{ "docId": "019dd923-622c-750b-8b98-916758668d1f", "docSlug": "34401c2968d1", "documentTitle": "Dexcom, Inc. (DXCM)", "authorId": "54_Spruce_Point_Capital", "authorName": "Ben Axler", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2019-03-21 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 29, "pageCount": 83, "prevPage": 28, "nextPage": 30, "slideType": "quote_slide", "function": "cite_precedent", "density": "dense", "nDataPoints": 0, "notes": "The slide uses three distinct callout boxes to present expert testimonials.", "elementsJson": [ "headline_text", "paragraph", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b98-916758668d1f/29", "deckHref": "/decks/019dd923-622c-750b-8b98-916758668d1f", "deckJsonHref": "/decks/019dd923-622c-750b-8b98-916758668d1f.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b98-916758668d1f#slide-29", "components": [ { "bbox": null, "kind": "callout", "text": "It seems well-understood in the medical community that the Libre will likely largely close any remaining gaps in accuracy versus Dexcom’s CGMs prior to FDA approval.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd952-f5d2-7501-bd8a-b85102e70ad2", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.09, "w": 0.96, "x": 0.02, "y": 0.16 }, "kind": "paragraph", "text": "In the course of our diligence, we interviewed numerous manufacturers, endocrinologists, engineers, and medtech experts to better understand the most important characteristics needed in a CGM. It seems well-understood in the medical community that the Libre will likely largely close any remaining gaps in accuracy versus Dexcom’s CGMs prior to FDA approval. We believe that a high / low glucose alarm is the most important differentiating feature of a CGM for more intensive users. Abbott’s FreeStyle Libre 2 system, which will be approved in 2019, will offer this feature at a significantly lower price point than Dexcom.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1e660e12-312d-4557-9175-709729f1f2fd", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.16, "w": 0.96, "x": 0.02, "y": 0.28 }, "kind": "quote", "text": "Once something is good enough, then you standardize it, and then you can interoperate. I use the metaphor of screws, once you converge on how many threads per inch and diameters of screws then innovations stops at the screw level and it goes up a level to machines. What machines can we build from those screws. So that commoditizes the screws. So, vendors are generally reluctant to do this. If you are a screw maker, 'look I got a fancy screw. I should get more money for my screw. Fortunately or unfortunately, many of these base technologies like CGM and insulin pumps are now sort of at that screw level that they are all good enough. They are serving the needs, they are accurate enough. Now we are going to see innovation one level up, at the machine level at the automated insulin delivery system.' - Lane Desborough", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "29fdd8db-d213-4267-ac76-44d95c9e0045", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.23, "w": 0.96, "x": 0.02, "y": 0.72 }, "kind": "quote", "text": "From a clinical perspective, we are now nitpicking [in regards to accuracy of CGMs]. As long as the patient know that [they need to react] that is more important.... In the life of the user, the differences [in accuracy between Dexcom and Abbott’s CGMs] will not change what the patient will do. Whether the reading is 52 or 62, the patient behaves the same way. I don't think the accuracy argument negates [Abbott over Dexcom]. It does not make a difference to me which [CGM] they use, the data is the data. As long as it is accurate enough for decision making [which they all are]. [Libre 2] having the alarms will even the playing field because this is the most common complaint for the [current version]. The Libre 2 is going to level the playing field. The Libre 2 is going to be a significant improvement. A patient who is seriously thinking about a CGM, it is going to be more about cost, [logistics of obtaining the device, and ease of use] rather than worrying about the nuances of accuracy. - Renowned Endocrinologist With Significant Patient Treatment Experience", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "6a8613b6-e18b-47ae-9ef1-e0c7bcc8a57a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.23, "w": 0.96, "x": 0.02, "y": 0.47 }, "kind": "quote", "text": "We looked at lot of detailed performance data for the Libre sensor. The difference in accuracy [between Abbott and Dexcom] is not that significant when it comes to feedback control. For closed loop feedback systems [the] absolute measurement of the sensor is not that important. What is more important is the rate of change of the continuous glucose monitor.... When you take all of these things into account, the better performance of the Dexcom washes out...it is not as significant. I don't think the error rates between [Abbott and Dexcom] are consequential. Abbott has been in a very similar path [compared to Dexcom in regards to improving accuracy in hypoglycemic range]. I would not be surprised if the next generation of the Libre system gets even better in [the hypoglycemic range] as well. If you look at both of them. The core technology that both Abbott and Dexcom have been using, is the exact same core technology that they started using ten years ago. It is exactly the same technology. - Former Senior Engineer, Diabetes-Related Medical Tech Company", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9262fe5a-7757-4287-9a69-0fd7a14047a8", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "Once something is good enough, then you standardize it, and then you can interoperate. I use the metaphor of screws, once you converge on how many threads per inch and diameters of screws then innovations stops at the screw level and it goes up a level to machines. — Lane Desborough, Chief Engineer and Co-Founder, Bigfoot Biomedical", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd952-f5d2-7501-bd8a-bff5add74ed1", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.06, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Medical Experts Agree: CGMs Are Heading Towards Commoditization", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "99aaeffe-1732-488e-938d-255589b4f008", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "authority-citation", "slug": null, "matchId": "5bb37442-dc3a-499d-a2a8-890966deb4a6", "evidence": "Citing medical experts and engineers to validate the commoditization thesis.", "confidence": 0.9 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }