DexCom, Inc. (DXCM) Earnings Call Transcript & Summary

Good morning, everyone. I'm Robbie Marcus, the med tech analyst at JPMorgan. Thanks for joining us at the first session to kick off the 2026 JPMorgan Healthcare Conference. I'll give a warm welcome to the DexCom's CEO, Jake Leach. It's his first time as President and CEO up on stage here. Jake?

All right. Good morning, everybody. Thank you, Robbie. It's an absolute privilege to be able to kick off the conference this year, particularly as my first year as President and CEO of DexCom. And one thing I just have to say, I'm incredibly excited about the opportunity that DexCom has to make an impact on metabolic health. Before I jump in, a quick reminder of our safe harbor statement, and I assure you this presentation does include some forward-looking statements. DexCom is synonymous with pioneering in the CGM industry. You can literally map the history and the development of this category based on the innovations that DexCom has brought to the market, being the first CGM to ever have a real-time hypoglycemia alert, the first CGM to have a remote monitoring system for caregivers and loved ones, the first CGM to replace finger sticks and the very first CGM to be available over the counter. All of this innovation has changed the way diabetes is managed. And we've paired all of this innovation with very robust clinical data and randomized controlled trials that have led to access and coverage for CGM for millions of people around the world. I really love speaking to our customers about how this innovation has changed their life. I remember speaking to a mother of a child with type 1 diabetes right after we launched our remote monitoring system, the Follow app. And she used to plan her entire day around going to her daughter's school to double check her glucose after lunch to make sure she's eaten the right amount of food, make sure she has taken her insulin. With the launch of that new feature, she was able to completely change her life. She could just open up an app and check on her daughter any time. Now innovation like that comes from being relentlessly focused on bringing new technology to the market that solves real problems for real customers. So the technology that actually sat behind that remote monitoring system was the connectivity to smartphones. When we first started prototyping that many, many years ago, we were actually working with BlackBerries. You guys remember that, we all love those keyboards. It was literally the technology at that time. And what we found very rapidly was the Bluetooth technology was too power hungry, [indiscernible] bank our wearables too big. We couldn't do it. So we actually went and advocated to Apple, to Samsung, travel to Korea, travel to all these manufacturers trying to advocate for a better way to connect our device to a smartphone. And they all looked at us and said like, "You guys are med tech. What in the world are you talking about?" And we said we want to combine the experience of this type of technology with a smartphone. And so ultimately, once Apple adopted low-energy Bluetooth, all of the other companies did as well. And that is now -- that technology is at the core of most connectivity for diabetes devices. So I'm -- as I step into the role of CEO, I recognize that my journey is DexCom's journey. And despite all that we have accomplished, diabetes remains an escalating health and economic crisis with so many health care dollars spent treating diabetes and the complications of diabetes. And if you look at the population of people with diabetes in the world and as it continues to grow every year, and let's think about that against the backdrop of CGM category growth. CGM over the past decade has been one of the largest, fastest-growing categories in med tech. Today, we estimate that there's about 10 million people around the world using CGM. And if you think about that 10 million against the backdrop of the diabetes population, it's less than 2% of the population is using CGM. If you look at prediabetes, 40% of adults in the United States have prediabetes. This crisis is not slowing down, and we have a technology that can make a significant impact. And so what this tells me is that we're nowhere near done, and we need to lean into our leadership in innovation and patient outcomes to really shape the future. So I laid out 3 key priorities for the DexCom organization to really help us unlock our next phase of our growth. The first is we will be the premier glucose solution for all: that's all customers, all prescribers and all partners. Glucose is at the heart of managing diabetes and metabolic disease, and we're going to enhance every aspect of our CGM sensing solution. The second is we will set the standard for customer experience in this category. Our customers expect meaningful and seamless interactions and we are going to continue to enhance every aspect of their journey with DexCom. And finally, we're going to expand our international market share. We've built our company based on leadership in the United States. We're going to now take that and apply it to the international markets, particularly our ability to open up access and coverage for people with CGM to unlock new opportunities that don't exist today. This requires our team to focus and operate on a scalable foundation and infrastructure and the opportunity in front of us is tremendous. Our teams are motivated to execute and help guide people towards better metabolic health. And it's because DexCom's impact is human impact, our mission is personal. These are all pictures of personal moments that are enabled by DexCom's technology. And my commitment to you and to the employees of DexCom and to the diabetes community is that the customers are at the center of everything we do. My background is an engineer. I value precision, I value problem-solving and continuous improvement. And that -- those values align well with DexCom's mission to innovate