireless and getting people the type of connectivity and voice services and stuff they need from home. That's been great.

We've had to keep the manufacturing plants open, obviously, because patients need product. In light of that, and light the fact that we are taking a group and making them come to work. We've provided them with economic benefits to whereby we can compensate for the fact for example that they are leaving their kids are home from school home. Whereas you don't have the summer daycare plan or the camps you could put them in so we've compensated our people a bit more to make sure they can take care of their families. We've reorganized the place and manufacture train with respect to small pods of people working together. So if someone went might get exposed, they we don't wipe out a manufacturing floor of 800 people just a few. We're making take breaks in groups, we're making them take it literally, we've got thermal scanners, we've we we've got time between shifts, so we're not at full capacity, but we're close. So I think our company's been absolutely as responsible as we possibly can. Through this to our people.

And we said that in the beginning that aren't you know, our first goal is our, our employees our second priorities can be making sure is our patients to make sure that they our product and our third goal for community and making sure we're good citizens in the community and do our part and I think our hospital efforts fall into both two and three diabetes patients but also this community in general because when we think of the risks our healthcare providers are going Through to find this. My, my second son is 36. Now so obviously this back many years, but when he was 10, he had bone cancer and he went to a camp called dream Street, a kid's camp, kind of like the diabetes camps, but it was really just a lot of fun. And one of his counselors there was a young man trying to be a stand up comic who abandoned comedy becoming an ER doc in New York City. And our family gets text messages from him on it on a daily basis, just he's giving us a diary. And when you read that, it's like, oh, my goodness. And that's what we need to do to help the community is is a burdens for guys like him.

 

Stacey Simms  3:42

Let's talk about the hospital program then. So tell me what Dexcom is doing the the release is shipping continuous glucose monitoring systems directly to hospitals, indeed, what is the thinking here?

 

Kevin Sayer  3:55

Well, let me take you back a little bit. When this all started More than a month ago when things started getting very big here in the US and even before that in Europe, it became very clear that people with diabetes are more at risk. If they get contract COVID than those without diabetes statistics, statistics are pretty, pretty staggering. I mean, it's, it's plain black and white here. And we had heard from hospitals in Europe and back east. This thing started to grow. They wanted to use our system in the hospital, where we are not approved for use yet. Our system has been used in a hospital and some IRB approved studies in the past because we were preparing for that day and trying to develop a body of evidence that would support this. But it you know, it early phases by us in early discussions with the FDA, because before we roll on full on commercial into the hospital, we need to understand all the things about how our Bluetooth interacts. With all the other communication protocols, in hospital rooms, what is going to talk to where it's going to be displayed. And also make sure that the actual sensor from a chemistry perspective functions the way it's labeled on people in a hospital who are on multiple compounds versus those of us who are home and other routines who are on the compounds we're used to. And so we've done some work on that, but once it started heating up, particularly in centers where an endocrinologist who knew of Dexcom got involved, it quickly became we want this and we want it now. We didn't have FDA approval there.

So we started speaking with the FDA. We did get an emergency provision that All right, go ahead. ship to hospitals. And we we we've looked at this and and and we've taken a lot of time on this Stacey . We got 100 f he's worked on this hospital thing full time. We put that many of our people into this to make sure that works. We needed to build a pricing structure for how they could buy it. We're charging the hospitals less than the commercial patients as part of our, our contribution to the community. We know that the sensor, the transmitter has to talk to something either a Dexcom, receiver or a phone. The phones are better options. So we are giving the hospitals phones and or receivers for the beds to manage the patients. We've developed separate training materials for the hospital, devoted our entire Education team, pretty much to them full time right now as they're training the hospitals get upon the system. We have developed a surveillance team literally to take calls to if we are anything going on with sensors to investigate and make sure we understand so that there's not something that we would have missed. We devoted a lot of time and effort to this as a company. We want to make sure it works. We want to make sure we're getting Go there, we are going to help people.

