← Diabetes Connections | Type 1 Diabetes
Diabetes Connections | Type 1 Diabetes
BONUS Episode: Dexcom Updates From ATTD with Jessica Castle, VP of Medical Affairs
00:27:45
Loading summary
Transcript55 lines
- [00:00]
A
Foreign.
- [00:05]
B
Welcome to a bonus episode of Diabetes Connections. I'm your host, Stacey Sims. We aim to educate inspire about diabetes with a focus on people who use insulin. And I had the opportunity to talk to the folks at Dexcom about their recent presentations at attd, and I wanted to bring you the interview sooner rather than later. ATTD is the Advanced Technology and Treatments for Diabetes conference. This year it took place in Barcelona, and if you're new around here, there are a few big diabetes conferences where studies are presented, news is made. ATTD happens in the spring, ADA and adces are in the summertime, and there's a few more scattered here and there. But these conferences are always interesting, you know, for the research that's presented, the headlines that are made. There are a lot of products that are shown. Some we will be using in the next couple of years, some will just disappear. But we will be sharing a lot more from ATTD in upcoming interviews with other tech companies. But today I'm talking to Jessica Castle. She's the VP of Medical affairs at Dexcom. She's also an adult endocrinologist with a lot of clinical trial experience. We talked just a couple of months ago and I will link up that interview. She refers back to it quite a bit, but you don't need to have listened to it to get the gist of what we're talking about today. But there were a lot of announcements in there, especially about the discontinuation of the G6. So I will definitely link that up in the show notes for you to go back and listen if you haven't already. And as always, I try to bring your questions to the folks in charge. We usually do that through the Facebook group Diabetes Connections. The group, but you can always email me stacyiabetes-connections.com One more quick thing. If you have not already done so, consider leaving a review in whatever podcast app you are listening. It's a great way to let other people who may be searching up shows what you like about Diabetes Connections, what makes us different. I would really appreciate that. It helps us out a lot. Okay. We did have lots of great questions here from you. I was able to bring a lot of your concerns to dexcom. So here's my conversation with Jessica Castle. Jessica Castle, welcome back to Diabetes Connections. And welcome from attd. Thanks for joining me.
- [02:21]
A
Yes, thanks so much for the invite. Today I'm joining you from sunny Barcelona.
- [02:26]
B
Excellent. So what's the big news for dexcom? What are you all showcasing? What do you want people to Take away from attd, we have a ton
- [02:34]
A
of great data that we are presenting here. So we actually have 12 presentations. So we're keeping the team very busy and I thought it might be great for us to touch on a couple of those. So we have two presentations on Smart Basil, which we talked a little bit about last time. So this is our first opportunity to share our, our clinical trial results in adults with type 2 diabetes on basal insulin. We also have some great data around cgm, reducing the risk of DKA or diabetic ketoacidosis, both in children and adults. And another piece that we're going to be sharing is around people with type 2 diabetes, not on insulin. So we have some data from our US registry where people are wearing G7 and showing improvements both in A1C and weight, I think really demonstrating the value of CGM across multiple populations, including people with type 2 diabetes.
- [03:29]
B
Excellent. And we'll, we'll, we want to get to all of that, but let's start if we could, with the CGM reducing the rate or the incidence of dka. You said kids and adults. I assume that's type one or was it all people with diabetes?
- [03:41]
A
Yes, this is, was specific in type one. And we looked at some retrospective so data in the past and using a healthcare claims database. And so we were able to look at for people with type 1 diabetes. So look at between years of age of 2 to 17 or 18 and above. And if they received Dexcom CGM, what happened to their risk of developing DKA during that time, the year before they started on Dexcom CGM and the year after. And we found really significant decrease in risk of hospitalizations as well as ER visits for both children and adults with type 1 diabetes. And amazingly for for children, the risk of hospitalization reduced by almost 94% with wearing Dexcom CGM.
- [04:35]
B
All right, I have to ask you a question about that. When you're saying the year before CGM and the year after, a lot of times kids especially are now put on dexcom almost immediately at diagnosis. Did this retrospective, did it look at, did it include DKA at diagnosis?
- [04:51]
A
Well, we don't have visibility in terms of exactly when they were diagnosed because of the, that this was health claims. So I think that that's a potential that in terms of seeing the rates of dka. That being said, we also looked at ER visits. Right. As well, and we saw both of those go down. And we also saw that in adults who, you know, would be less common for them to develop DKA and I would also add, there was a recent publication that came out that also showed that people that are in the T1D exchange, this is looking at diabetes centers across the U.S. also found that the rates of DKA was very low in people wearing cgm. So I think all those things together help reinforce that. We do think CGM significantly reduces the risk of dka.
