← Juicebox Podcast: Type 1 Diabetes
Loading summary
Transcript117 lines
- [00:00]
A
Hello, friends, and welcome back to another episode of the Juice Box Podcast. Today's podcast episode is sponsored by Medtronic Diabetes, who is making life with diabetes easier with the mini med 780G system and their new sensor options, which include the Instinct sensor made by Abbott. Would you like to unleash the full potential of the MiniMed 780G system? You can do that at my link medtronicdiabetes.com juicebox while you're listening, please remember that nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or. Or becoming bold with insulin. Welcome, Hugh. How are you?
- [01:10]
B
Can't be better. How are you?
- [01:12]
A
This has been a good morning for me so far. I appreciate you asking.
- [01:14]
B
It's Friday, so that is why it's been a good morning.
- [01:17]
A
Yes, exactly. I'm just, I'm doing this and one other thing, getting my passport renewed. I can't imagine a more boring afternoon, but at least I won't be sitting at my desk for a couple hours. I thought it'd be cool to have you on and get to know you and to find out a little bit about what's going on at what we're, I guess, not going to be calling Medtronic Diabetes anymore. Can you first let me know a little bit about yourself and maybe how you got into this position?
- [01:41]
B
Absolutely. Well, since you asked, I'm going to bore you a little bit about myself, please. I don't know if you remember the, you know, the pictures of boat people in the late 70s, you know, escaping Vietnam after the fall of Saigon. Well, I was one of those boat people. I was five years old and our family was making this, you know, grand escape on really a rickety riverboat in the South China Sea. So not really a seaworthy boat at all. And we got shipwrecked. We got rescued by, on this tiny island in the Filipino archipelago. And my parents and my, my three year old sister were on this journey. So we were in this refugee camp for, I don't know, eight months, something like that. And then luckily we got granted asylum in Australia. So that's why, you know, you hear the speech impediment that I have now, but we grew up super poor in Sydney. Character defining moment, if you like. And you know, I really believe that, you know, life gives you the tools depending on how you, you know, you get brought up. And when you grow up really poor, you get a lot of tools.
- [02:44]
A
Yeah.
- [02:45]
B
So, you know what then? Follow Was kind of, you know, know 20 years of, you know, poverty in Australia. And my mom was, she was a single mom. She actually was pregnant during this whole time. And when we arrived in Australia, like two weeks later, my, my younger sister was born. Wow. So we were four kids, newborn baby. You know, even though she was a trained lawyer, spoke three languages, you know, she worked as a postal worker on the night shift. So I grew up to taking care of my three younger siblings. So we couldn't afford a lot. It was really rough. I worked on, you know, I sewed things for a dollar a piece for a T shirt and, you know, I learned to cook, you know, even woodworking, becoming really self reliant. So, so I have a, I guess a lot of deep empathy for people who struggle, you know, trying to get out of poverty for really half my life. And, you know, that's kind of how I started and I worked for everything. So how I got to Medtronic, it was really happenstance, you know, kind of, it's never a straight line, Scott. And I don't have diabetes, but I have a lot of people my life that do. I mean, frankly speaking, you really can't go very far to find people who know someone who really suffers from the disease. And so my background's in software and tech. You know, previously I was at Honeywell and Honeywell works on a lot of things that kind of control problems. Like you, you can have how you regulate temperature in a building or autopilot in an aircraft. That's a controls problem. And actually what diabetes is, is a controls problem because you're sensing glucose and then you got to do something about that. And so there's actually a lot of software in it. So given my software background and manufacturing background and sort of consumer background and given that I knew a lot of people in my life that it just was a perfect marriage to, you know, to join Medtronic and lead the diabetes business. So that's how I kind of randomly got here, obviously was not very planned.
- [04:47]
A
So with your background and what you just explained about control, what do you think the people who hired you were thinking when they hired you? What do you think they thought the future was and how could you shepherd towards it?
- [04:59]
B
I think it was largely driven by the consumer experience I had with software, software and services. Because a lot of this is, yes, you've got the medical device, but there's a lot that gets involved, you know, that is involved in managing diabetes. It's like how you get supplies, how you manage all the admin associated with all the software tools for the caregivers. And so I think they were probably attracted by that in my background and I've always been, you know, worked in areas where I love building things, building products. I've worked in, you know, launching a lot of products. And so given the innovation cycles in diabetes technology, I think the people at Medtronic felt that that was a, that was a good fit. It was a, it was probably a bit of a, if I'm honest, a very unorthodox selection. But in some ways, given the state of where the business was when I joined with, you know, some of the challenges, especially in the US business, having fresh legs and fresh eyes are probably a good thing.
- [06:00]
A
Yeah. Where would you assess Medtronic has as being in this landscape before you got here and where is it that you're trying to take it to?
- [06:10]
B
Well, I think, to be candid, I think the business lost its leadership position in the US and fell behind. And I think at the time the warning letter had just landed on the doorstep. And so While there's a 41 year history in the business of many firsts, the first portable size pump, the first CGM that physicians use, the first seven day infusion set, the first CareLink and the first aid system, there's a lot of first. That's the heritage of the business that was always there. But the business hit some troubles, to be fair. And so I think I don't mind struggle, that's a bit of my background. And I saw something that was so important and if we care about choice for people living with diabetes, you know, and all the innovations that came out of Minimed, I saw that there. And so I was very energized to be part of restoring that heritage. And I think you've seen some of the innovations coming out that we are thinking differently, we are moving faster. And, you know, it just was a shame to not, you know, to let it sort of atrophy. So that's. So despite the fact that there was a warning letter, I saw Waterfront Property.