and drive patient impact. Now our journey forward requires us to balance the successes that we've had with all the learnings that we've had along the way. And I would say 2025 was a year of success and learnings for DexCom. Today, we announced full year 2025 revenue of approximately $4.662 billion. That represents growth of 16% or 15% on an organic basis over 2024. Now that is just above the guidance that we gave on our Q3 earnings call, that we raised on the Q3 earnings call. We did this by adding a record number of new patients to DexCom. We exit 2025 with approximately 3.5 million active customers, which is an increase of over 20% from where we exited 2024. We also saw a significant uptake of our Stelo product. One thing to note is the 3.5 million active base does not include those Stelo customers. But if we look at Stelo, it was a really nice tailwind for our growth with $130 million in revenue in 2025. We also saw in 2025, the most significant expansion for coverage of CGM in the United States in the history of our company with now the top largest 3 PBMs in the United States now covering DexCom for all people with diabetes. That was really adding in those non-insulin users to the category. We also received approval for 2 very important new products that will help ensure our growth into 2026 and beyond. The first is Smart Basal, which is really a technology that's designed to improve the user experience for both the patient and the physician with basal insulin therapy. We also got approval and launched the G7 15 Day sensor. Very excited to get that out. We launched it at the end of last year in our durable medical equipment supply channels, and now we're in full launch across all channels in the United States. And then finally, we made significant progress on our next unlock of sensor manufacturing capacity with our Ireland facility, which we anticipate will come online later next year. We also had some learnings in 2025 that we feel really set us up well operationally stronger for 2026 and beyond and really to build on the momentum of the '25. So today, we expect another strong year of growth for DexCom in 2026 with annual revenue of $5.16 billion to $5.25 billion, which represents growth of 11% to 13%. An important note about the basis for this guidance and the assumptions is that right now, we're assuming that the coverage landscape for CGM around the world remains largely the same as it does today. So in other words, this doesn't anticipate any large coverage unlock in 2026, although we are working hard around the world to unlock coverage, and we do anticipate that coverage will come at some point soon. We also are anticipating an expansion in our gross margin really based on the success that we had in the back half of '25 in improving gross margins as well as further uptake of our G7 15 Day as more customers begin using that product. We also anticipate operating margin to expand to 22% to 23%. And one reminder on that, that includes the additional spending and hiring that we need to do to bring up our Ireland facility. We've built a strong foundation for this top line growth, and we do have the levers to continue expanding our earnings as well as cash flow. All of this, we're executing against these metrics with a strong commitment to the community and an unbelievable market opportunity still in front of us. There are over 9 million people in the United States that have coverage for CGM that aren't using it today. So in other words, with all the expansion and all the growth that we've experienced in all the patients using CGM, not half of the ones that have coverage are using CGM today. And we believe we're on the cusp of some pretty significant expansion in that type 2 NIT, making that little green circle quite a bit more green based on Medicare expansion for NIT as well as some further commercial coverage. The reason we're so confident in that coverage is because of the data that we have created with our type 2 registry. So when we started to see at the beginning of 2025, late '24, some coverage for this population of users that have diabetes that aren't on insulin, we started this registry where we could track these patients from the time they start CGM through their experience. We've reported on this data before. We've reported 6-month outcomes. This is the first time we're talking about our 12-month outcomes in this population. And there's 2 really important takeaways here. The first one is that we're seeing sensor utilization rates in this population that is very similar to what we see in those basal insulin using patients. That was, I think, a question that we were all interested in understanding. And in this environment where people have coverage, we're seeing great sensor utilization. The other thing we're seeing is that the rapid improvements in A1c and glucose metrics that occur pretty much in the first 3 months of use of this technology are sustained for that 12 months, which pretty much makes sense to be because of the high sensor utilization. People are using this technology and they're getting the benefit. So as I said, for the past couple of years, we have pretty strong clinical support from physicians. The ADA just recently updated their guidance for this population, and we're building the clinical evidence. And this year, we anticipate releasing the strongest clinical evidence to date for this population, a randomized controlled trial in patients with diabetes, not on insulin. So like a quick rewind real fast is that 10 years ago, we gave the results of the DIAMOND study, which was a randomized controlled trial for intensive insulin users, both type 1 and type 2, and that led to expanded coverage. We then followed that up with another large randomized controlled trial, our MOBILE study for basal users, basal insulin. That was the cornerstone to coverage expansion for that group. And now this year, we'll be releasing the randomized controlled trial results from our non-insulin