- [05:40]
B
And I may have missed this if you said it did it look at people who were not wearing a CGM and compare or this was purely year after and year before of people.
- [05:48]
A
This was the year the. The year before and the year after. So the same group of people. And that's actually important because you can imagine that there are other risk factors. For example, if someone doesn't have good access to insulin, that there would be other risk factors. So in this way, then we are. We're comparing that same person and their risk of developing DKA before and after getting cgm.
- [06:11]
B
It doesn't sound like this is in the same study, but I know one of the big concerns that a lot of families, you know, have a kid or an adult with type 1 in it are hospitalizations once you are in the hospital. And there's been some controversy in years past about keeping a CGM on. I know Dexcom has been doing more of trying to urge hospitals to. To keep CGM on patients. Is there any update on that or any new information?
- [06:33]
A
Yeah, it's definitely still very much an interest of Dexcom in terms of being able to support inpatient use or in hospital use of cgm, something that we've worked closely with the FDA on this topic, and I think more to come in the future as we find the best path forward.
- [06:50]
B
Great. All right, let's talk about that smart basal. Redefine that, if you don't mind, and then tell us what you found.
- [06:56]
A
So this feature looks at CGM data every single day and then helps give a recommendation to the person with diabetes on how much basal insulin they should take. So this is designed for people with type 2 diabetes. And as a reminder, basal insulin is the insulin you typically take once a day. This one was specifically glargine insulin. People used the system for about a month, and we looked at their CGM data before they started Smart basil and then after they had been on smart basal for about a month. And this is something that the healthcare provider puts in some settings. So, for example, how much the system can go up on the basal insulin per day and in when it reviews the CGM data. And again, this is all automatic within the app. It's looking at how to try to minimize hyperglycemia as well as minimize hypoglycemia. And it uses that information then to say, hey, this is how much insulin we recommend that you take today. And then the next day you'd get a new recommendation. And I think it's good to kind of compare how people historically have done basal insulin. Often you get like a written titration scale from your doctor and you'd have to, for example, do a finger stick every morning. And then you'd have to look at your last three days of finger sticks and try to take the average and then look at the scale and try to compare what you should do and how much you should increase. And that can be really difficult for people with diabetes. It's also, then the health care provider is not there to help provide recommendations. You know, maybe they don't see their doctor again for a month or three months. And so this is the smart basal tools is really optimized to help make it easier for healthcare providers to start people on basal insulin and then also for the person with diabetes to help reduce their, their risks of highs and lows.
- [08:47]
B
Yeah, before we go on, we should just say insulin glargine, if you're not familiar with that, the brand name is Lantus.
- [08:52]
A
Right.
- [08:53]
B
Very, very commonly used, long acting. So what did you find?
- [08:56]
A
So on average, their mean glucose, or average glucose dropped by more than 40 points and their time and range increased by more than 20%. And the O. You know, and when you have improved glucose like that, you're your, your concern is, well, did that cause hypoglycemia? And it did not increase. And on average, people had the time below 70 of 0.1% and time below 54 of 0. So very, very little hypoglycemia and significant improvements both in time and range and average glucose.
- [09:34]
B
Yeah, it amazes me. A few years ago I was talking to an endocrinologist who, he was trying to work with general practitioners. You know, most. As you listen, you may not know most people with type 2 do not see an endo. They see an overworked GP who may give them a Lantus prescription that is much less or much more than they really need. Not because of any kind of, you know, he's not a dumb doctor. But they. It's not the personalization, it's not the same as seeing an endocrinologist. I'm fascinated by the smart basal. I think this is so interesting not just for people with type 2, but what it might mean someday, right, for people with type 1. Are you looking at that at all yet, or am I getting too far ahead?
- [10:12]
A
Yeah, I think it's always. We're always looking for how we can best support people with diabetes, both type 1 and type 2 diabetes. So I don't have any details to share on that today. In the past, we've talked about smart bolus. That's a way for us to be able to help people when they put in how many grams of carbs they're eating for the system to automatically calculate then how much insulin to take based on the carb input and then also the glucose rating from the cgm. It's not a feature that's available today, but we're going to talk. We talked a little bit about it in past conferences and we're going to talk more about that tomorrow during our symposia. And so something, I think that will be a great feature for people with type 1 diabetes in the future.