The most appealing thing about Dexcom in the hospital over anybody else in the space, there's a couple you know, the first one is the connectivity, like connecting to a phone. Theoretically if the phone can be outside the room where a patient is, or even if it just hangs from the bed, from the from the bullet the bed, but it's a phone and you can use Apollo on an iPad out in the hall, you're able to monitor patients remotely. You know, I've been an ICU use around the country as we studied this market. And I've seen ICU is where the protocol is a finger stick every 30 minutes 48 finger sticks a day. Don't think nurses are following that protocol right now they're too busy. So to the extent we can make that labor much more efficient, and if we can take and the problem in the hospital is not hypoglycemia as it is for the patients in the field so much it's hyperglycemia not only our They they're getting too high because they don't want to be too aggressive on on a direct insulin. If they're not going to be sticking the finger every half hour, they don't have a CGM. So they're monitoring less aggressively. On top of that the steroids treatment and some of the other treatments for the respiratory ailments can go Cause glucose to rise much faster than it would if you weren't in that environment. So what we're seeing is patients going DK and fighting DK at the same time they're fighting to breed. And that's what the physicians and the hospitals are saying. So we have developed a plan and a protocol as to shipping products to the hospital supporting the hospitals, educating hospitals, training hospitals, giving them a place to call, learning as we go, because the other thing remember, most of the doctors here are not people who are used to CGM every day right there, your docks.

 

Stacey Simms  8:57

That's the question I wanted to ask is Can you tell us a little bit more about the training? You said you had people who develop this? I, you know, I'm a huge fan of CGM. We've unfortunately we had to take Benny to the hospital - not diabetes related. But having the CGM was fantastic. It helped so much, but we brought it in, you know, they didn't provide it. But how is an ER doctor? How is a nurse in an ICU? going to take the time to be trained? Can you share any of kind of the process here?

 

Kevin Sayer  9:28

We started with 108 slides user guide and realized that was never going to work

 

Stacey Simms  9:33

108 slides like a PowerPoint?

 

Kevin Sayer  9:36

Yes, slides because that's what you do you become FDA compliant, and you do a follow on user guide and try and walk them through every page. And after one training session. We said yeah, that's not gonna work. And so we condensed it. We have a two page quick starter. And then we have, I don't know, just a several page, other user guide and then we have people available by the phones that they need to solve. For that, and then what we're providing is video training. And we find we can get those trainings done in just under an hour. And then what really is happening, I will tell you where the early phases of this hospitals are phasing it, they're putting it on a few patients and watching seeing what they learn seeing what the outcome is. And then after they do that, then the roll it out bigger are constraining items so far has been getting phones, we've had to go procure the phones ourselves. We've had to buy them from the usual sources and pay cash to get them so we're getting the phones, we're pre configuring the phones. We've got another entity involved who's literally pre programming the phones whereby the only app running on the phone is going to be the dexcom g six app. So again, we are learning what physicians aren't gonna want to do.

You talk about training, we don't want to have to train them to program phones. It's easier if we have somebody else program the phones when we're funding that effort as well. But every day you come across a new barrier and a new hurdle to jump over to make this work everywhere. Some of the stories we've gotten so far, anecdotally have been extremely positive. The, but I can tell you the the hiccup today that I heard from one facility is we got we got phone shipped to this hospital, one of the first ones to get phones. And their ID department won't let him use them on the wireless network, because they haven't been tested to meet the hospital security. And so you think you know everything about the hospital environment. And Stacey, that's why we have been so deliberate and thoughtful, and methodical as we do this. We don't want to just drop sensors on a hospital and say use these because if we do what we're going to get as a bad outcome, we have an opportunity to make this work and to make this For patients going forward, so we are really heavily invested in making sure we do this the right way. And, and so yeah, we train them, we get calls back in the cases and several of the hotspot hospitals.

We're dealing directly with an endocrinologist who's training patients because there's so much diabetes in the hospital that the endocrinologist literally got involved in the training. Yeah. And and, and so that's been good, but it has been. It's just been crazy. And we have, we very much appreciate the FDA willingness to let us go here. We're going to gather all this data. When we're done. We're going to gather every bit of data that we can gather, and use this as real world evidence and then go back to the agency and say, Look, here's what we've learned about use of the product in the hospital. What do we do next? Yeah, I think that is a great use for this product.

 

Stacey Simms  13:00

You had mentioned that the you're going to be giving the phones and possibly the receivers to the hospitals and selling the sensors. And I believe the transmitter correct me if I'm wrong, a discounted price. What happens to the patient? Because I would be very concerned, having you know, the most notorious - you get an aspirin in the hospital and it costs you $800. You know, if I come in with my own Dexcom sensor, it's one thing but if a hospital puts one on me, is there a guarantee here that the patients that are using this discounted system are not going to be charged full price or even more on the other side?

 

Kevin Sayer  13:44

These people are so sick, that's the least of my concerns.

 

Stacey Simms

Interesting

 

Kevin Sayer  13:44

I think I guess I would hate that. This is not being used to keep somebody there to keep somebody safe at school. This has been useful. Thanks. somebody's life and and if our data can can make somebody healthier and better one of the initial stories I heard, for example, young woman comes into the hospital type one, she's in total renal failure. Things look bad. They're gonna put on our ventilator. They said, Wait a minute, she's DKA, let's put her on CGM first. Four hours later, her glucose levels are back down in the range. And not only did she feel well enough to be conscious, but they didn't even put her on a ventilator. And she got Well, what's that worth?

 

Stacey Simms  14:34

Well, Kevin, and let me ask you this, why not then give the sensors free and clear to the hospitals so that they won't I mean…

 

Kevin Sayer  14:42

I will tell you, I will go through that as well. First of all, they don't have devices to receive the data with. Second of all, we've been very thoughtful and plan this as much as we can. Because I don't want to be the person who tells all the parents of Children that you don't have sensors anymore. So when we started this process, we have three groups. We're considering our employees, our patients and our community. We are going to make sure our patients who have CGM in the field still have CGM. And we and we will do that we are charging the hospital some we're giving away the phones to the receivers. This is not a money making endeavor for us, given the amount of people we have working on it, or we're going to get enough to cover what we put into it at best when all of a sudden done. The reason we're charging and we're limiting demand is because the last thing we can afford would be for our patient community to have every patient in a hospital walking on maglev CGM slept on can't do that. We don't have the capacity for that. We have the capacity. We're very familiar with the number of we built models Stacey , based on the number of ICU beds, based on the projected number of cases based on peaks by state Based on everything you could think of the percentage of the patients that have diabetes, the percentage that don't we have a sensor forecast. We said in our initial news release, we've allocated up to 100,000 sensors. And that also means 50,000 transmitters to this, and if the need comes for more, we'll certainly evaluate it. But those allocations are based on what we could see being used in ICU beds. And the demand, we believe we'll have enough. And we'll make enough available demand from the hospitals and supply everything to all of our patients.

 

Stacey Simms  16:37

Kevin, my question was not about Dexcom making money. The question was about the hospitals charging patients and the unintended consequences.

 

Kevin Sayer  16:47

They won't. They won't. if they do, like I said, if they do, I can't control it. The hospital does but but if you look at a hospital and I've, I've had discussions here, Stacey  and it's, you know as we go through this crisis, And we look at this as a country and as an economy now I'm getting way off base, I apologize. But it's fascinating to me how the the, the ramifications are going to reverberate through the community. elective procedures in the hospitals are not being done. So because nobody's going in, if you can get that knee replaced in two months, you're probably not going in today. And so you have, you have an economy that's going to be affected long term by all this.

 

I have no idea what hospitals will charge for these sensors. They'll build what they'll bill we've made it as as affordable as possible. And if we can get all these logistics worked out, and the connectivity and all the other issues, we think it's just going to be a win for them all. Going forward. We're also relatively convinced based on the data that we have seen and again, you go to the University of Washington, john hopkins, we've mapped out the peaks in all the states, how many people they think will be in hospitals, and we're very comparable, we can serve that with what we have and then we'll go from there.

 

Stacey Simms  18:11

I'm jumping off the the point of how things are going to change. And as I know, you saw, obviously the whole diabetes community is following Lilly's move to cut insulin to $35. With restrictions. I got a lot of questions from listeners when I mentioned we were talking today about whether Dexcom had any plans for financial assistance programs for people who have lost their jobs and lost their insurance or and feel that the

 

Kevin Sayer  18:37

grant we're studying that right now. And putting together they're putting together several alternatives for me. We are studying that. I won't commit to anything but the time absolutely initiative that we are undertaking and looking at, because this does has become that important to our patients. So we're trying to figure out how that works. And I've had calls with Numerous other companies in the industry to discuss what they're planning and what they're doing. Just so I can get a grasp as to how that works. But we were working on something I don't have anything to announce. And it may be a while we'll see. But but we are considering it. Absolutely. As,

 

Stacey Simms  19:17

as the as you said, as the landscape changes, you know, we're not quite sure what insurance will look like I'm unemployable. Like, there's so many people who have been on the, you know, Dexcom customers for a while. Oh, yeah, I know. We're gonna run out of time.

 

Kevin Sayer  19:28

Go ahead. No, I I agree with you 100%. There are people now Stacey , who have no idea how to manage their glucose without a CGM, because they didn't even learn on finger sticks. These new patients have learned on dexcom from the beginning. If we have learned one thing through this process, in the diabetes community, and we do hold it very reverently, how important this technology is becoming people's lives. And it's not just the patients we're getting every day. testimonials from dogs saying the only patients I can care for my next commerce, because I have their data in clarity. And I've got this role monitoring capability of my account patients I don't have with the others. This is awesome. Thank you. And that's the clarity.

 

Stacey Simms  20:16

So making some changes this week.

 

Unknown Speaker  20:20

Could be

 

Stacey Simms  20:20

I got an email about that.

 

Unknown Speaker  20:22

Yep. Okay. Well,

 

Stacey Simms  20:24

I was just curious what why or if there's any you want to say about that, while we're talking?

 

Kevin Sayer  20:29

I don't think they're major are going to change the whole system. Okay. We continually try and improve that.

 

Stacey Simms  20:36

And then another question I'd like to ask is that this month Dexcom announced that in June, it will discontinue g4 Platinum and G five transmitters

 

Kevin Sayer  20:50

That's a plane I'm sorry. Are you still there?

 

Stacey Simms  20:53

That's okay. Can you talk about that? You had mentioned that at one point this would be happening. But can you talk about that? And then I'll also ask the same question this on the front end g7 where we stand with that,

 

Kevin Sayer  21:06

you know, I'll start with the easier one g7 we're working through, obviously, with what's going on clinical trials has slowed down significantly, our ability to purchase equipment on the outwit while we purchase a lot of manufacturing equipment, our ability, set it up and get it in, has been affected by all this will give more color on the earnings call about that. We're still extremely bullish on it, and we will do everything we can to accelerate those timeframes we, we really haven't taken a full inventory of where everything is. We'll talk about that more in a couple of weeks. But there certainly are are environmental factors that will have an effect on it right right now what my team is doing is looking at the mitigation possibilities for any of this stuff and I don't have anything in front of me but it is front and center. I thought it was back to G four and G five From a manufacturing and a cost perspective, it's costing us a tremendous amount of money keep those lines running. We need the space for G six and G seven. And in addition to that, by supporting g four and G five we're supporting. They gave me a list of how many dexcom software apps we were supporting the other day. And I went, yeah, it's time.

We believe g six is the right product for our patients. We believe when they use it, they will find that it is I know why people don't want g five and G four shut that discontinued all always relate to extending the life of the center and I get it. I'm hopeful that over time we can make it easier for patients to get and and a better commercial structure to whereby it's not as important economically as it was before as we continue to drive. For more pharmacy coverage which typically results in lower CO pays for our patients. But operationally It just doesn't make sense for us to continue to, to build those things. And we shut the transmitters off first because we know people will still have sensors. If they have a transmitter that works, they will still want some sensors. But there's a day shut off day for sensors coming Not long after that. And we'll be P six driven and then be getting all our g7 lines up and running. And this is in the, you know, this is in, in conjunction with the plants we had at the beginning of the year. So this is not a data we've moved up from a back that's exactly what we were planning on.

 

Stacey Simms  23:32

Right. And you have mentioned that here before as well. Um, Kevin, before I let you go, I do have to ask I feel a responsibility as a person with access to you. And again, I appreciate how accessible you are you always come on and answer these questions. It's not always sunshine and roses and I do appreciate that. But I feel obligated to just ask you one more time, or at least put this out there. This is really an unprecedented time. I'm so appreciative of what Dexcom is doing, getting into the hospitals, you know, making things more affordable that way donating what you are donating, putting all these people to work to get this stuff done. But as you consider pricing and help for people who have lost jobs and lost insurance, please keep in mind the diabetes community that has helped Dexcom get to a point where you're about to join the NASDAQ 100. I know with a successful product. Yeah, I mean, it's exciting times. But it's also a time of worry for so many people, our

