Senseonics Holdings, Inc. ($SENS)

Thanks for joining us. And as we update you folks on the Senseonics story, it's a pretty exciting time for us. As many of you know, for those that were able to join us a year ago, we had a partnership with the PC Corporation for the commercial activities. We've transitioned that since we last spoke. And it's a pretty exciting time for us as we've been able to leverage that experience and that capability significantly with our strategic investment into the commercial organization. And frankly, we're very excited with the commercial results that we're now getting. Obviously, the control of our destiny is very, very important because it gives us the ability to pivot and move quick, make adjustments, expand those areas that make the most sense. And frankly, leverage the internal capability. But we've been able to do that because although we did the transition, we've essentially brought the entire Ascensia commercial organization over under Brian's leadership, and that really has made a seamless process that we've been very excited to be able to execute again. So we also made the decision as part of that transition in the last year that the primary issue for growth with ever since in a highly competitive market, but a very attractive market, really had to do with awareness of the product. So for us, it made sense that we needed to make a significant increase in awareness, especially at the DTC level to drive that revenue performance. And we've actually seen that wear out. Our partner, although a good strong partner, was not in the position to be able to do that. So as we got to the 5-year point of the contract and knowing that we needed to put more into the organization, not less, it just made sense for us to do that transition. So people have asked why, yes, it's a divorce. It's an amical divorce. They've been a good partner for us. But at the same time, this is the time to add fuel based on where we were, really driven by the 365 product, answering a lot of the needs for patients and be able to take it to the next level. So we're excited to see some of those results. Obviously, we all know that the CGM market is huge and large. We were well over 25% CAGR. I think we're now around 20% or high teens, maybe slowing down a little bit as penetration goes in with some of the larger guys. That said, for a company of Senseonics size and where we are today, we're seeing about 90% of our patients are actually coming from the installed base. So the growth opportunity really comes from driving patients through that awareness through the facilitation of getting them access to the product to jumping on to it and then making the choice to go with a long-term implantable. And we've been successful with that as we showed. So in addition, it's an exciting time. Many of you are aware, we are on the cusp. There is the expectation. The clinical benefits for CGM have been very clear, right? You continue to provide people with the glucose information, they'll be able to act on it. It started out, of course, with a type 1 indication, a clear recognition. It's gone to the type 2s that are on MDI. We now have the basal indication. And the full expectation is that we will get the huge population of folks that are on the oral agents, the GLP-1s, the diet and exercise. So it's just a continuing expansive opportunity. It makes sense for those people to be monitoring their glucose and doing it with a technology that provides them a facile way while being high quality is an absolute expectation. So we're excited to be delivering as those who have been watching us, we clearly have made some commercial momentum success, and we're going to continue to leverage that and to grow on it. So this morning, we'll have an opportunity to hear from a number of folks. Dr. Fran Kaufman, our Chief Medical Officer, will be previewing the real-world experience. We've now been on market and have thousands of patients that have experienced the Eversense 365. We're getting very attractive performance as measured by the time and range. And then continuing that when you put them on the closed loop, which we'll see with our partnership with the Twist pump, there really is best-in-class performance. And that comes from the high-quality product and the compliance that you get with a 1-year product as well as a very accurate sensor, a very good pump. And quite frankly, I think you're seeing some of the value of the loop algorithm that comes from the development of that organic environment. So at the same time, we're able to convince and we're able to educate folks on the long-term CGM that our experience with it, that we do offer some benefits that you don't see with some of the other technologies. as good as they are, they've helped a lot of people, certainly with diabetes, but they've really coalesced to the same product at this point, right? They're both 15 days now. They both use glucose oxidase, so they generate current -- the basic molecular level technology is slightly different between the 2. But from a user's perspective, it's a transmitter on the skin, through transcutaneous sensor that stays resident for as long as you can keep the wound open for as long as you can keep the adhesive on and then it's time to replace it. So what it's really come down to for those 2 technologies is high, high control of their manufacturing, right? They're produced in large volume. And as they're able to control that and the one that will win, quite frankly, is the one that has that best high-volume manufacturing. When you see perturbations or you hear complaints about accuracy or you have recalls, unfortunately, that's going to be as a result of their high-volume manufacturing. But again, they're very, very similar technologies. Eversense has been able to answer many of those for some of the patients. And those are the success we've seen, and that's why 90% of our patients, quite frankly, and we target existing CGM markets because the market is so large to transition from those. So we focus very, very much on the expansion. We're addressing many of the pain points that exist with CGM. We're now at over a $13 billion market, a huge space to participate in. So it's an exciting space to be here. So next up, we'll speak with -- we'll hear from Dr. David Ahn. David is an adult endocrinologist at Hove. He's Director of the Diabetes Services there. And for many of you that watch the space, we'll recognize David as being one of the leaders in the area of patient choice, new technologies around medical devices for people with diabetes, and he's just taken an active role. And what a great time in his career to be able to do that because as it's just exploded over the last decade, there are now so many more options for people that if you're compliant with it and stay with it. So then obviously, a lot of questions around how is it going commercially. We'll get an opportunity to hear from Brian. He'll talk about what the transition has been like and why he's been able to be successful here in the last few quarters are really driving some pretty significant growth with the Eversense. Most exciting that's coming, of course, is our Gemini and Freedom product. So we'll certainly give you a little bit of an update, see some encouraging data on the early concepts for Freedom and why we're seeing success with the BlueSuken Corporation. And of course, the questions we always get, what's the timing? How is it looking? And then we'll ask Rick to wrap up and do some financial discussion. As many of you know, we recently did a significant funding round that's given us the opportunity to go ahead and make this investment in the technology as well as the commercial execution. So as we look at the opportunity, obviously, as I said, it's huge. It continues to grow because of that need in the diabetes space for glucose monitoring, and we will continue to see