- [07:25]
A
It's interesting the way you're talking about it because I didn't expect this today when I got on with you, but I see a lot of similarities between what I do and what you just said. Because I struggle every day with this idea that I've built, this thing that I know helps people, I watch it happen all the time. But then how do you talk another person into giving it a try or get it into their attention like, so they can even consider it, like that's Most of my life. Most of my life especially spent, like, trying to serve it to people. And it's a very, very frustrating aspect. And you don't have the same. You were candid earlier. Like, Medtronic had a stranglehold for a long time, right? Like, doctors just prescribed Medtronic. So, like, you were ahead. You probably had first movers on a lot of things, and that doesn't exist anymore. So now I'm, I'm excited because now what I'm hearing is you're gonna have to deliver stuff that helps people, that works, because that's going to be your only growth opportunity, I would imagine.
- [08:18]
B
Absolutely. And look, we want to earn it. Like, it's not gonna. It's not an entitlement. We want to. And we're going to do that because we listen to patients and we're going to work on great ideas. We have unbelievable, a great team at Minimed. I mean, about roughly 20% of our employees live with the disease and more than 70% have a personal connection, so they're related to someone that has the disease. And so it's very personal for us. Like, we don't like not being number one. We think we have the best therapy on the market and we have hundreds of thousands of people in over 80 countries who use our solutions here. And so we absolutely want to earn it. Actually, the first thing that I did when I joined Medtronic was I met with employees that have diabetes. And I wanted to understand, like, you know, what were we doing well, what weren't we doing well? And so that gave me a lot of insight. And I think, you know, we've been on the path now to, you know, obviously we got out of the warning letter in 14 months. We've got an unbelievable quality system. Obviously, that's in the news, too. It's important that that's a core foundation. We didn't cut any corners. We've also rejuvenated our innovation pipeline, which I'm sure we'll get to talking about. We just leads to awesome sensors into the market. And so hopefully the other signs that we are on that trajectory, we're not there yet, but we are absolutely going to win back the hearts and minds of people with diabetes.
- [09:46]
A
How long have you been in the position?
- [09:47]
B
Three and a half years.
- [09:48]
A
Three and a half years. Okay.
- [09:49]
B
Seems longer, though.
- [09:51]
A
What led to the name Shift? Right? I mean, I've been saying Medtronic Diabetes forever, but now that's not the case anymore. Tell me what the shift. How did it come to be? And why do you think it's important?
- [10:02]
B
As you know, we've announced that we're going to win the process of separating from Medtronic. And while our product was still called minimeds, it's minimal, 780g and so forth. We need to have our own name so we can't be called Medronic Diabetes anymore. And so it made perfect sense to go back to the original mission of Mini Med, which really was the original category creator of diabetes technology with the 502 pump that was portable and small versus what was there at the time back in 1983. Actually, you know, we picked Minimed because we wanted to recommit ourselves to the original mission. I mean, we, we only serve intensive insulin users in type one and type two. We're not going after wellness, we're not going after pre diabetes and things like that. This is our sole focus. And when you look at the history of the business, it's been the pioneer of many, many firsts in setting the standard for that. And so while in recent years we lost a little bit our footing in the U.S. we continue to be super strong outside the U.S. and we're regaining a following back in the U.S. as well. And so that's what, that's what's behind the name Mini Med. And we want to live up to the 41, 42 year heritage for the next 4142 years or until, until being a smaller unit.
- [11:24]
A
Now how is that going to help you accomplish that or is it going to make it more difficult? Because I know sometimes when this happens, when companies, you know, kind of sell off or separate a little bit, it's not always easy to take the, I hate to say it like this, but sometimes the good, the good talent doesn't go with you and sometimes it does, like. Right? So you've got to look at the entire reporting tree again and start over. Right? So it's a great opportunity if you can put it in place. So I imagine you've been doing that for a while. Like, do you feel like that kind of structure exists now? And how do you think being leaner will help you?
- [11:59]
B
Well, a couple things. From a talent standpoint, the good news is we have had no trouble attracting talent into the business because people are very motivated, energized by the mission to help people. Because as I said, most of our employees, a lot of our employees have a personal connection. So it's very personal. Like we, we hear the feedback, we respond to it. I mean, we're not, we're not very far Away from the patient. So that's not been an issue. The other thing I would say is the leadership team that's gone through a lot of adversity together, restoring the business back to growth, are part of, are going as part of this separation of with Medtronic. So it's not like we have a brand new team. We have the same team that have been executing this. You know, there's a lot of IPOs in medtech, but one of the things that people don't realize is we're almost a $3 billion business in revenue. And that puts us as a top 20 medtech company by revenue.
- [12:54]
A
Okay.
- [12:55]
B
So we actually have a lot of scale. And I would also say that we are in over 80 countries around the world. We support 26 languages, we have 24, seven tech support and we have hundreds of thousands of people in our therapy globally. So we are really not that small. We have a lot of scale behind. I know of 8,000 people. So we have a lot of scale behind our product and our innovation. I'm actually excited because Medtronic is huge. Part of being huge. One of the downsides is you can be a bit slower in places and we're going to have the opportunity to move even faster than we are at the moment.