 

Kevin Sayer  24:37

hours, our culture from the beginning has been if you take care of the patients, things will eventually work out. We will absolutely consider this and do everything reasonably possible while maintaining obviously our position as a public company and taking care of our shareholders as well. There are a number of things going on internally that we really haven't talked about. As we increase capacity, as you know, as, as we phased out in G four and G five, quite frankly, can double that space to G six and G seven, that might give us more flexibility with respect to to our inventory because a lot of our calls last year Stacey  was me explain to you why we had 10 day weights before we could ship. And we don't want to. We don't want to go through that again. So we are absolutely looking at all these things, all the logistics involved, all involved, everything involved all over the world as well. And that's another thing. You know, one of the things used to be much more simple about XCOM. We were so us focus that we just did whatever we wanted to in the US and now our worldwide basis getting very large. So we were making worldwide decisions to which is really cool, but it's also complex. Everything has to be everything needs to be considered. We'll be more cognizant of that. We will think It, we will develop what we hope will be a good plan.

 

Stacey Simms  26:06

Because, you know, the fear is that if you can sell the hospitals, you don't really have to worry so much about individually. Yeah,

 

Unknown Speaker  26:12

that's that's very difficult to hear for people. Well,

 

Kevin Sayer  26:15

as I said in the beginning, that's why we've taken this hospital approach, very measured, and very thoughtful, and and made sure that we have enough capacity to take care of our next commerce, who depend on this each and every day we have to. And fortunately, as we've spoke with many of the hospitals when they get an endocrinologist involved, they very much know that we have to take care of the diabetes patients first and foremost. So that has been

 

that has been easy to explain so far.

 

Stacey Simms  26:50

Kevin, I forgot to ask you one. I have to ask you one technical question that I did not ask earlier. I'm sorry about the hustle. So much of the COVID reporting has been that it's devastating. For people with type two diabetes, obviously we were talking about people with all types of diabetes. But are you finding that are these decks coms going to the hospitals? Are all these people using insulin? Is this for all people with type two who use insulin? Is it just for type two? Are you just leaving it up to the hospitals? Because it just used to be that putting a dexcom on to type two doesn't use insulin? I don't understand why no endocrinologist, I'll

 

Kevin Sayer  27:24

be able to explain it to you. What is happening with type two patients when they go in as their glucose is spiraling out of control every bit as much as an insulin user. It appears that the effect of the virus and the treatments related to the virus are causing glucose challenges in these people far beyond what one would have anticipated. We're very early in our hospital phases, I believe. haven't talked to all of them, but I believe that they're starting with the insulin using patients. But in all candor, a lot of these type two patients are being put on insulin IV insulin as well, to get there Their glucose levels under control. So it's being used across everybody. I think I need to give the FDA kyudo akuto here because they gave us permission to treat anyone, not just people with diabetes, that's a huge step. For us, if somebody glucose compromised during this time in the hospital, if we can bring their glucose back under control, that that's a big win. And we are reading a lot about, about type twos who have glucose levels that are just going nuts Actually, I'm hearing about people who don't even know they have diabetes, who this glucose levels are behaving like that. So it's like this is it's unprecedented times on a number of fronts. And we're still here we are absolutely working on things and considering things for our patients first, but we see an opportunity. Whereas if this thing works, and we can can save some lives and make health care givers you Better, and make them able to treat this better. We're gonna we're gonna do this and we're gonna do it right. while balancing the two, we're never gonna, we're never gonna ignore patients, Stacey , that that's just not how we're wired.

 

Stacey Simms  29:16

Well, I really appreciate you spending time with me, Kevin to talk about it and explain the system and we will look forward to seeing how it works out, you know, we'll follow up. So thanks for being here today. Appreciate it.

 

Kevin Sayer  29:25

Well, thank you for taking the time to chat with me really inspired the airplanes zooming over my head I it's always fun to talk with you. And again, kudos to all those on the frontlines doing this. But kudos to our team, these people. I mean, it's been 24 seven for about a week and a half. They're, they're tired. So getting this this thing rolled out. It's just been it's what we're best at. We are really good at figuring things out

 

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