success associated with it. Eversense, of course, is completely different, right? We've designed the technology because we knew there are a lot -- and for many of you get an opportunity to go to -- you don't see it here in the U.S. because of the FDA approval. But if you go to the corollary meetings in Europe, you'll see a lot of the near East competitors in the transcutaneous CGM. There are multiple systems that are out 10, 14. There's even a new one for 21 days that are transcutaneous CGMs that are really trying to capture the low-cost market. They don't have the accuracy requirement to come to the U.S. So they haven't been submitted for the indication. And then of course, the barrier, which is a reality today for the iCGM designation is even that higher standard. So unlike a few years ago, when we saw a lot of offshore competition come in, in the strip and meter business, it's going to be a higher hurdle for people to come into the U.S. to bring some of those knockoff markets. Never mind the market dynamics or IP dynamics that go on that are associated with it. So what you really do see in that space, of course, is they're really capped at about 15 days. The reality is that wound that you create to put the sensor is going to close up. It's going to heal and the body is going to go -- want to go back to its native state. And then you have the adhesive issues in the -- as you get more and more aggressive to stay on longer and longer, you're going to get more and more skin reactions. So where they've really focused, this is in 2 domains. You're well aware of this is really about transmitter size, right? The how small that we can make it. Everything we're trying to do is make it less intrusive for folks. And you've seen even now with the announcement of the G8, they're really going to be approaching the Libre size in regards to the transmitter. Obviously, that's not a space that makes sense for us as an implantable to focus in. We do have a transcutaneous component for it today called the transmitter, but we're working very hard to eliminate it, and that's ultimately the Freedom product. So we're fully incorporating all the components. We'll be the first folks that have nothing on the skin. And that's really our point of differentiation. We'll be able to leapfrog the technology that's associated with it. So we'll spend some time talking about it, but obviously, we're pretty excited. In regards to the commercial strategy, Brian will go into this into much greater detail. But as I said, for us, it really is about awareness at our size. Once people understand that there is an opportunity for a year-long sensor, they're willing to give it a try. The one hurdle that we go through that we work significantly on and many of you are aware of it is through our EON network, and that's in regards to access. We have good coverage. That's not been an issue for us. But you want to make sure that it's easy for people to get the sensor and get the product. So our expansion of the EON nurse network, which is now at around 80 nurses has really given us and really taken that burden off from us as a company and allowed us to give it to the patients as an easy access. So we're pretty excited about the progress that we've made there. And we're working on penetration. So we're going to more clinics, and we're going deeper in the clinics. And then finally, of course, what's very, very important, we're starting to see some of the fruits of that labor is the retention, right? People need to feel that this is the right product choice for them, and they're willing to come back. And we do see that. The product, especially after they've been on it a couple of times, you've been on 2 sensors now. That's 2 years of your life. You're really committed to it, right? So we're seeing a lot of the folks come back. And I think David can certainly speak to what his experience is with his patients in regards to how many will be able to use the product over and over again. So exciting times. Now that we are fully integrated, it is an exciting time to move the organization. We had the full team together. He can feel the energy, some success that we've seen with commercial has really allowed us to be a little bit bolder with our step and feel very, very encouraged with what we're going forward with. And it's allowed us to make changes and change some of the acceleration. And then importantly, obviously, the change also significantly changes our financial profile. Not only do we, of course, get to recognize all the revenue now, but that, of course, all falls through. And as you've seen, we've been able to publish some pretty exciting margin profile for a company of our size, and that's driven by the once-a-year disposable, right? As opposed to a 2-week sensor instead of producing 25 sensors to keep that patient for a year, we only have to produce. So we get to leverage that denominator, pretty significantly. So a little data to support that. New patient growth, and this is Q1 data. We'll obviously have Q2, but obviously, there's significant growth. As we see in the first quarter, we saw over 100% growth in the DTC patients and a 40% growth in the HCPs. So the sales team is doing a great job. The DTC is really driving that awareness. Not only do we have folks that come in through the web and we facilitate that process, but they also come into the sales reps as well. So they'll go to their doctor or they'll do a Google search on Eversense, and they'll come in through their doctor, even though that they were stimulated by our DTC commercial advertising. So it's really helped in both domains. And as you know, CGM is a very high touch. It's like the pump space. The patients do want to spend time. They do want to get to know their sales folks. A lot of our sales reps carry the cell phone numbers of their patients. We'll take really the first questions. The inserter growth has been significant as well, especially with that Eon Care, right? That's up over 900% year-on-year. It's really been a major focus for us. It's one of the key strategic changes that we've made that's really facilitated the process. And then we get asked a lot about the prescribers. They continue to grow very nicely. They're up 80% year-on-year in the first quarter as well. And that's resulted in the growth that you've seen in the revenue, and we continue to hold guidance at $60 million to $64 million for the year. So as we look at Eversense, clearly, we are a difference maker. We're going to continue to leverage that with the new technologies that come out. There's a lot of folks that are excited about the future with what we can do with the Gemini and Freedom products. And we really look to, at that point, really be a difference maker in the space by driving folks to the highly innovative concept. We'll do that. We'll certainly, of course, take a larger market share as a result of that, both with patients that are switching, which is where we focus our attention now, but new patients that are coming to the market as well. So with that, we started in an environment, of course, with the short-term CGM, they have helped a lot of folks. There are millions and millions of patients on it. We're going to continue to support those. We've entered the first long-term CGM, but we want to take it to the next step. We're going to make it invisible for folks. We have an exciting platform. We'll be able to continue to do the exact same insertion that we do today. It will last for a full year, but it's completely invisible for folks, right? So we're not in the race to reduce size of transmitters. We're going to leapfrog that and we're going to jump right over that. So with that, I want to thank everybody again for your time today. And what I'd like to do is introduce Dr. Kaufman that can show you just exactly how the product has been performing since we put it on market about 16, 17 months ago.