study, which we really feel will set us up well for global expansion of coverage for this population. And one of the keys to increasing international market share is driving awareness for CGM and driving the coverage. We've had some good results in the last couple of years with Japan and France now covering CGM for all insulin users. We also saw some great wins last year in Canada around type 2 users. And we do anticipate that in 2026, we'll see some additional access wins for type 2 patients in Western Europe as well as in Australia. Now one of the keys to our strategy here is when that access comes, we want to be ready to grab that share. And this comes from the design of our portfolio of products that are designed for patients and health care systems around the world. It starts with our G Series product, which is a sensor that's specifically designed for integration with AID systems as well as a whole host of programmable glucose alerts and alarms for patients. The next product in the lineup is DexCom ONE+. That is a product that is extremely important for users that are not on automated insulin delivery systems, but are still taking insulin. That does represent the vast majority of insulin users outside the United States. And in 2026, to increase our flexibility to capture more share internationally, we're going to introduce a new product into this category, and we'll talk a little bit more about that as we get closer to the launch. We're also going to continue to innovate across all segments of our business, starting with our type 1 automated insulin delivery and type 2 automated insulin delivery customers. We have had a broad strategy for partnerships for many, many years, and we've come a very long way from the first systems that I worked on 15 years ago integrating CGMs and sensors. We're very proud of the results that we've created for patients here with our partners. Together, we've generated over 2.5 million patient years of insulin delivery, and we're going to continue to extend our leadership in this category by focusing on faster developments with our partners, more accurate sensors as well as enhanced connectivity, really focusing on the distinct needs of this customer base. As I mentioned, we're also in the midst of our G7 15 Day launch, which is going extremely well. It's the most accurate, longest-lasting CGM on the market available. And the feedback that I've heard from patients that have tried this sensor, particularly ones that have upgraded from previous -- from the G7 10 Day and G6, it's the best CGM experience they have ever had. By reducing the number of sensor changes per month, we're significantly enhancing the user experience around CGM. And now that we have pump compatibility with Insulet and Beta Bionics, Tandem will pump very soon with this product. We're excited to continue to build on this momentum of this launch throughout 2026. We're also looking at continuing to enhance the user experience beyond just the product. Service is a critical important part of CGM experience. We launched the My DexCom Account, which is a whole new digital experience. We launched it in North America last year. This year, we're going to bring it out across all of our markets globally. And the early feedback is it's saving patients' time, it's reducing friction and everyone is having a good experience with it. We intend to continue to enhance this. We're just getting started here. There's a lot we can do to continue to enhance the user experience digitally. Another innovation that I mentioned is the DexCom Smart Basal. This is really focused on one of our key growth segments. That's been one of our strongest areas of growth for the last couple of years, which is the basal insulin using market. This is a technology that's designed to help a patient and physician get to the optimum dose of insulin for that patient in approximately 4 weeks. Normally, this takes many months. Normally, a physician prescribes an initial dose for the patient and then they don't adjust that dose until the next visit. This is a system powered by CGM that does it automatically and recommends to the patient every day how much insulin to take until they get to that ideal dose. And what the physicians have commented about, the ones that have used the technology so far is that they're getting the outcomes that they want with that Basal Insulin so much faster, and they're seeing better adherence because patients are seeing the result of that insulin. Focusing on prescribers is a really important part of expanding and capturing more share. We've been working on direct EHR integrations for a number of years. Several years ago, we announced this particular technology at a diabetes conference where the clinicians and the audience gave us a standing ovation because they finally had a tool that fits into their workflow, allows them to look at CGM metrics and output and help focus on the patient during their visit instead of trying to analyze all the data. We have over 160 health care systems either up and running or in the process of onboarding with this technology. We do expect that to continue to grow. It's the first time that it is truly a seamless experience from within the EHR and -- both with the prescribing as well as the viewing of CGM data. And turning to Stelo, which is another very important part of our portfolio. It's -- for those of you who are newer to our story, this is our over-the-counter CGM. And we launched it at the end of 2024. 