- [10:55]
B
All right, well, we're talking today and not tomorrow. Will any news be made in this? I'll hold it. Or is it just going to be a look at what is coming in the future?
- [11:03]
A
Yeah, just to look at. We don't have any timelines to share quite yet, but something that we've been working hard at at Dexcom and important to know that we're continuing to look for ways to innovate both for people with type 1 and people with type 2 diabetes.
- [11:19]
B
And you also mentioned another presentation you're doing for folks with type 2 about the G7 you said at the beginning.
- [11:24]
A
Yes, yes. So this is data from our US registry. And so we followed over 300 people in primary care centers on G7 and followed both their time and range, their A1C and their weight, and found that people actually had both a significant improvement in their A1C as well as we saw an improvement with weight. And I think this really reinforces the value of Dexcom CGM for people with type 2 diabetes, even those that don't take insulin. And I think for many reasons. For one, when you can see how different foods impact your glucose, you can then understand you can really tie kind of dietary choices back to your glucose level. So that can be really helpful. As part of the presentation, we're talking about how we see in that registry people, you know, chose less sugary drinks, chose fast food less often, exercise more frequently, and followed a healthy behavior, eating more consistently. So lots of great information there. And I think just showing that CGM can be helpful for so Many people living with diabetes.
- [12:33]
B
The biggest question I got from my listeners to bring to you were concerns about the discontinuation of the G6 and moving everybody to the G7. Can you just take a moment and talk about what's happening, give us the facts about the discontinuation of G6.
- [12:50]
A
Of course. Happy to. We talked a little bit about this last time in December, and as we had talked about, you know, we guarantee supply of G6 up until July 1st and encourage people to switch when they can to Dexcom G7 or for adults, G7 15 day. I'm hearing great things about G7 15 day, both from, you know, people with diabetes as well as healthcare providers. And I really encourage people to switch because we think we've got great products for all of our different users. And G6, I understand, is a beloved product. It came out when I was in practice. I think we talked last time. I'm an adult endocrinologist. I worked at Oregon Health and Science University caring for people with type 1 and type 2 diabetes. And so I got to experience prescribing G6 for so many different people and. And understand how people have become very attached to it, but would encourage people. You know, I'm seeing now that G7 and G7 15 day are great options for people with diabetes and encourage people to make the switch.
- [13:54]
B
Yeah, we are very fortunate in that my son has had a very good experience with G7. He switched to it pretty much when it first came out and has had. Or when it was compatible in his pump and, you know, has really had very few issues. But I will say there's a lot of vocal people on social media. When I asked about this in my Facebook group, they're very nervous about it. They don't. Jessica. They don't really seem to like it. And I know that's not everybody. Right. But I just have to get that out there. I'm curious, do you see different data? Because, you know, Dexcom does have data in terms of sensor failures and how long things last and even just from customer experience reports. Do you see a difference from G7 original to G7 15 day, or are they pretty much the same?
- [14:38]
A
Yeah, I would say it's still, you know, G7 15 day is still new to the market, so I don't have details to share in terms of comparison between the two, but would just reiterate that people, you know, we've gotten a lot of great feedback. It's something that we're continuing to look at as a company and overall I think people have had a great experience with both the G7 and G7 15 day. And back to your earlier point around people that are vocal around G7. I just want to make sure your listeners know that feedback has been heard. We've made a lot of changes and you know, we continue to improve our products and so we take that feedback very seriously. As I mentioned, as an adult endocrinologist, I know that this is life saving technology and so we need to make sure it works for people. In the rare cases that it doesn't, we do replace those sensors and we're constantly learning. We have a new CEO, as you know, Jake Leach, and he talks very much about being a rapidly learning organization. And so when we do have challenges, we embrace those, we understand them, we make improvements. And I think people can really see that in our products. And we're never satisfied with the current status quo. We're always looking to, to make things better and to innovate. And we, you know, welcome feedback as if people have challenges. We want to hear about that.
- [15:59]
B
Thank you so much. I did get comments from two parents, two different parents, and I had not seen this, that they feel like there has been a change in the G7 in terms of the tape or the adhesive. Children that were using the product before with no issues are suddenly develop developing reactions. Did there something change? Have you been seeing this? I know, gosh. You know, we've been following Dexcom story on this podcast since the beginning of the podcast and there have been changes on and off that do result unfortunately in this for some people. Any idea on that?