Thank you, Tim, and good morning, everyone. And for me from the West Coast, this is really early morning. My goal is to dazzle you with some numbers that we have now. And I will be presenting later today at the conference our latest numbers. We will go from this 5,000 kind of sensor area, which I presented at ATTD to 12,000 as well as an increased number of patients on the Twist integration and their real-world data. And just really excited to dazzle you with what these are. So we're able to anonymize our sensor glucose data from our data management system and look at the glucometrics. We do ask the patients to identify themselves as far as whether they have type 1 or type 2 diabetes and their age as well as a few other metrics about themselves. And we've been able to also write a manuscript. We've submitted it now to DT&T, and we're waiting to hear. So I'm going to show you the first 5,000. And later today, I will be again presenting the next 12,000. So the mean age of our cohort is 55. You can see the distribution by gender, and we are a predominantly type 2 cohort. All of these patients are in open loop, either with MDI, including with Afresa or on open-loop pump therapy. And then when we look at the number of data points we can get per sensor, the mean is almost 28,000 data points from a sensor. So here's what the data looks like. And what we wanted to do was compare the first 6 months to the second 6 months of Eversense wear and then aggregate that data and look at the entire cohort. So when we look at the wear time, it is truly impressive. So the patients are using their transmitter on body 93% of the time, which means they're generating glucose data that allows them to manage their diabetes as well as generating glucose data that they can look at retrospectively, either on their own or with their health care provider. And then obviously, mean sensor glucose value is very important. And we're talking about 160. And also the GMI, the glucose management indicator, which reflects what the A1c would be is 7.14. And I think you can see when we compare the first 6 months to the second 6 months, there's no decrement in these numbers over time. Then if we look at how are these numbers actually distributed now we've kind of all agreed on what these buckets of glucose values are. So the hypoglycemia range, the time in either tight range or the time in range between 70 and 180 and then the hyperglycemic values. And then we can look at from the consensus data, what we are really aiming for, for our patients, which is the percent of patients with less than 70 milligrams per deciliter less than 4% of the time and less than 54 milligrams per deciliter less than 1% of the time. And when we look at, again, there's no difference between the first 6 months and the second 6 months. So we can look at the data aggregated and see that we actually have very little hypoglycemia. What is this attributed to? It's obviously attributed to the fact that these patients are using their transmitter, are using the Eversense. And as well, they don't have these periods in which they're switching out one CGM for another and maybe I'll take today off or maybe I just won't use this data at all, and I'll wait to put another CGM on. So I think that enables them as well as our settable predictive and threshold alerts really enables them in open loop to acutely manage their diabetes. So we can look at time and range, and at 66% of the time, again, in open loop where we're really the goal is to be 70% of the time or greater, and that was really designed for closed-loop kind of therapy. So now interestingly, we can look at by age cohorts or age buckets from young adults all the way through the Medicare age range and see that actually all the glucometrics improve with age, which is what we've seen across all the type 1 and type 2 patients who really, as they get older, maybe it's a survival issue or they're more acutely able to manage their own diabetes. So when we look at the Medicare age range now, we're getting to the kind of values that are the target for closed loop. So a mean glucose value that's really acceptable of 154 and a mean GMI that's below 7%, reflecting likely what their A1Cs will be. And even in the young adults who have the least favorable outcomes across the board in any study we look at, our values are really pretty good with a mean GMI of 7.32. And then we can look at all these glucometrics, again, we see that with increasing age, improved outcomes so that by the time we get to the Medicare age range, we're above 70% of the time in the values between 70 and 180, very little hypoglycemia and now greater than 85% of the patients meeting the hypoglycemic targets. So really the kind of outcomes that we're hoping for, for our patient population. So that's the real-world data in open loop. Dr. Ahn is going to talk about the Twist integration and some of our real-world data now with that integration. So I thank you.