2025 was really for us about expanding access to this product through different channels and partners. One of the big ones was we went live on the Amazon storefront. We've had since launch over 500,000 people try this product, and many of them have signed up for subscriptions to continue receiving the product and using it. As I mentioned, we have approximately $130 million in revenue for 2025 from Stelo, and we anticipate that continuing to grow. The other thing we did with Stelo over the course of '25 is we continue to enhance it. We actually introduced a feature that is AI-based. It's a meal logging feature that allows users to easily enter their meals into their system by just taking a quick picture. We have over 10 million meals logged already in the system. And we're going to continue to innovate on Stelo. So this year, we'll be introducing a completely new revamped user interface and experience with Stelo. It's a brand-new app. We took design cues from some of the most loved consumer technology apps out there. It really is designed to surface the insights that we gather from all of the CGM data as well as the other data. Our partnership with OURA is a key part of bringing in additional sensing technologies into our portfolio so that we can provide users with enhanced insights. We're also building out an even more robust meal logging feature. It will include the macro nutrients in addition to the meal description. So all of that information really helps us with users and connecting the dots between their CGM data and what's driving the variability, whether it's nutrition, or activity levels. As you can see, we have a lot of new products and new technology coming to market in 2026. It's also important that we learn from the different challenges we've had over time. And one of the most important things is ensuring that we have a strong infrastructure that is resilient to serve both the millions of customers we have today but the millions that we're going to add. We've made significant updates to our quality management system, test procedures. We've reorganized our teams. We've brought in some key talent. I'm very proud of how the teams have responded to this charge to enhance everything about the quality of our product, the quality of our service. We've also spent a good amount of time investing in our supply chain. One of the lessons we learned was that both our current and future suppliers are an absolute key unlock for our scale, and we have continued to invest more in those suppliers. And then finally, we have our next unlock of capacity for sensor manufacturing coming later this year with the Ireland facility, which is on track to launch in Q4 and begin production. So with this type of scale, it is critical that we have it so that we can introduce the next generation of hardware for DexCom. Every system that we've introduced has raised the bar for CGM. G6 was the very first iCGM ever approved. G7 significantly improved the user experience, reduced the size of the wearable and also significantly increased the accuracy of CGM. G8 is going to raise the bar again. It's going to be the most advanced wearable system we've ever produced. It is going to be another step change improvement in accuracy and reliability of the glucose sensor, ensuring we maintain the most accurate sensor on the market. It's also a significant reduction in the size of the wearables, a 50% reduction from G7. It will make it the smallest CGM available as well as significant redesign of the electronics internal to the system, which really gives us advanced sensing capabilities, advanced error detection and really a lot of technology that's been under development for almost 2 decades, is coming out in this product. We also plan to use this product as a way to expand into other opportunities in the market and other clinical areas. Gestational diabetes is an area where we've built good coverage, but we're still driving awareness of the outcomes: the outcomes of reduced emergency C-sections, reduced NICU admissions. The results in this -- from this sensor use in this population is very significant. It should be the standard of care CGM in this population. There is another significant opportunity in the hospital setting with over 14 million dysglycemic events. There's a significant need for a better way to manage and monitor glucose. As a reminder, there's no continuous glucose monitor CGM subcutaneous that's ever been approved for use in the hospital. So we do feel that this is a technology that could be well applied there. And then finally, prediabetes with almost 100 million people in the U.S. living with prediabetes, there's a significant opportunity. I was actually talking to one of our warriors the other day, her name is Norma, and she had prediabetes and wanted to donate a liver to her brother and her doctor said, you got to get your prediabetes under control. You got to get it down. And so basically, she used Stelo over a 6-month period. By just changing her behavior, she got her A1c back down to normal levels and was able to provide that kidney to her brother. There's no reason why anyone who is either diagnosed or concerned about prediabetes doesn't start with a sensor as the first-line defense. It's about education and training, behavior modification. It's an amazing opportunity for us to make a huge impact. And so if I was to summarize that entire overview that I just gave you in a very simple investment case for 2026, we expect strong top line revenue growth with the foundation of making this growth durable through the access expansion that we're working on around the globe. We also anticipate operating at top-tier cash flow metrics with a $1 billion of free cash flow delivered in 2026 and $1.5 billion in adjusted EBITDA. And we are executing against these metrics with a strengthened commitment to the entire diabetes community, to bring new innovation, to help change their lives. And so with that, I want to end on the pictures and faces of some of the amazing employees at DexCom that I have the privilege of leading every day. These are also pictures of people that have diabetes. I think at DexCom, we probably have more people with type 1 diabetes than any other company. And we innovate for them. They're counting on us. We innovate for the diabetes community because we are the diabetes community. It's what motivates us. It's what keeps us going every day because they're counting on us to succeed. Thank you.

