A leading developer of sensor technology, Dexcom believes data has the power to revolutionise diabetes care. Saša Janković reports
Rates of diabetes continue to rise across the world, with data from Diabetes UK estimating that 415 million people are living with the condition – that’s one in 11 of the world’s adult population. This figure is expected to rise to 642 million people by 2040, despite the fact that diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
As the concept of the ‘expert patient’ and the idea of self care gain traction among healthcare professionals and the public alike, the ‘knowledge is power’ ethos has become a guiding principle for Dexcom, a California- headquartered company that has been working on developing simpler and better ways for people to measure, track and manage their diabetes for the past 20 years.
When Dexcom started out, the only tool available to measure blood glucose levels was the fingertstick test, which gave patients and their clinicians a snapshot of one moment – making it difficult for people to understand their glucose levels over time.
In the intervening years, Dexcom has developed real-time continuous glucose monitoring (CGM) sensor technology systems for people with type 1 (T1) and type 2 (T2) diabetes. This gives users a fuller picture of their glucose numbers and trends to help them better manage their condition.
UK and Ireland
After previously using a distributor for its products in the UK and Ireland, Dexcom decided to go direct in 2016, and set up an office in Camberley, Surrey, to manage its operations over here. It now has almost 100 staff working there, as well as more than 300 people at its EMEA arm, based in Edinburgh, growing its headcount during the pandemic as well as its patient reach.
“Diabetes technology is moving at an extremely fast pace,” says Ben Byrne, country director for Dexcom UK & Ireland. “While supply has generally been dealt with in secondary care, updates from NICE guidance are now pushing this more into primary care as secondary simply cannot support all those patients.”
Indeed, with a population of some 400,000 T1 patients across the UK and Ireland, and the NICE position that real-time CGM should be offered to patients with T1 diabetes, Mr Byrne says Dexcom has 15 per cent of that population using real-time CGM, up from less than one per cent in 2016.
Light bulb moment
The Covid-19 pandemic has also had an effect on uptake. “I’ve worked in the diabetes space for almost 20 years and there has always been this mindset that patients need to come into the surgery or hospital every three to six months to be seen,” says Mr Byrne.
“But the pandemic highlighted to the NHS that patients can self-manage and, from a clinical standpoint, be managed virtually, thanks to the use of video calls, as well as software like ours. There’s been a bit of a light bulb moment in industry and healthcare about what tech can do, and while it won’t work in all areas, T1 and T2 can certainly be managed this way, and that frees up surgeries and hospital time for the patients who really need it.”
Another benefit of managing their diabetes with CGM systems is better engagement and compliance from the patient.
“Patients face hundreds of extra decisions a day that a person without T1 diabetes doesn’t, looking at how diet and exercise affects their blood glucose, and what insulin decisions they have to make,” adds Mr Byrne.
“Our products give them multiple data points in a day of what their blood glucose is, so they can make more effective decisions because we are able to give them more information.”
With Dexcom in the UK and Ireland growing during the pandemic “in line with expectations rather than the pandemic stopping growth”, according to Mr Byrne, the next step in the company’s plan is to expand the use of sensor technology to anyone on insulin managed through secondary and primary care, including in community pharmacy.
“There is a massive opportunity when you look at people on insulin and compare the number on an insulin sensor, versus those still pricking their finger,” says Mr Byrne. “The NHS says that within the T1 community, about 70 per cent of patients are using a sensor (ours and others), so that still leaves 30 per cent who are not. Going forward, we are looking at how to support the rest of that T1 community as well as moving into the T2s who inject.”
As for bringing new products to market, he says: “We are always looking to improve our product, and launched two new ones in the UK last year – the Dexcom G7 real-time CGM system for people with T1 diabetes who may need extra support, such as people who are hypo unaware or children; and the Dexcom ONE real- time CGM system for people with T1 or T2 diabetes using insulin who are looking for an easy and accessible real-time CGM system on prescription.
“We are still in the launch phase of these at the moment,” he adds, “but outside of diabetes, we are looking at how we can use our sensor expertise in other areas too.”
In the meantime, there remain some barriers to using CGMs that still need to be tackled. There are, of course, certain clinical criteria that NICE has set out for clinicians to work to in order to determine which patients qualify for CGM technology. Then there is funding. Dexcom ONE became available on the Drug Tariff in March this year, but the company’s two other products are funded through specialised commissioning.
“When we first started, a lot of patients did self-fund to purchase products where there wasn’t initially a lot of funding available through the NHS, so there will always be an element of self-funding,” says Mr Byrne, “but my goal is that no one with T1 or T2 should have to pay out of their own pocket, which is why we are continuing to work with the NHS to address this.”
And while he says “the NHS across the nations see the benefits of sensor products”, there will always be “a small minority” of the population who are happy pricking their finger.
“Part of self managing is,” he says, “from an education standpoint of ‘what should I do if this happens in order to get the best outcomes?’
“This means there also needs to be capacity within the healthcare system for training patients to use these products and interpret the data."
Mr Byrne sees a “massive opportunity” for community pharmacy to engage with patients on this, especially as they are so used to blood glucose meters. “Dexcom ONE only recently went onto the Tariff,” he says, “but our plans beyond this are to help community pharmacy with product education on how they can support their patients.
“We definitely see the role of community pharmacy as key, but it’s now down to us to help them to work, collaborating with us and our patients. This includes FAQs on cost and how to order the products, as well as webinars for pharmacists, a dedicated community pharmacist website and other supporting materials.
“There are lots of patients out there who could benefit from the use of sensor technology, and we have three products that I believe are the best in the marketplace.
“It’s about what is the right product for the right patient and I believe our portfolio can support 99 per cent of those patients, but we all need to work together to promote what this kind of tech can do.”
Further information www.dexcom.com/en-gb