- [13:35]
A
Right. No more turning the Titanic when you want to make a decision, Right?
- [13:39]
B
Exactly. Exactly.
- [13:40]
A
I might be wrong. Right. But I'm an outsider who pays a bit of attention. But I'm trying to understand with what's going on now, new sensors, new systems, thinking about algorithms, getting that all set. What happened in there? How did you, like, I don't know, it feels like you went out to like a first place lead and then coasted. Like what happened to Medtronics? Like how did you get. How did they start so strong? Here's a sensor. Nobody's ever had one before. You just got it, you start selling it and that becomes the, the business instead of the innovation. Like how does that gap happen? I guess because you're. Would you describe yourself as, as catching up or like where do you think of yourself as? I guess there's two questions here. Like how does that gap happen? And where do you see yourself in the moment? Unlike other systems that will wait until your blood sugar is 180 before delivering corrections. The MiniMed 780G system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. Today's episode of the Juice Box podcast is is sponsored by Medtronic diabetes and their MiniMed 780G system which gives you real choices. Because the MiniMed 780G system works with the Instinct sensor made by Abbott as well as the Simplera Sync and Guardian 4 sensors giving you options. The Instinct sensor is the longest wear Sensor yet lasting 15 days and designed exclusively for the MiniMed 780G. And don't forget Medtronic Diabetes makes technology accessible for you with comprehensive insurance support programs to help you with your out of pocket costs. We're switching from other pump and CGM systems. Learn more and get started today with my link medtronicdiabetes.com juicebox I think honestly.
- [15:34]
B
Lots of companies go through it. I think it's called the innovator's dilemma, right? You kind of, you're the innovator. You get to a position and what's very natural is you lose sight of why you exist and you know, hubris sets in and you don't think you're touchable. That's a very common cycle a lot of people, a lot of companies go through, to be honest. I mean there's many, many stories of that, right? Kodak, Intel, I mean there's a lot of examples. So I'm sure we went through a little bit of that. I think the other part of it is when you're part of a big company, you fight for capital. Like you, you've got to, you know, you've got to be a better business case than another business. And so, you know, when that happens, sometimes the investment moves in different parts of the portfolio. I mean that's a bit of the focus thing. Now Medtronic gets to focus more, we get to focus more. And all we do is serve people on who need, you know, need insulin. So those two things I think contributed to, I would say choices that were not optimal. And so, and so you see some missteps, especially in the U.S. but for us, I think I'm super excited by our innovation that we have in the pipeline. We see ourselves as an aid company. We don't just do cgm, we don't just do pumps. It's really about the automation that brings all of that together. And I think we are leaders in aid.
- [16:59]
A
Why do you think that? Is it something special about your algorithm or your hardware coupled with it? What do you think puts you in that position?
- [17:06]
B
We invented aid. We were the first closed loop system with 670G back in 2016. With 780, we are now in our second generation algorithm, it's really the only system on the market with order corrections every five minutes. So if you miscalculate your bolus or you sometimes forget to bolus, the system can detect that you're eating and can give you the corrections and bring you back in range. And so we perform very well in the hyper range because we're able to bring you back in range a lot faster. It's a very aggressive algorithm and it's the lowest commercially available set point at 100 milligrams per deciliter. And we can do that and be aggressive without increasing risk of hyper. And that's why we have several hundreds of thousands of people on 780 around the world. And we've got incredible clinical Data that says 780 is for many people, whether you're young or old, whether you're good at technology, whether you can good at math, if you're coming from different therapies. I mean it is really a democratizing therapy. And we're working now on our third generation algorithm which is going to push the envelope even further on that front.
- [18:18]
A
How much can you talk about that? What are the goals for that algorithm?
- [18:22]
B
Well, we really believe that the promise of aid is freedom, peace of mind and safety. And so the goal is to have the automation take over the work so you don't have to today, to be honest. Well, we like our technology and there's a lot of aid systems on the market. It's still work, you still have to put in a lot of work. 780 does push the envelope where you don't have to put in as much work, but the holy grail I think is not to actually do very much at all. And yet you can get above 70% time in range. I think that's really our goal. Can we help people who live with diabetes have more freedom? They don't have to make a trade off between glucose control and lifestyle choices and therapy burden. We want to solve all three.
- [19:14]
A
Does that answer lie in the hardware or in the data or in how the data is interpreted? What do you think holds us back from having more freedom?