All right. Great. So I'll tell you a little bit about myself. I'm an endocrinologist for adults. I'm the Chief of Diabetes Services for Regional Hospital in Orange County, California. This is a beautiful view from Newport Beach. So I've been supporting Eversense or using Eversense in my patients essentially since it launched. And I've had hundreds of sensors in my patients. And as Fran mentioned, I really -- I'm a big fan of choice in having options for patients because every person with diabetes has a different experience, different preferences, different needs. I've done over 350 of these procedures. I do insertions for patients in my panel. I also end up being a referral center for people nearby. I'll just be the proceduralist for those patients and then send them back to their endos. It has not been a huge issue fitting the procedure into my practice, but it's great that Eversense also has that network for the clinicians that don't want to do the procedures. Essentially 0 adverse events related to the procedures over my, I guess, 8 years now. And my patients really love Eversense and you'll see why. So when they announced that their partnership was going to be with Twist or their initial partnership was going to be with Twist, I was really excited because outside of maybe the big 2 or 3, I think the Twist has a lot of unique advantages that I think would help support kind of the strength of the Eversense. So to kind of summarize, I'll go into a little bit of detail on some of these line items, but the Twist has a lot of customizability. And I think a lot of -- kind of like the Eversense, I think it draws in early adopters, but it's also usable at scale for kind of your average person with diabetes as well. So it kind of has the optionality to be very precise to have a lot of fines and kind of levers to adjust. But if you set it up in kind of a standard way, you can get a really good experience even if you're not that type of person who likes the tinker. So some of those things that are really unique about the twist is that it has the lowest target setting of 87 milligrams per deciliter. You can have various targets throughout the day, and you can also have it go really high. So it can be for the person who wants to run really low. It can also be for the elderly grama who is worried about running low and would prefer to keep her glucose numbers higher. It also has the ability to do a couple of modulations to the algorithm that none of the other system -- commercial systems can. So there's something called like a premeal override where you can set a temporary target that's lower going into a meal. It also has the ability to pick different speed insulin action profiles in its calculations with a very simple option of a lollipop, a taco and a pizza and the user can just kind of say, "Oh, my meal is going to be a really quickly absorbed carbohydrate like a lollipop or it might have kind of a double wave pattern or an extended pattern like a pizza. One of the unique features of the Twist system is their iSure technology, which allows it to detect occlusions much faster than other systems. You can see the minutes listed here, but it's about -- I think they're advertising about at least 5x faster than other systems and significantly faster than other -- 5x faster than the next competitor and up to like 10x faster than some of the other competitors on the market. And the Twist does hold 300 units as well, but it's still relatively sleek. So it does kind of have a little bit of the best of both worlds there. Now of course, the Eversense 365, you've heard a lot of the advantages of it. But I can't reiterate enough that I think a lot of the patients that are drawn to the Eversense are also drawn to Twist. So I was really excited to kind of see that partnership happen. And this is some real-world data that Fran presented. I would imagine, Fran, it was Fran, but I wasn't there specifically. But they shared some real-world data from the first initial wave of patients going on automated insulin delivery. And this is the data that I was really looking forward to hearing because whenever there's new technologies, as much as I like it on paper or as much as I like the sensor in my patients, I always want to see how patients actually perform with it. So I was kind of nervous for how it would actually work in the real world. But as you can see here from their full commercial launch in February 19, they did their data analysis on March 2, and this does include patients kind of in their early preliminary -- they had some patients start slightly earlier, as you'll see in some of my test cases. So they looked at patient -- 122 sensors for patients that had at least 7 days since integrating with Twist. The average age of patients was 45 years old and 64% of them had type 1 diabetes. Once again, the median transmitter wear time was very high, 99%, which is very impressive if you -- because patients can take it off and put it back whenever they want. So the fact that they're wearing at 99% shows the value that they're getting from the system. And the average sensor glucose was 144 milligrams per deciliter. The GMI was 6.76%, which is fantastic, under 7%, of course, is our goal. And in the box on the right, you can see that the time in range was 76.6%, which is a very impressive number. And the time and tight range was also very impressive at 53.94 with very little hypoglycemia at 0.5 % in the less than 54 milligrams per deciliter range and less than 3% in the less than 70 milligram per deciliter range. So I'm going to go through 3 cases, and these are all patients in my panel. So I know them and their stories pretty well. And I think they represent kind of different situations that all really benefited from both the Eversense and Twist integration. So the first patient, she's a 31-year-old female, diagnosed at the age of 12. She had been on open-loop pump therapy from diagnosis. So I had met her kind of earlier on when she was on Eversense and combining it with -- well, I guess you'll see. So initially, she was on MDI and then she went on a Medtronic pump paired with the Eversense and then she eventually went on Twist. And her issue with the other sensors was that she had very sensitive skin and she had concerns about the accuracy of these systems, and she felt like it was not very accurate for her. So over time, prior to going on Eversense back in 2019, her A1c had been rising. She had been having very variable glucose levels with highs and lows, which makes it really challenging for us as clinicians until she started the Eversense in 2019, which she tolerated without skin or accuracy issues. Naturally, over the years, she's been very excited to go on an AID system, but it needed to be one that integrated with Eversense because she only trusted that as her sensor. So she was part of the limited launch starting in December 2025. So this is some of her data back before 2019 when she was -- or sorry, this is when she was on the Medtronic system. So she's using a Medtronic without CGM, so just the pump, but no CGM. And as you can see, orange represents high numbers and red represents low numbers. And the bulk of her numbers are either too high or too low, which for us as clinicians is very challenging because then you can't just ratchet up