- [16:30]
A
We did change our adhesive last year and that's something that we continually to work on and actually we'll be releasing a new adhesive later this year as well. It's very much a balance of finding something that's sticky enough. Right. That can last the full time, but not causing a reaction. Sometimes when people have repeated exposure to something, including adhesive, they can develop a reaction over time. We have some good information on our website in terms of how to best manage those reactions and good for people to talk to their healthcare providers to make sure that we can minimize those reactions as much as possible. Overall, we actually see less problems with the adhesive. Yeah. And with this new adhesive. So I think it's working well for most people. That being said, you know, I know it's incredibly frustrating when people are having challenges with it, in particular children with diabetes. And as I mentioned, we'll have a new adhesive coming out later this year.
- [17:28]
B
Yeah, it's interesting because in the same thread we did get another comment of someone who said, boy, they've made it so sticky. It used to fall off. Now I can't get it off.
- [17:37]
A
Right.
- [17:37]
B
So, I mean, I understand that it's a balance. I mean, the adhesive issue for all of the wearables has been a tough one indeed.
- [17:44]
A
Right.
- [17:45]
B
Yeah. I got a couple of questions about AI. I know there's been some advances in this, particularly over at Stello. Can you talk about how Dexcom is planning to use AI or maybe talk about that first and then go into G7 and I don't know, Jessica, maybe G8?
- [18:00]
A
Yes. So Stelo is an our over the counter glucose sensor. It's for people that don't have diabetes or have prediabetes or type 2 diabetes that don't take insulin. And we talked a little bit last time in December about the ability to take a photo with the app. And you can, it'll generate a description of the meal and that's available both in our, you know, G7 app as well as the Stelo app. And we'll be launching here soon the ability in Stello to actually, when you take a photo, to be able to see an estimate of how many calories are in that meal as well as protein, fat and carbohydrates. And that uses the AI in the background as well as a database of over a million foods. And, you know, I suspect your question is also like, when will we find that Right. Coming up in G7 or future products. That's something we're always looking at. It's a balance of making sure we have, you know, really accurate information if people are going to be making insulin dosing decisions off of that information. And so continuing to look at how we can best bring that for people with diabetes that are on insulin. Yeah.
- [19:19]
B
I don't know if this is a question or more of a statement. We'll see where it ends up. But I feel like one of the big advantages for the diabetes community of you all, and certainly an advantage for Dexcom in having the Stelo, which is for people who don't dose insulin and is an over the counter product, is that you can get all of this real world data to give to the FDA without having to do the incredibly, I assume, tightly controlled trials and expensive trials that you have to do with people who do use insulin. So it wouldn't be a, an apples to apples comparison at the end of the day, but it's interesting to see the amount of information you Know, my dad, who has type 2, uses Stelo. And we were joking the other day. It's like, well, all the information he's given to you guys is maybe gonna help Benny one day down the road. Right. I mean, it's really interesting to think about it that way. So perhaps not a question, but could you reflect on that?
- [20:08]
A
Yeah, I would say real world data that we have from our users has been incredibly important. We, for example, published back a little over a year ago now using that information, how much people's time and range improved with using dexcom CGM from when they started wearing it over time using the G7 in people with type 2 diabetes, not on insulin. And I believe that that helped the American Diabetes association update their standards of care. That was part of the evidence that they cited in terms of recommending using CGM in that group. We've also, you know, presented data on Stelo, for example, at the ADA's scientific sessions last year. In terms of device or feature approvals, we're always looking for the right path in terms of getting approval for different features. And like you said, it's hard to wait for long clinical trials. And so we were always talking with the FDA to find the most efficient, but yet also safe way to get clearance for different features and devices.
- [21:15]
B
I got a very specific question about access that I want to ask, but I want to broaden it out. The listener said, can you please ask about access for people in the Bahamas and the possibility of collaborating with organizations that support the less fortunate in the Bahamas? If you can answer that, great. But I'd also like to ask you about access in countries where dexcom really isn't widely available, perhaps, and other programs, because I know you have Dexcom 1, not in the United States. Any new plans or anything you'd like to say about that?
- [21:42]
A
We are constantly looking to expand globally. So we, we had a new Chief Commercial officer joined about a year ago, and one of his objectives is making sure we're bringing CGM technology to as many people across the globe as we potentially can. And so I would say, yes, I think you can expect to see CGM in more and more countries in the future. And it warms my heart to think of that, that we've impacted the lives of many millions of people, patients or people with diabetes. But we have a lot of work yet to do. One of the things we have to go through is, is go through registration in every country. Right. You know, in order to be able to provide CGM in each different country. But so it's a lot of work, but it's important work so we can reach more people.
- [22:33]
B
I know I have a lot of different areas of expertise that I'm asking about, so I appreciate you taking on all these questions. A couple of more that are may not be your department, but Dexcom's partnership with Oura Ring has that launched. Can you tell me a little bit about what you all hope to learn from that?
- [22:49]
A
So, yes, so we definitely have a partnership with Oura Ring. People can actually buy stelo and access the CGM data through the Oura Ring platform. I think a lot of great opportunity for us to support different populations. For example, you can imagine the activity data that's coming in from the Oura Ring. I actually wear an OURA ring and I like to be able to track the number of steps. And so we're definitely looking at how to best leverage that in our own products to help support people, for example, to, you know, make lifestyle choices in a different way that are informed both by their CGM data, but also other information like their heart rate or, you know, physical activity from the Oura Ring.
- [23:34]
B
Yeah, I'm really interested to see what, if anything, we learn, right? What if the ideal amount of sleep is something bananas for people with type 1 versus people who make their own insulin, Right. Or what if it's something about, like you said, activity that we haven't thought of? I don't wear a ring sleep ring. I can't stand rings. Jessica. I'm the weirdo who's like, yes, I'm still married, but I can't wear my rings most of the time. So I'm really interested. And the other question I wanted to ask you was we haven't talked a lot about Direct to Watch since it came out. It was kind of like, yay, it's here. A lot of people were waiting. Anything that you've learned from that in how people use it? Anything surprising or any information about dexcom Direct to Watch?
- [24:14]
A
Yeah, I think people really enjoy the flexibility that it allows right to being, you know, don't have to have your smartphone with you. And I think as people are exercising, they may not want to have to bring their phone along. And so I think the biggest thing is that, you know, people with diabetes really want flexibility. They want choice and, you know, smart, you know, direct to the Apple Watch affords them that ability to make different choices.
- [24:39]
B
Before I let you go, let's talk about the board for just a second. Kevin Sayre, former CEO, as planned, is back on the board. And a lot was also made of a new addition and that was Rick Osterloh, who's with Google, who is on the board. I don't really. I mean, I guess what I wanted to ask about that is so he's over things like Google Play, Google Devices, you know, Pixel phones and Nest and all that. Could we see new and interesting Dexcom partnerships? I know a board seat doesn't necessarily mean changing the direction of the company, but this was some interesting news.
- [25:11]
A
Yeah, I would say always we're looking at, you know, best ways to partner to better serve our users. So wouldn't leave, you know, anything off of the table. And I think it's great where we have such a deep connection to innovation, both with our new CEO and as well as new additions to our board.
- [25:31]
B
When you're at a conference like attd, very technical, lots of interesting stuff going on there. When people find out you're with dexcom, what do they want to ask you about? Like, what's the first thing people say? Do they show you a Dexcom? Do they ask you about the G8? Did they ask you about the G6? Like, what's the first thing people want to know?
- [25:49]
A
Oh, such a variety of different things. And the investigator initiated study team joined my team last year. And so often it's people bringing great research ideas to Dexcom and seeing how we can collaborate. So it's a time for us to meet with lots of different researchers and we want to make sure that we're getting our technology into the best hands and, and learning how we can best leverage it for both people with diabetes and also, you know, in the future, potentially people without diabetes. Excellent.
- [26:20]
B
Well, Jessica Castle, thank you so much for joining me and answering so many questions. Safe travels and I hope we talk to you soon.
- [26:26]
A
Very good. Thanks so much for your time today. Appreciate it.
- [26:33]
B
I'm going to link up more information in the show notes, including that previous episode that we did with Jessica a couple of weeks ago ago, late last year, I guess that's a couple of months ago already. We will obviously be following along on many of the things that we talked about today and asking more questions. I'm particularly interested in the adhesive change. I had not heard that anywhere else. And I'm also very interested how the, the G6 discontinuation is actually going to work if they will stay with that deadline. It sounds like they really are sticking with that deadline, at least for right now. And we'll see what happens with the G7 original recipe and G7 15 day in terms of how long those kind of stay side by side. As always. Definitely. Let me know what you think. Thanks to my editor, John Buchanis from Audio Editing Solutions. And thank you so much for listening. I'm Stacey Sims. I'll see you back here soon. Until then, be kind to yourself.
- [27:32]
A
Diabetes Connections is a production of Stacey Sims Media.
- [27:35]
B
All rights reserved.
- [27:36]
A
All wrongs avenged.