- [19:25]
B
It's actually in the system. So we are the only company that is commercializing CGMs, pump or insulin dosing devices and the algorithm around all of that. And so similar to if you use an iPhone, it just works because Apple tightly integrates the software and the hardware together. And we're the only company that has CGM data and insulin data. And so and we've been more than 10 years at algorithmic development, we have a lot of data with both and so that allows us to innovate very fast on our automation algorithm. And so now we're now third generation system in development plus we've got two new CGMs and new form factors on the pump. When you think about the trifecta of are you getting the clinical outcomes you want? You don't want hypo, you don't want dka, you don't want complications. Our timing range is the highest amongst all the aid systems and you can see that in over 200 publications in peer reviewed journals. Then the second part of the trifecta is you got therapy burden. So how much interaction do you have to do to deal with alarms, to deal with imports into the devices? Every AI systems has therapy burdens and then you've got lifestyle, you know, what does it look like, you know, how does it affect food, sleep, you know, social, you know, embarrassment if your alarms are going off and things like that. So we, we want to solve, we want to solve for a very tightly integrated system that is kind of like self driving cars. You don't have to do very much but you're getting outcomes. We don't want people to have to trade off. Hey, lifestyle is very important to me. Like let's say you're a teenager and so I'm willing to give up on safety and glucose control or I don't want to do the therapy burdens too much and so I'm going to give up on that and again not get the outcomes. We intend to solve for all three so that you don't have to do very much. Put insulin in, wear the device, respond to alarms if there are any, and live your life.
- [21:35]
A
So what I'm hearing, I think is that I shouldn't be expecting a mini med pump to work with a Libre. Ever since Dexcom, anything like that, you're going to keep it, your stuff is going to just work with itself or do you think you'll ever have interoperability with other CGMs?
- [21:49]
B
We have a partnership with Abbott for instinct, so it's not interoperable in the sense of, you know, mix and match. And the reason why we do that is we're not stubborn, obstinate, we've heard the feedback around our senses and that's why we're excited with Simplera coming out as well as instinct because we really believe in not having technology be yet another thing you have to do. Right, right. And just as a very silly example, the Libre sensor doesn't Have Apple Watch functionality. Right. But the instinct in our system does. Right. And so we want to curate a system that just works. You don't have to think about, does it work together? Two phone numbers to call companies, pointing fingers at each other when you're troubleshooting. We want to be able to just keep it very simple. The technology just works. The automation is seamless. The devices look sexy and have a lot of appeal. And they're very designed with modern consumer electronics in mind. And you have one phone number to call if you need support in whatever country, around the world, in whatever language. The burden of diabetes isn't just the device, it's all the other things around it too, that we want to solve for. That's part of the peace of mind. If you happen to be on a holiday and your pump breaks or something goes wrong, you forgot to bring such and such, we'll airship it to you. And so we can do that with our presence and scale that we have around the world. And that's one of the reasons why people value the service we provide. That's why. I mean, it's a kind of a tired cliche a little bit to compare ourselves to Apple. That's the experience that we're going for.
- [23:26]
A
Yeah.
- [23:28]
B
And I think that's only possible when you tightly couple all the elements of an AIG system with 1-800-minimed.
- [23:37]
A
Right. It just occurred to me that we should be a little clearer about this. You're introducing two new CGMs, but one of them is a MiniMed CGM and one of them is an Abbott CGM. They're both going to work with your pump. That's right. Correct. Okay, Correct. Will the Abbott CGM work with anybody.
- [23:55]
B
Else'S pump the instinct? No. No, it wouldn't. It only works with that. It only works with our system.
- [24:00]
A
Same with the simpler Earth.
- [24:02]
B
Same with the simpler.
- [24:03]
A
Okay, and where do they stack up as far as marred and lasting the full amount of time that you say? Like how, how, how. Have you seen that? Why did it and why did it take. It feels like it took long. Why did it take long? What were you doing?
- [24:17]
B
Yeah, it's fair. It's. No, it's a. It's very fair.
- [24:20]
A
It's.
- [24:20]
B
It's hard. Look, sense CGM is hard to do. I can't even tell you how much we've invested to do this. But yes, it takes a long time because it's actually technically for very sophisticated device. You've got a lot of. Bring a lot of things together, not to mention Going through clinicals and the FDA process, getting coverage. I mean there's, there's a lot. I mean I'm not making excuses. It's way too long.
- [24:46]
A
Yeah.
- [24:46]
B
And it is a new platform for us, but future iterations will not take as long. But look, simpler, sync the mods about 10.2. It's pretty accurate and it's very accurate when it comes to dosing. So again we're an aid company, we're really not in the standalone CGM business. And so when it comes to dosing, when you need to, at the low and the high range, we have extremely accurate. It's in the middle where frankly speaking, we tune the algorithm to it doesn't really matter because you're not going to take a different action in the EU glycemic range. And that's up to seven day sensor with simpler sync and people really like pairing that with their weekly routine. So we have a seven day infusion set. So people like sort of the weekly set change and site change that they have to do there. The instinct is 15 days and it's got a mod of similar and it's a very similar experience to a Libra A3.
- [25:48]
A
Okay, I'm going to fomper through this because I don't have the wording, but there's a thing with the FDA with devices, right? Like if somebody already has something similar on the market, isn't there like a, like a fast forward that you can use off of that? Like when you're bringing something. Am I out of my mind or what am I thinking of that? Or maybe I, maybe I'm crazy. You know what I'm talking about?
- [26:08]
B
Yeah. Nine. So what you mean? I think, look, I think there's a myth that at least in the US the regulatory pathway with ICGM and the special controls means it's fast. It's not like a USB stick where you can just plug and play. Because look, we dose insulin and you dose wrong. It's dangerous.
- [26:31]
A
Sure.
- [26:32]
B
So the regulatory process was actually not long. I mean we announced Abbott, the deal with Abbott in August 2024 and we, we started taking pre orders in, you know, kind of late September. That's 13 months. If you look at the other integrations that have happened, it's taken years. We took 13 months.