insulin therapy or back off because you kind of have to fest it a little bit more, which is why automation is so important. So she then added Eversense to her open loop journey. So she's now using -- in this picture, she's now using Eversense with a Medtronic system. And as you can see from this day for her, she's having much less hypoglycemia and her time in range in this statistic is 67%. So she was getting pretty decent control. Her time spent low had significantly improved. But this is her first 2 weeks on Eversense 365 after integrating the Twist -- or sorry, this is more recent data. So she started Eversense 365 with Twist in December, and this is data from April. But you can see that her time in range is now 76% and her standard deviation is 50% and her GMI is 6.8%. So for reference, that's an improvement from her time in range of 68% to 76%, which is a very significant improvement. And for someone like her who had been waiting so long for an AID system and the benefits of automation, this has been really liberating for her and just kind of seeing her come back and really perk up because as we all know, there's only so far you can get with closed loop -- with open-loop therapy. And this is just an average day looking at her experience with Twist and Eversense 365. As you can see, very little hypoglycemia and she is having much less hyperglycemia as well. On this specific day in question, her time in range is 81%. And of course, the overnight periods are fantastic as is the case with automation. The second case report is a 29-year-old male. He is a police officer, who is now part of the SWAT team, but SWAT in Irvine, California is probably less exciting than other parts of the country. But he's on -- he had been on Eversense and MDI since 2020. And he had chosen Eversense because of adhesive issues. He found that with his jacket and his equipment, sometimes it would fall off, and he would then be off a sensor until he can get back to his locker. And so also, he preferred the vibratory alerts. He didn't want to hear little trips and beeps while he's doing his work. And so he had been on Eversense since 2020 and was very excited to get the benefits of automation and start the Twist. So he started on January 2, 2026. So just for reference, his background A1c was 7.5 in November 2025. And this is his last 2 weeks of data prior to going on automation. And as you can see, he runs a pretty tight ship. His time and range is pretty good at, I think that's 61% or 81% and his average glucose is 143. But the thing that stands out to me as a clinician is obviously the significance of his low blood sugar numbers. Obviously, that's something we don't want, and it kind of artificially makes his GMI A1C and average glucose look good. Now this is the improvement that he had over time to wearing -- these are literally the first 2 weeks that he was on the Twist system and his time and range improved to 80% -- sorry, I think that initial number was 61% -- and so a significant improvement in time and range and his time spent low had decreased significantly and is now at the ADA recommended targets of 4% and 1% for time spent low and very low. The other thing I think that's very meaningful is average glucose significantly improved from 143 down to 132. And I think this is kind of a nice side-by-side comparison looking at those 2 data sets. So it's the same data sets I just showed you, but kind of side by side. And the funny thing is if you look on the right side of the screen, that first night was actually -- it's including the day that he got trained. So this -- my mouse isn't showing up. But you can see that the top left box on the right graph was that night period where he ran high was actually before they turned on -- before he started the Twist system. So if you take out that chunk, his overnight period would be even better. But overall, you're reducing lows, improving highs, -- and overall, he's been really thrilled with the system because he doesn't have to worry about it as much on his shifts when he's working. My third and final case report is a 41-year-old male. He had used Eversense in the past. So I had met him, I think, around 2020 initially. And he's kind of an early adopter type person. He always wants to try out the latest technologies. He found that some of the other transcutaneous sensors were lacking in accuracy. However, he had ended up going back to Dexcom because it was the only system that integrated with the Omnipod, and he wanted to wear an Omnipod and have automation. However, he started to get intrigued by -- he felt like the algorithm was not aggressive enough for him, and he wanted something that gave him the option to have a lower target. So he ended up starting the twist and the Libre initially because that was what was first more easily available to him in March. So this is his data when he was on the Omnipod and Dexcom. So his time and range was pretty good. I think that's -- yes, 88%. And so obviously, his performance was doing pretty well, but I think it's also -- you'll see his average improved quite significantly over the next couple of slides. So his average glucose was 141, but overall doing well. But to his preference, he wanted to run lower, but he felt like the system was not allowing him to have a lower average glucose. So initially, he went on the Twist plus the FreeStyle Libre 3+ because that was the fastest thing he could get on at the time. And his time in range went down ever so slightly to 85%. But his average did increase or improve from 141 to 136. And -- but then eventually, he went on Twist plus Eversense 365, and then you can see that his time in range improved to 93% and his average sensor glucose dropped to 112. So that's from a baseline of 141 down to 112, which is hard to do, as you might imagine, in the real world. And he felt -- or as you can see, he was able to achieve those goals that he was trying to do to improve his average and improve his time and tight range. So yes, I think this slide kind of speaks for itself. So to conclude, my patients, first, we're getting a lot of benefits of the Eversense 365 CGM experience in open loop, but really that those improvements get exponentially increased when they integrate that with Twist and an automated insulin delivery system. My patients really love Eversense 365. You can see that many of them returned to Eversense 365. There are a few other patients I can think of that also had switched away from Eversense, but came back now that it was an option with automated insulin delivery. And I think it's really important. I kind of preach this in everything, but what I love about Eversense is that it's a unique system with unique benefits and profiles. And I think what Tim shared earlier, where a lot of the other sensors now have similar benefits, similar limitations, whereas the Eversense has very unique benefits and disadvantages and a lot of those benefits are in the exact areas where some of the transcutaneous sensors struggle. So pressure lows are a common frustration, day 1 inaccuracies are a common frustration. And of course, the Eversense has one day 1 every year. So I think choice is really important, and I enjoy doing the procedure, and I hope more patients have the opportunity to get the benefits of Eversense and Twist.

