Telemedicine Is Changing the Game in Diabetes Management

There was a lot to unpack from Dexcom's first-quarter earnings call this week, but one of the key takeaways from management comments is that diabetes patients and caregivers are latching onto telemedicine as a way to stay on top of their glucose levels during COVID-19. This isn't surprising, given that we've seen a substantial increase in telemedicine adoption across healthcare during this crisis, but it is especially important for newly diagnosed patients needing continuous glucose monitoring (CGM) technology.

"Our extensive virtual resources for patient and clinician training and customer support are proving to be especially important as the world embraces the increasing use of telemedicine platforms," CEO Kevin Sayer said during the call, according to SeekingAlpha transcripts. "The drastic but necessary steps to mitigate the spread of the virus have also created some areas of unpredictability for us as we continue in our second quarter and the remainder of 2020. We have seen some impact in new patient opportunities since the broader social distancing measures were put in place in mid-March."

Previously, CGM adoption was driven primarily by office visits during which physicians saw a need to recommend the technology to a diabetes patient. Sayer and other executives on the call seemed hopeful, however, that telemedicine patient encounters will provide a channel for those new patient CGM recommendations to continue.

FDA recently removed the three-hour delay requirement for CGM data into the Clarity software, allowing for faster data integration, Sayer said. That means Dexcom's remote monitoring solutions will be further enhanced in both the hospital setting and for telehealth patient consultations, he said.

"In these early days, we have seen the benefits in the shift to telemedicine because Dexcom’s real-time CGM is connected," said Quentin Blackford, Dexcom's COO and CFO. "It has become one of the primary methods for physicians to monitor their patients and get newly diagnosed patients up and running."

An article published last week in Diabetes Technology & Therapeutics highlighted the way that telemedicine benefited two newly diagnosed diabetes patients (type 1), a 20-year-old male and a 12-month-old female. Both patients were recently given a Dexcom G6 CGM and treated via telemedicine.

"Using G6 and our software tools, clinicians at the Barbara Davis Center in Colorado were able to significantly improve the glucose levels of these patients through virtual care," said Steve Pacelli, executive vice president of strategy and corporate development at Dexcom.

As a further testament to how much awareness of Dexcom's connectivity with telemedicine has increased during COVID-19, the company hosted a telemedicine webinar last week that drew in 900 participants, demonstrating newfound interest from physicians.

"We don't get 900 people to anything here. That was a huge win for us as we talk and learn more about that," Sayer said. "We think we solve a very serious problem by getting data to patients and their caregivers in a very timely basis."

What to expect in a post-COVID world?

As MD+DI has previously reported, telemedicine is here to stay.

"We believe that telemedicine and virtual connectivity capabilities will create a more efficient, organized healthcare continuum – connecting clinicians, patients, and medtech companies perhaps to a degree that we have not seen before," said Jason Mills, a medtech analyst at Canaccord Genuity, in a report published April 13.

Kyle Rose, another medtech analyst at Canaccord Genuity, noted in a report this week that the Dexcom G6 is "very well-suited" for the telemedicine opportunity because it is already equipped with remote data tracking capabilities.

Beyond the telemedicine opportunity, COVID-19 may also motivate people to be more proactive about their health in general.

"I think if anything, people are going to be more concerned about controlling their diabetes to make sure they're healthy," Sayer said. "So, if something like this happens again, that will not become a complicating factor because their diabetes is in control, not running rampant. So again, we see this as an opportunity to almost increased retention and increase usage within our current patient base as much as it is to grab new ones. So, I don't want to sound too opportunistic about this, but we have an answer to a serious problem here and we think people will come to it."

Leveraging the hospital opportunity

FDA has given both Dexcom and Abbott permission to supply CGM systems for use in the hospital setting during the coronavirus pandemic. This allows frontline healthcare workers in hospitals to remotely monitor patients' glucose levels while minimizing exposure to the virus that causes COVID-19 and preserving use of personal protective equipment.

"Recent data published in the Journal of Diabetes Science and Technology shows the clear need for glucose control in the hospital and cements the reason we are so committed to assisting in this crisis," Pacelli said. "The study found that the COVID-19 mortality rate for people with diabetes or hyperglycemia even in non-diabetics during their stay was more than four times greater than patients without diabetes or hyperglycemia."

Even more alarming for those who had no evidence of diabetes prior to hospitalization who developed hyperglycemia during their stay, 42% died in the hospital, Pacelli said.

If CGM works in the hospital setting the way they think it will, we could see the hospital setting become part of an expanded indication for CGM devices down the road, beyond the pandemic.

"There's a lot of complexity around running this product in the hospital and we do appreciate the FDA working with us and talking to us. I mean, when you think about a patient in the ICU and all the other vital signs that are being measured and all the other signals going back and forth, we now have an opportunity to make sure our product can function in that environment," Sayer told MD+DI in an interview earlier this month. "On top of that, the sensor on the body, we want to make sure that all of the drugs and the compounds that these patients are subject to don't interfere with the sensor's accuracy. So, we now have an opportunity, in real time, to see how the product performs and we are going to gather up all this data and build the file and show real-time data on how it works. And if it does work the way we think it's going to and the way we think it does, we hope to turn this into a longer-term situation with the hospitals."

Dexcom's management team also suspended its 2020 revenue guidance due to COVID-19 impact uncertainty, and said it expects its G7 pivotal trial to be delayed by about six months. Click here to read more.