- [26:52]
A
People have been telling me about how great their medtronic pumps have been for like, it feels like I've been hearing it for a couple of years where people are like, man, this new algorithm is great and you blah, blah, but it's always Somebody from overseas. And maybe that is why it feels a little longer to me, if I'm being honest.
- [27:08]
B
You know, having the warning letter didn't help us get 780 in the market. It probably was late by a couple of years.
- [27:14]
A
Okay.
- [27:15]
B
So I know how, you know, a lot of people were frustrated by that, but since it's been here and we've got hundreds of thousands of people on the system and so, I mean, you know, you can look at social media, but you know, for a lot of people it's changed their life because they have to do less.
- [27:29]
A
Right.
- [27:30]
B
But yes, I wouldn't bolt the regulators here. I think FDA has really made it easier to get new innovations out. But to make it work, say integration with Instinct and Abbott, it takes work. And what we're really proud of is whether it's our own sensor Simplera or with Instinct, you're still going to get the great outcomes, you're still going to get the minimum work needed. The meal detection technology still works. While there are different slight differences in CGM experience, the same easy insertion process, it's actually the algorithm that delivers the ease of use and the outcomes.
- [28:07]
A
Right, right. How do you get over. So my daughter's 21. She's been wearing an Omnipod since she was 4. If I came to her today with a tubed pump and I said, hey, this will be better for you, it'll be easier, she'd say, no, thank you. I mean, how do you deal with that? That, that's a. It seems like a real issue. Like, I can see in the, in the community there are people who are like, I don't want tubing. There are people who are like, I don't care about it either. But like, how do you, you know, I mean, how do you broach the subject with those different groups?
- [28:36]
B
Well, I think there's a couple ways. I think, look, there's preferences. And so we believe in choice, not. It's not going to be one side, one thing for everyone. And that's why we have the broadest portfolio. So we have two CGMs to choose from, depending on your preference. With Simpler and Instinct, we have a tubeless option today. It's called Inpin. So if you don't even want to wear a pump at all, but you can have a bit of help with technology. We have inpaint with our cgm, we're working on our next generation tube pump called Flex Mini Bed Flex. And then we also have a patch pump in development that we call Mini Med Fit. So Some people are going to want a patch pump and some people are going to want a tube pump and they, they like being able to detach from their pump or not having such a large surface area. If you look at the size of the infusion set versus the size of a patch infusion set's tinier on your body. So there's going to be preferences. So we believe in actually having a portfolio. So people can maybe want to pump holiday or they can pick the impin for that. But we actually do get a lot of people who aren't in good control. They're not doing well with the patch pump or our competitor systems. And so we offer trials and people can trial our system and it is a different experience. It's a bit like until you really get on our system, it's hard to you go, well, it must all be the same. But it isn't. We don't think AI systems systems are the same.
- [30:06]
A
No.
- [30:07]
B
And so we encourage people to try our system and we actually get a lot of people converting from patch and seeing actually the algorithm, how the system work makes it worth it. But some people won't and that's okay. And that's why we have a patch in development.
- [30:21]
A
I want people to have choice. I think it's incredibly important. So you see the space as tubed, patch and tubeless, like is that. Are those kind of the options there? And you're going to jump into the other spaces. I mean, what's the time frame on that?
- [30:34]
B
Today again, we serve people who are on intensive insulin therapy and if you look at that cohort, say in the developed world, there's about 10 million people, so one and a half million of those are on tube pumps today. They like it. And you've got about half a million who are on patch pumps, but then the vast majority are on mdi and we think those people should have the benefit of a bridge between just pretty low tech, where they've got to do all the work and a bit more software to help them do better. And so that's where the inpen system, we call it minimed go. The inpen system comes in. It helps you not stack insulin if you don't. Maybe you forget when you dose incident last time. It gives you data that your doctors have so you can have a better discussion about your therapy and how you're doing things that you can do to be better. It helps time your doses more accurately. And so inpenn has a lot of value for the. Call it 6 million people on MDI that don't have the benefit of technology and we want to help them too. So we actually have a solution for all three cohorts and our goal is again, the trifecta of we want you to have if you're below 70% time in range and your A1C isn't good, we have the solution for you. And that isn't going to raise your therapy burden and isn't going to make you compromise on your lifestyle.
- [32:05]
A
Right? Oh, that's awesome. Gosh. I've talked to a lot of people about impens over the years and I know a lot of people that use them and find them really valuable. They talk about it as having a lot of the data functionality of a pump without the pump itself. I wonder about this all the time. Those numbers you just said about there's certain amount of people on pumps, certain amount of people, a lot of people just shooting MDI still, are those people reachable? Are they missing it because they have bad advice from physicians? Because they don't have insurance, because they don't have education? Like, what do you think is keeping them from pump therapy?
- [32:40]
B
I mean, you said it. It's, it's a lot, A lot of it is just knowledge and education of what's out there. And, you know, people may be comfortable, like they may say, I don't want to wear a pump because they don't have experience of wearing one. And so they think it's, it's yet another thing you have to do. That's why there's so much to do in a day if you have diabetes. It's hundreds of decisions. We don't want technology to be yet another thing you've got to do.
- [33:03]
A
Right?