Thank you, Dr. Ahn. As a commercial guy, I really like watching that, right, what Fran presented, what David presented. When we went through our clinical trial process, I was very concerned that if it wasn't going to make it a year, what were we going to name it, right? Ever since 340 wasn't going to sound near as good. And then we had the real-world data come, and we weren't quite sure how that was going to look when we presented ATD to see it perform just as well on day 365 as it does on day 180 or 90 or 20 makes my job much easier. And the fact it survives as well all the way through is quite a testament to the work Hari is doing, Mukul will talk about a little bit. But as a commercial guy, we have a product that we can really stand behind. And David, what I really like what you said is offering choice, right? If we can offer choice to our patients, everybody wins. And I think that's something we certainly strive for. So you guys have seen this slide before. We've really tried to work on scaling. We've really tried to make our product more available to patients, easier to prescribe does certainly start with driving volume. The more volume, the more opportunities we have to put people in place to insert it, the more volume gives a better seat at the table with payers, with physicians. As Tim said, our DTC marketing, we did so much of it in the second half of last year, and we learned a lot from that. We learned what levers work, what levers don't. We'll talk about that in the next slide, but it really was optimizing our awareness that really has driven some of the success in the early part of the year, making it easier to get our product. Again, we'll talk about our young care network here in a second. Tim said that expanded coverage has really made a difference. We're getting more from our existing physicians. And so our field really focuses on that, not only driving our DTC opportunities into new clinics, but also those that are using it doing more. I was out with our largest clinic for dinner last night and their plans to expand continue to amaze me. Why? Because the system works for them, right? There's an economic advantage to inserting it. But when they do insert it, it works very well for their patients. So it's a win-win on both sides. And then obviously, retention. That number continues to get bigger and bigger. It's easier to keep a patient than it is to go get a patient, and we're seeing really good results in our early stages of renewing our 365 patients. So really making sure that 1-year patient is going to 2 and then Tim will always say, once they get to 3, 4 or 5, they tend to stay very consistent with the product, very pod committed. So we have a lot of programs in place right now to make sure we walk with that patient all the way through that year journey. And when the time comes up, we have them scheduled, we have them ready for an insertion and there's no lapse there in care. We won't go through this any deeper, then we're seeing 60% of our business come in from our direct-to-consumer advertising channel, 40% from our efforts in the field. And trust me, the field does support the DCEC piece as well, and it does open up new doors, but there's a lot behind what we have going on. At the end of the day, John and the marketing team really is looking to drive workable leads that our inside team of 55 inside sales reps can go through and drive a higher percentage to close. We could get many more leads in if we throw a wider net, but then you sit there and get a bunch of leads that don't qualify, not on insulin, don't have proper insurance coverage outside our coverage range of insertion. We're very targeted in our DTC spend. And we spend about $1 million a month. We'll up that a little bit here in the second half of the year, but it's driving in right now some very high-quality leads, and we're seeing our metrics move in a very positive direction. Our territory coverage in the U.S., roughly 45 territories supported by some clinical individuals, some management team -- many of these folks have been in the diabetes business for a while. You guys know this across the industry. We're all kind of incestuous and have worked around. So some of my friends have joined us over from a few of my prior lives, but we're very happy with our team. And our entire team came over. We saw literally no turnover in our transition from Ascensia to Senseonics. So we're very proud of that. As we look into next year, we'll see where we can start to add a little bit here, getting the raise has helped a little bit. Tim has said we'd like to expand some, but we're going to do it smart. And the more we can add inserters, the more we can add reps, the more we can increase where we are advertising because we do geofence our DTC advertising. We just don't advertise in 50 states in all counties. If we can't insert, if we can't support, there's no reason to do that. So the more that I can expand, the more I can do on the DTC side and allow us to get to more patients and physicians. Eon Care. This is something that we decided to do roughly about 1 year, 1.5 years ago. We had partnered with a nurse practitioner group. Kelly and Jeff in the back there are instrumental in building this out, but we made a decision we wanted to control our own destiny here. And we finished the year with about 35 inserters. These are 1099 nurses typically for us that are doing the insertions, trained by us, become really, really good at it. They've really become partners with us, and they're also really good at educating the patient pre and post. So it takes some burden off of my sales team, which they don't need to be spending that time doing. They need to be selling when they can. But we have a goal to get to 100 by the end of the year. We're roughly at about 80 now. So we've done a great job in the first half of the year, adding strategically where our commercial team feels it's important and also where we can drive additional volume. And again, if we have these -- sometimes there's a chicken and egg here, sometimes we'll put somebody in a market that we want to grow, and then we'll start to really hit that with our reps as well as our direct-to-consumer advertising. So this has been a tremendous success for us. There is good economics to this as well. So this pays for itself. And ultimately, as we build it out, it will be a very important part of our both commercial and growth strategy. 90% of our folks are coming from another sensor, which is great, right? And certainly, they are more familiar. They're easier to onboard, 10% are CGM naive. But again, we get a lot of very positive feedback for the performance of our system, and that's certainly something that we're always proud of. The system works tremendously well. And once somebody does try it and once someone has access to it, it tends to be very sticky. And as Fran and David both said, it's used quite often, right? So the persistency is there. Super happy about our relationship with Twist. One of the things for me as a commercial guy with Twist is they have 100 territories, right? So I've been able to amplify my small teams voice through their partnership and vice versa. So we're bringing new patients to Twist, and they're bringing new patients to our Eversense product. And we've actually exceeded by quite a bit how many have combined systems or are using the combined system. My 8 years at Tandem, there was different uptakes when we did different versions of CGMs with our pump, but this went much faster than I expected. So I know you all want to ask, are we doing additional ones? The answer is yes. Tim and Muk and I will be meeting with our normal friends as we're here at the show. But right now, we're really focused on this. And then hopefully, we'll be able to do some additional integrations here over the coming year or so. And then in Europe, we have transitioned successfully 3 out of 4 of the countries this past week. So they've come from Ascensia to Senseonics. So they're now fully over as Senseonics employees. Our General Counsel back there, Ken, can you say Italy will be Monday, I hope. So we are close to the last one. But we've had a transition service agreement with Ascensia all along. They've been great partners. As you know, I came from that team. So it really hasn't hindered us, but we're looking forward to getting everybody over. And we have now replaced the BGM sales efforts with our own sales reps and about 95% of those folks have either been identified or hired now by us. So we're going to have very focused and targeted commercial and sales efforts in those 4 countries. And 365 has launched in Sweden and Spain already. Germany will go here next week, and we just need to move some of the tenders over in Italy, and we'll be launching in Italy here, most likely in July timing, but there is certainly some pent-up demand. And then we will have 365 in all markets, which Rick likes because that helps the margins. E3 will transition out and then we start to move towards Gemini. So that is my quick slides, and Mukul will talk about Gemini and Freedom and how easy it is to get those to me.