Great. There's a lot to talk about. Maybe we could kick it off with the fourth quarter preannouncement. You beat the Street by about $18 million in sales. Any color you can give us on how that split U.S., OUS? And any color on patient trends or interesting things you saw in the quarter?

Yes. It was a very strong new patient trend for us. I think we've really been over the course of the year, building some strong momentum in new patient adds. I think the 15 -- as we looked at -- we just launched 15 Day in the back half of the quarter, but we saw some real nice momentum there. I've seen -- I was talking to a physician the other day, some of the patients that were waiting to upgrade from G6 when the 15 Day product came out, that was something that they were really looking forward to, and they've been upgrading more and more folks to that. So I think that's been a key in strengthening the confidence in our system as well as understanding the performance and accuracy we can deliver. New patients are also starting up on 15 Day. And so we're excited, particularly when we think about some of our key growth areas like basal and type 2 IIT as well as the non-insulin users. It's really an opportunity for people to experience the best sensor out there.

You talked about 2025 as a record new patient year for DexCom. Did that also hold in fourth quarter?

It does. It was a record number of patients for '25. It's really close, probably too close to call at this point, but it was a very strong quarter for new patients. We want to continue to build on that as we go into '26.

I know we'll get a lot more color on the fourth quarter call. Anything you could add on U.S. trends versus outside U.S. trends in the fourth quarter?

Do you want to take that?

Yes. So I think what you saw -- and really, it was OUS and in the U.S. We really saw some really interesting sell-through as we progress through the quarter. And sell-through, again, alluding back to Jake's point, new patients takes a little bit of time to tabulate that data, get it in from the various sources. But sell-through is an indicator of usage and usage pattern in the field. And we saw really strong usage patterns in the field in the U.S. and outside the U.S. as the quarter progressed. So certainly, I think that's a good thing for the community.

If we turn to 2026 guidance, sales growth of 11% to 13%, same as you announced on the third quarter earnings call. You talked about how that doesn't include any expansion in coverage. What does it include? I imagine, I think you mentioned record new patient starts in there. How are you thinking about the building blocks to get to 11% to 13%?

Yes. That's a great question, Robbie. So new patient adds is extremely important. So it will require a significant number of new patients near record levels. And again, that's based on the current coverage. And as I mentioned, there's 9 million people just here in the U.S. that have coverage that aren't yet using CGM. So there is a significant opportunity for us to bring in new patients and also bring innovation to the patients that we have and continue to retain them. The concept of building the best user experience, it's not just a talking point. It's actually a growth driver because it increases the lifetime value of a customer, the longer we retain them. So it is extremely important for us to continue to innovate across the whole portfolio, both new patients and existing ones.