- [33:03]
B
So you take 7ADG with Instinct as an example, and our 7 day infusion set, it's 6 perks a month compared to 12 to 16 with other AIG systems. People used to care about finger sticks. You don't have to do that anymore. We got six perks and so that matters. And that's why our mil detection technology is important. The automation is important because we don't, hey, you don't, you know, perfect bolusing, no problem, right? So Mandg has these auto corrections. It's really the only system on the market with this mill detection. And so people find that liberating. You know, I had patients tell me I, you know, they had a day where they were doing graduations, meals were all over the place. It wasn't their regular routine. At 78, the automation just kicks in and delivers that. The Insulin they need, you know, so I think education is part of it. I think it's also people's preferences and so we want to meet people where they are. We don't want to go, well, you should be on a pump if you don't want to be. That's why we have input.
- [33:59]
A
Yeah.
- [33:59]
B
But we do believe that we can help you and get you a little bit better so you have to do less work. And actually a lot of times when people come into our ecosystem, say on, on Mini Med go, they then say, actually this is good, maybe I'm willing to try a pump now. Maybe I want more automation. It's education. And then, you know, as you know, there's a shortage of endos around the world.
- [34:21]
A
Yeah.
- [34:22]
B
So a lot of it is primary care. They don't always have the latest and greatest in terms of what's available. And so we have to do a better job. Honestly, you know the industry to, you know, get the word out.
- [34:32]
A
You got to educate the educators and make the.
- [34:35]
B
Exactly.
- [34:35]
A
I think to making the algorithm such that a doctor can feel comfortable not understanding it but still prescribing it.
- [34:44]
B
Yeah.
- [34:44]
A
I mean, how do you decide then? There's only so many hours in the day. Right. Like, and there's a lot of things to do. You've got to get your pumps and your CGMs around the world. You've got to improve the algorithm. You try to make your hardware smaller. How do you prioritize what to do next and what's most important? I mean there's gotta be a big roadmap. Right. But how do you figure out which is which?
- [35:06]
B
Well, we think of it in generations. So you know, we were first with the 670G system. 780 was a second gen system that's really five years now in the market. And we're very, very close in getting our third generation system out. So that's come from a lot of feedback and interactions with all of our, with our customers. I mean it's hundreds of videotape videos to figure out features that we want to invest in. And so we've been hard at work. Like we can't always talk about what we do, but we've been hard at work every day getting this third generation system out. Starting with the CGMS last month with new form factors on the hardware and then of course our next generation algorithm which we're super excited about. I think really Scott, if I reflect on how we as an industry are doing, I think the fact that the penetration of aid which is superior to mdi. It has such low penetration in the United States and around the world. Is because technology is a burden. That's our goal. We got to make technology not a burden. So you actually don't have to do much and not a burden. Also on busy clinics. And so with 780G, a clinician just has to really know the insulin to carb ratio. That's really it. We don't have a lot of dials you need to turn. If you go with our recommended settings of 2 hours and a set target of 100 or 110, all you have to figure out is the person's individual insulin to carb ratio and you're off to the races. That's 780G. In the future, it's going to be even less than that.
- [36:44]
A
You said something a minute ago that I just got back from. I don't want to say the company, but I just went out and gave a talk to a pretty big organization, right? Because they help people with diabetes all day long. But a very small percentage of the people that work there have diabetes or know somebody with it in their minds. It's a, you know, it's a widget, right? It's a thing I do every day. I get to work, I work on code. I don't know the code says this about that like it doesn't matter to me as long as it works in the end. I've heard you say a couple of times, like, we brought people together and we asked them, like, what are we doing? Where are we missing and everything. Can you talk about some of the things that those conversations brought to light? What did you say to yourself? This is what's important. Because I know what I think is important. I think that meal detection technology is a huge thing for me. Right? You should be able to miscount a carb or forget for five seconds and not end up with a blood sugar of 250. You should be able to fall asleep without waking up at 300. Like that kind of stuff. I think that's huge. I think sets working well, not having to be changed all the time. Really great. Sensors that don't fail, that report accurately, that make people actually comfortable using aid. Like that stuff's really important. I don't want to call it on the ground actual lived experience stuff. I think is what's most important. But I'm wondering, you coming from an outside perspective and then hearing those people talk, what struck you in those conversations?
- [38:07]
B
Well, typically our process is we always involve our customers. We always and we don't go to them and say, would you like this feature? We ask them what problem would they like to solve in their life. And it's based on that, that then we go through a very complicated process to figure out how do we innovate to solve that problem. So it's not about, hey, here's 10 features, pick the ones you like the best, right? And so that's how we came up with male detection technology. Like it, we have that with 780G because no one counts carbs correctly. Nobody actually it's estimation, it's no one actually counts carbs. And so that's why this was being very liberating because you don't have to be exact at all and feel bad about that. And so you describe seven, eight exactly. That's why in our portfolio we think about the different preferences people have. So I'll give you an example. Let's say with instinct. Why do we have instinct? And simpler. When we developed our sensor, we did that with insulin dosing in mind. One of the things that our loyal in store base likes to do is they like to be in tight control, right? They were known for, you know, very superior clinical outcomes and really tight control. So they like to occasionally calibrate their sensor, right? Because it just helps them, just they want to manage it more. And so with Simplera you can do that if you want to. You can calibrate your sensor, get tighter control. With how Libre started, they started with as a diagnostic. It wasn't built with aid in mind in the very beginning. And so now it's a great sensor and it can be integrated into aid, but you can't do that now for some people, they don't care. That's not important to them. But for certain people who want tight control, they do care. And so that's what's behind a choice and why we have different sensor options and why we have different dosing options. We want to be able to meet people where they are and not force people to, well, you need to do this. And that's what's behind all the investments we've made. We don't want technology to be a burden. We want it to be a companion, an aid, a tool. And the holy grail for us is if we can take away all that work and still give you the health outcomes you want, no fear of hypo, get your hyper back in range very aggressively and help you deal with long term complications. If we can deliver that but not add to the burden, but help you live your life Right. That's what we work on.