Always difficult to come behind a commercial guy. So when we set out on this journey a long time ago, we had -- when we started with the 90-day and then 180, but we always had this one vision in front of us, get to one sensor that will last the full year, get rid of those daily calibrations that was a burden. And then no transmitter, no on-body component for the device. We have achieved the first 2, right? We do not have any changes for the entire year, no daily calibration with the weekly calibration we have won ever since 365. And now we are looking at how do we remove those transmitters completely. So to look at that, the 2 things that the transmitter does today is to power the sensor for every reading because the sensor does not have a power source. It powers the sensor. And then the second thing it needs to do is get the data out from the sensor. So it takes the RF through RF gets the data out and then sends it over to the phone by Bluetooth, right? So those are the 2 functionalities we need to build into that sensor. And then we are able to do something that other CGMs cannot do. No on-body component for a CGM that works the entire here. So we set out on this journey, and we are right there knocking at the door now with Gemini, which is the first step of adding a battery. So in this version of the product, -- we will -- we have added a battery to the sensor. We went to the battery company that is very well known for implantable devices, Integer or for people who have been doing this for a while, Wilson, Great Patch. They had a battery. They made it small enough for us. And now we can basically get the sensor to collect data every 5 minutes. But to get it out, we still need the RF energy. So we still need to either get it out with a phone. You can scan it with your Google Pay, Apple Pay, the RF that you have on the smartphones or you can wear a transmitter, which will continue working at a full-service CGM. So now you have a combination, the flexibility in one sensor to either use it as a flash FGM mode or as a full-service CGM mode, right? Most important here is we kept the same sensor that we have heard from Dr. Ahn, Dr. Kaufman and from Brian, we have tremendous success with the 365-day sensor, right, the Eversense 365 makes FDA very comfortable. They know that the sensor works. So all we are doing now is taking the new functionality that we have that we need to prove out, right, which is how do you get the data out with an intermittent scan. So that's Gemini. And then the next stage beyond Gemini is to get communication inside the sensor, which is the same Bluetooth communication. Now there are many other implantable devices that use Bluetooth, but none of them use it in the size we are talking about, right? So that's the challenge in front of us. That's the one we are solving for. And I'll talk about the time lines and where we are in those 2 programs. But here, this is the Freedom product where you have taken out the RF antenna, created room to put the Bluetooth chip and the Bluetooth antenna. So we are basically keeping the same sensor, keeping the same form factor as Gemini here and now going on to have a sensor that's fully implanted with no on-body. So where we are with the Gemini? We are currently in a pivotal study in the U.S. plan to finish it up by the end of the year. The study is a 3-month study. The patients are enrolled for 3 months. They come in. They are wearing Eversense 365 on one arm and the Gemini sensor on the other arm. they go through the clinical session and at home, they are scanning that device many times. And that's what FDA wants to see is the reliability of that scan feature, and that's all we are trying to prove to them. We finished it up end of the year, submitted to FDA. Since you're keeping the same sensor, we keep the same performance, iCGM designation, do a 510(k) and expect to be on market by Q2 next year in 2027. Right behind, we are already doing a lot of work that I'll go through in the next few slides on Freedom. That's pretty much running about 1 year behind it and expect to be on the market in second quarter of 2028. So talk about Freedom, right? So same sensing, talking about communication, we were able to find the right-sized Bluetooth chip off the shelf and a Bluetooth antenna that works for us. And then we are basically putting all that together. We have done a few iterations in technology, done a lot of testing, both on the bench and a couple of animal studies now. I'll show some data from the second animal study that we are still kind of concluding, but I stole away from the engineers. And then from the battery perspective, we were able to get -- while we were working on Gemini, Integer was able to put in the second-generation chemistry in the same form factor. That was the challenge we put in front of them is to not grow the size of the battery, but get me more juice in the battery so I can power the Bluetooth. And they were able to do that. We have about 1 month buffer where we stand on today's Bluetooth communication that we are running. And obviously, we are trying to refine that with external partners. better protocol so that we can get it to be even less power hungry. But today, we already have a 1-month buffer, right? So for a 12-layer or whatever our power budget is, the battery has proven to be more capacity than that. The battery is finishing up. They already have batteries for us that are in a first in-human coming up, and then they will finish their verification testing end of the year, be production ready by Q1 '27. So we just concluded an animal study. Again, this is some imitations of bench and then going into -- sorry, animal study, 3 animals, pigs, and we had 2 different antenna variants that we were trying to figure out. One was hand-wound helical antenna and other one was just off-the-shelf that we call the Johnson based on the name of the vendor. The way we were doing it