Yes. And Robbie, we'll push the organization. I think you could imagine, obviously, we have our Chief Commercial Officer sitting here, so no pressure. But we'll push the organization to achieve record new. I mean that's always the goal. And Jake alluded to a massive untapped market out there. So the push is going to do that. We gave you a range, right? And we gave you a range for a reason. There's multiple outcomes that can happen within that range. But make no mistake, our goals internally are always to push for that. Some other -- you asked for some other puts and takes. Look, no massive coverage unlocks. I think you'd expect to continue to see the revenue volume deltas come in over time as that matures. And then there's a nominal contribution from Stelo from a percentage growth perspective. I think we said approximately about 1 point or so would be from Stelo. So a majority of the growth is going to come from our [ GMD ] series.

One of the things we've seen progress over the past several years as more patients are in the pharmacy and as international continues to grow and get bigger as a percentage of sales, some of the seasonality trends are a bit different than people are used to from 5, 7 years ago. So how do you want people to think about first quarter is top of mind for everyone here. I know you typically give a percentage of sales and how to think about it?

You want me to start?

Yes, sure.

Yes. So I think the first quarter, I think what you've seen, and I'll use just maybe sequential growth as a good example. Historically, what you would see is from Q4 to Q1 globally, you'd see a mid-teens sequential decline. That came down to low double digits. Last year, it was 7% to 8%. We'd expect to see another point of progression there. And so it's that continued progression where Q4 would maybe come down a little bit, Q1 comes up a little bit relative to that sequential total company growth.

Maybe we can jump to margins. And this is where I think you have -- there's a lot of interesting avenues and margins. And I'll say, to me, the guidance looks particularly conservative when I think about 15-day sensors and just mathematically, you're spreading the cost of goods out over 50% more days, but there's a lot of upside there. 63.5% is where the Street was coming in today on gross margin, guidance of 63% to 64%. Maybe same sort of question, what's assumed in that? What percentage of U.S. sales or 15-day sensor built into that? And I know you're launching -- breaking ground on the manufacturing facility in the fourth quarter. I imagine there's some start-up costs involved with that. Maybe just some of the components there?

Yes, sure. So you're right, Robbie, the 15-day product does give us a lot of flexibility on our margins. Now it does take time for people to upgrade to that product. So we'll be starting new customers on it, and then we'll upgrade our base over time. It does require a new prescription and a visit to the physician's office. But we do feel that with the performance of that product, we're counting on significant uptake across the whole portfolio. We're also working on launching it across -- outside the U.S., working through the different tenders and regulatory approvals to get that product launched. Over time, we intend to take the whole base over to 15 Day, but it's going to take a little time. And you're right, there is some additional spending that's already built into the gross margin and op margin for the year on bringing up that Ireland facility, which is really important for our ability to produce enough sensors to meet this market demand.

Yes. So geography-wise, just so you have it -- I think you expect there to be a bit of a burden on the Ireland manufacturing in OpEx for the first 3 quarters. But in that fourth quarter, you're going to turn on a factory with pretty low volumes. That's all going to sit in COGS. That's all been contemplated in the 63% to 64%. So it's important to have that. The underlying performance in the base is even obviously, therefore, a little bit better than that. But naturally, this is just part of every evolution. You had this when we launched Malaysia. You'll have it again when we launch Ireland, but eventually, Ireland will be a contributor to marginal volume.

Down in OpEx, R&D and SG&A, where is the incremental dollars going right now? I know a lot of the incremental patients are coming more and more from primary care channels than endocrinologists. So is that where the dollars are going?

So speaking of -- first, just starting with the question around R&D, it's really across the board. We have a significant investment going in our software, but also as we're working on our G8 system, that's a next-generation platform. All the work we're doing in the factories as we're standing up Ireland, we're designing the systems to be able to manufacture both the current G7 and DexCom ONE+ and Stelo wearables, but also this G8 wearables. There's a significant investment going on there, but it's really across the board.