- [40:38]
A
So how much ceiling is left in that algorithm? Like, how many more dials can you turn until it. It's giving you that kind of like, is there a world in your mind where people could be 90% in range and never low for days at a time? Like, is there, you know what I'm saying? Like, is there room in that algorithm for improvement? Or does something have to be. I don't know what I'm asking, like, does something have to be invented before that's going to happen next? Like, are we at a peak right now or are we still in a version of learning about it?
- [41:09]
B
Well, with 780, I mean, in the real world, we've got a lot of studies in the real world, evidence of over 350,000 patients on 780. In this particular study, I can actually send you the publication if you're on our recommended settings. On 780, you're getting 80% time in range without doing a lot to get that.
- [41:32]
A
What's the range you're using?
- [41:33]
B
70. 70%, 80% time in range. Using our recommended settings, what is that range?
- [41:39]
A
Like 70 to 180 or like, where do you set the range to do the measurement?
- [41:43]
B
The range is 70 to 180, so the consensus driven range. And then if you're talking about 70 to 140, which is where people who don't have diabetes spend most of their time in, we're at 55%, what we call time in tight range. So 780 already gets there. But we absolutely believe that where this is going is we shouldn't have any buttons at all. And you're getting above 70% timing range, that's really where we want to push the envelope. But if you want to have even tighter control, because we have people on Facebook with 780 saying, I got 100% time in range. And, you know, they're proud of, you know, you know, hitting sort of goals like that. For people who do want even tighter control, we want to be able to give them the option that if you want to engage, get more tight control, you can do that, but you don't have to if you don't want to do anything. We want to help get you above 70% time and range. That's, that's where the future, the algorithm is going to go.
- [42:41]
A
Does that algorithm need to include some AI at some point? I'm going to be very like ham fisted about this, but are you going to have like your own little AI agent inside your pump that's like looking at your food and decisions and helping adjust more than just what the math tells it.
- [42:54]
B
We don't need to do that, Scott. We use a lot of AI in the development of our products. But think of it as a lot of AI requires you going to the cloud and having a lot of compute. And if you think about the pumps, we have our algorithms on the pump because you're not always going to be connected. Like you could be hiking in the mountains in the wilderness and not having Internet connection. Our pump's going to work. The algorithm's still going to work. Right. It's not dependent on all this infrastructure. So from a safety standpoint, we have to be extremely efficient. How the algorithm works on the pump, because it's not a supercomputer, it's a pretty smart device. But AI isn't used in the development. But we don't need. Our algorithm is very good because we have had hundreds of millions of points of data on CGM and insulin over the last call it, decade of algorithmic development that we don't need to have gen working in the pump for us to deliver an even better algorithm in the future.
- [43:53]
A
So the math will handle it at some point better than I imagine it can.
- [43:57]
B
Yes.
- [43:58]
A
I've heard you say a couple of times, no buttons. So right now when I hear people talk about that, they'll say, well, that was great until I got my period. Or that was great till my, my kid had a growth spurt. Or that was great until, until. Until. And then I need to set a temp. Basil. I need to do this like, et cetera, that along in the future idea to you. Like we have a couple of go before it's buttonless. Or is that more of a way of thinking about, like, there'll still be buttons, I can make adjustments, but I just probably won't have to touch them very often.
- [44:26]
B
We want to be able to serve people who don't want to do anything, because you got a lot of those. But if you want to do something, we will provide options if you want to engage more. But that engagement isn't like many dials and buttons. It's super simple, but you're always going to have a spectrum of people who, they want to be more active in managing their diabetes and they like doing that because they want to be super tight. But for other people, they don't want to do anything at all.
- [44:53]
A
Right.
- [44:53]
B
And so we want to accommodate both. But yeah, the. I think the holy grail is just not having to do anything other than Put insulin in.
- [45:02]
A
And in your mind, is that the thing that opens you up to find those other millions of people?
- [45:07]
B
Yeah, I think it will attract a lot of people and you know, probably a lot of type twos. Right. Because you know, typically they, they're willing to do less if technology is just in the background. You know, just imagine like a self driving car.
- [45:22]
A
Yeah.
- [45:22]
B
And you don't have to drive it. I think the adoption will go up, but if you still have to do a little bit of something, you know, for some people it's not worth doing that versus what they're doing at the moment. So we want to make it easy because we think that people will be healthier if they are on aid. Look at a 1Cs in the US it's above 8, despite the fact that CGM penetration is 70, 80%. Pretty much if you need a CGM and you're on diabetes, you need CGM, you're going to get one. It's not good. So people need help with insulin dosing and diabetes management, but it's still too much work.