Yes. And then in terms of just the rest of the P&L, obviously, in G&A, a lot of that's in Ireland. But in sales and marketing, I think if you look at our P&L over time, I think we've done a really nice job creating leverage there. The leverage is to then pour it back into investments like in our sales and marketing team, which is where a lot of the dollars are going to go, which is about raising awareness with all of this incremental coverage, expansion outside the U.S., it's a key priority for us. We'll continue to get leverage across the classic G&A functions in all of those areas. You might not see it always playing through quarter-by-quarter because of this Ireland investment, but you can obviously imagine as that Ireland investment comes out, you'll see the underlying leverage we're getting to the P&L.

There's a lot going on. You talked about R&D. You mentioned the G8 sensor. I'd love to get a time line if you're willing to share. But the question is really more -- as you're stepping into the CEO role, there's new products you're rolling out. There's a new product you're working on. I'm sure there are several in the pipeline. We're hopefully waiting for Medicare to open up coverage for non-intensive patients. International is still a large untapped opportunity. Where are you spending most of your time? And what would you say are your biggest strategic priorities for the next 1 to 3 years?

So the priority is basically ensuring that we remain the optimum solution for all glucose monitoring needs. So that's the whole spectrum. When you think about type 1, we're still significantly innovating for that group all the way down the spectrum and introducing new products and keeping that cadence going so that when a user goes on to a DexCom system, they understand that they're going to continually get updates. They are going to enhance their experience over and over again. And the significant investment in our systems around customer support, we already started launching those last year. That's another very important part of serving our customers for the long run. So I am spending quite a bit of time there. Also, obviously, out on the road talking to physicians and patients and understanding where we can continue to improve what we do. The next-generation hardware is a very key part. I mean many of the projects that I mentioned are being built into that new generation. We started in the early days of DexCom with an idea that we might be able to introduce this type of technology. And finally, with G8, a lot of those things are coming together to build the most advanced CGM system available. Also driving awareness and outcomes, right? We're running large randomized controlled trials and making the investments required to expand coverage because expanded coverage is the key for growth in this category. And we have this evidence that shows just the benefits to both the users, but also to the economics around the health care systems on CGM being a very cost-effective way to manage this global crisis of diabetes. And so we're investing across all those different avenues.

You talked about in the fall last year about DexCom being a sustainable double-digit growth company for the long run. So maybe I'll flip it around. Of those you just talked about, which are the most important to keeping DexCom's strong double-digit grower for the long run?

Continuing -- there's 2 really. It's continuing to expand the access internationally. The opportunity international is actually bigger than the U.S. opportunity over time if you think about the populations and the impact that we can have. And so expanding that coverage globally is extremely important as well as in the United States. As you mentioned, Robbie, we're waiting for Medicare approval here for NIT. And so that's a key part. But also driving share, right, driving share towards DexCom and ensuring that we have the best solution out there for patients when that coverage comes. And so I think those are 2 of the important keys to sustaining -- making that growth durable.

As I look international outside the U.S., there's millions and millions of patients, many without insurance coverage. Is there a world where DexCom can come out with a product that's at a low enough price point to move into that part of the world? Or are you really commenting more on the parts of the world with insurance coverage and DexCom's ability to help improve that coverage over time?

We look at all aspects. I mean, certainly, there are certain markets that are more price sensitive. I mean, in almost all markets, we see that the out-of-pocket cost does impact sensor utilization even in the reimbursed markets, right? So as we -- one of our focus when we do expand coverage, is to ensure that out-of-pocket costs are the lowest possible. But we will be bringing Stelo to international markets this year. And so we intend to continue to launch an over-the-counter cash pay option across the world. Now it is one of the ways that we've been able to actually accelerate coverage is bringing a product to market that's available with a cash pay opportunity for users. And then once we start to see traction in that country, often reimbursement comes. We saw that in Eastern Europe, some coverage come quite quickly once we launched DexCom ONE there. And so we do believe that Stelo is a great opportunity to introduce CGM to a market and then potentially build coverage after that.

Well, unfortunately, we're out of time. Congrats on a nice fourth quarter and into 2025 and look forward to a lot more.

Thank you, Robbie.

Thank you.