- [46:00]
A
I talk about this a lot, that it could get easy to get into this ecosystem that I've created here and think like, oh, everybody's got like a six and a half or a five, a one C or something like that. But the vast majority of people that are on insulin and eight, I interview people all day long that, you know, they have 12s, they live with, they have complications in their 30s. Right. And they're not. When you talk to them, what always strikes me over and over again that it is not a lack of their. They're not, not concerned, they're not, not trying it just for reasons that are hard to kind of like compute, like human reasons just not working out for them. Well, and those are the people I think about all the time. Also. Those people often see their general practitioners about their diabetes on top of everything else. They need a thing that you can just go, look, take this. This is how it goes on. This is where you put the insulin. Here's your A1C in the sevens. That's life saving for a huge swath of people who need insulin every day.
- [46:55]
B
Anyway, Scott, I'm with you. It's so sad. And that's why we really believe 780 can help people like that. Because look, people try and life gets in the way and you got kids, you got a job. I mean, it's not easy. So that's why we really believe if you're not doing well and you're not in control and it's a lot of work. You're not getting the return on the effort. We think 780. Try 780 because we think it's for very little effort. You're going to get great outcomes and feel better.
- [47:30]
A
Okay.
- [47:30]
B
Every day.
- [47:31]
A
So my last kind of question, it's going to be a little jumble here. Seven 80G ready to go. Now lots of CGM options. You're going to like it, go give it a shot. But you're working on other stuff too. Patch pump, tubeless option. I'm going to ask you how long do you think until people see those? And then my last, last question, which I think you can dovetail into is if you come back here five years from now. We started by talking about like you know, where Medtronic started, you know, like get that old CGM people, you know, people used to call that CGM a harpoon. Right. So you've gone from there to like where you are now to where you're trying to go. So five years from now I get you back on here and we're talking. What are we talking about? Where are you at at that point?
- [48:15]
B
Great question. So for the first part we got 7 AG2 new sensors. Give it a go. And on the new, the new durable pump, the new patch pump and then a new algorithm for the durable pump. We said that we're going to submit very soon on that in our fiscal year. In a month or so I'll be able to share a bit more timelines on a bit squeeze with our process at the moment separate from Medtronic to reveal too much. In a, in a month or so we'll be able to say the timelines on those. But it's very, we're getting to the tail end of those new products so we're really excited to introduce that to everyone. But in five years time, you know, I hope people will be saying that mini med just works, that's our goal and that it just fits into their lifestyle. They don't have to do anything, they just live their life. That's what we want to be able to contribute to and that we've truly entered a hands free era that you just put insulin in, it just works, you don't have to think about it. And so that's where we think our third generation system is going to be there. And life was like diabetes is a little simpler and you can move on to other things. So that's what we hope. And you know, but I tell you what Scott, I'll come back in five years time on your podcast and we'll have a discussion about it.
- [49:32]
A
Awesome.
- [49:32]
B
But that's what we hope a free a hands free era with mini Med.
- [49:36]
A
I hope too. Maybe you can come back a little sooner and tell me a little more about these new pumps when you're more free to talk about details. Also, I'd like to ask if you've ever owned a bearded dragon because you lived in Australia, but we don't have time for that.
- [49:47]
B
I do. I do have a Rankian's bearded dragon.
- [49:50]
A
You do?
- [49:51]
B
I do.
- [49:52]
A
Oh, they're the small squad Fizz. Yeah, the smaller ones. How old is it?
- [49:56]
B
One year actually. One year on Veterans Day.
- [49:59]
A
Oh wow. We don't have time now but the reason you're There's a green screen background behind me because behind me is my Parsons chameleon and like some other little things I keep in my office. So we'll find more time later. I'd love to know about your Rankin's dragon. I'm not kidding. Thank you very much for doing this. I really do appreciate your time. Thank you.
- [50:16]
B
Yeah, it was fun. Thanks Scott.
- [50:18]
A
Awesome.
- [50:18]
B
Foreign.
- [50:24]
A
I'd like to remind you again about the MiniMed 780G automated insulin delivery system, which of course anticipates, adjusts and corrects every five minutes 24 7. It works around the clock so you can focus on what matters. The Juice Box community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, Visit my link MedtronicDiabetes.com Juicebox if you've listened to any number of podcasts or maybe watched a YouTube video, you're very accustomed to listening to the creator of that content. Ask you, and sometimes just outright beg you without any feeling of self respect for you to follow. Subscribe, share an episode the reason that happens in podcasting specifically is because podcast players don't have a sophisticated Recommendation engine like YouTube or TikTok does. They can't watch listener behavior and then give you content that you might like. Word of mouth skips that line completely. It's an instantly expanding reach engine and really the only thing I've ever found that helps to keep the Juice Box podcast growing. So subscribe and follow because that the algorithm understands. Set up automatic downloads. Listen to the show, but share it with somebody else. Leave a five star review. Make it a thoughtful review that the algorithm can understand. I really appreciate the time it takes you to do those things and I hate that I have to say this to you because I feel like an idiot. But subscribe and follow. Tell a friend please and thank you. Have a podcast. Want it to sound fantastic? Wrongwayrecording. Com.