was looking at a couple of locations on the pig. These were early prototypes. So you can see that RSSI is the lower number, lower absolute number is better. That gives you the strength of that Bluetooth communication. And this was somewhat freeform study. We were kind of -- this data shows you an aggregation of 50 days, about 18,000 points, I believe. And it's basically let those animals move around and enclosures, and we tried 3 different enclosures, starting with an 8-feet enclosure, then going to 15 and then going all the way to 25. And this is basically just looking at what works and what doesn't work, right? Very directional study. So as much as we would have wanted many more greens, this is very exciting, right? What it tells us is Johanssen antenna, which is basically off the shelf. I don't have to have somebody wanted an antenna. That works for us. And we have configuration where we are seeing 100% success rate when you're within 8 feet, right? Think of the typical use case, most of the other implantable devices using Bluetooth are always labeling it up to 6 feet, right, arm's length. But this, we were able to get up to 8 feet, 100% communication and then varying when they're allowed to walk up to 25 feet in that enclosure, we are seeing, in some cases, up to 83% connection. So this is a really exciting start. They're still looking at the data. They're still trying to understand when the failures happen, we had cameras in those enclosures. So that people are trying to figure out when do we really lose communication, what does it correlate to. But overall, we are very excited where we are today. What this does is get us ready for building a census for first-in-human, which is the next step. So we plan on starting a first-in-human study somewhere in Q3, early Q3. That should give us the confidence and the data to support a pivotal study and go to FDA looking for an IDE at the end of the year, early next year. And then from there, get into a pivotal Freedom study in 2027, finish it up by end of '27, go through 510(k) Q1 '28 and get in front of public by second quarter. So that's where we are. And we can talk more about it later. Thank you.

Thanks, Mukul. Good morning, everyone. I'm Rick Sullivan, the Chief Financial Officer of Senseonics. All right. First, let's start with the financing last month. So we raised over $100 million of growth capital through both an equity offering and an amendment to our debt facility. This should provide us enough capital, we believe, to fund us through the launch of the Freedom product. The equity offering was just about $90 million of net proceeds. It was really led by 5 institutional investors that had really strong conviction in the Eversense story, and we appreciate their support. And then Hercules Capital has been our lender for a number of years now and provided an amendment that gave us access to $20 million immediately and then have another $85 million that will be available over the next 18 months with the first piece of that being available later this year. From a pro forma perspective, certainly improves our balance sheet over $160 million, the $60 million we finished the quarter with plus the more than $100 million we raised. And then from a fully diluted position, we had about $52 million increases to 70 million shares outstanding. All right. So for the past couple of quarters, I've tried to describe in lots of words on our earnings calls, the revenue streams and different channels of the business. And so I thought a visual might be helpful. So Brian spoke about our sales channels, the DTC channel with the advertisements, about $13 million we spend -- plan to spend this year, social media campaigns that are supported by that inside sales team. The HCP channel, which is the territories, the sales reps calling on physicians' offices across the country and then our reorders. And as our patient base grows, the reorders will become a bigger piece of our business each and every year. Next are the reimbursement channels. Our products reimbursed through 2 primary channels. One is DME, durable medical equipment through distributors that have contracts with insurance payers. It's about 40% of our volume. This is historically how CGM has been reimbursed. Through the distributor channel, we have distributor margins, there's prompt pays, there's rebates and our patient assistance program is more heavily utilized through that channel. On the other hand is bundled pay, which is a bundling of both the product and the procedure. And because we don't have those gross to net adjustments from the DME channel, and we have Medicare included in the bundled pay, which is reimbursed at a premium, we do see higher ASPs and more of our business is now flowing into that bundled pay channel. historically, had been about 50-50. We did spend some time trying to optimize that channel and are now at 60-40 and expect to remain there for the remainder of 2026, but do foresee improvements in future years. That leads us to reimbursement -- excuse me, revenue. So distributor, first is the distributors. Those are the ones that service the DME channel. They typically hold 30 days of inventory. We recognize revenue upon our shipment to those DME distributors. Eon Care actually does support those DME distributors. So a patient would get the product from the DME channel. The Eon Care would do the procedure through a referral, and we would be able to bill those CPT codes just for the procedure. So there is some procedure-only revenue that comes out of our Eon Care network. Eon Care also supports both Medicare and the commercial payers that use the bundled pay. And in that case, Eon recognizes the revenue upon insertion for both the product and the procedure. And then we have our consignment program. The consignment program is when physicians elect to enter into the program. There's a couple of hundred today where they'll have product on their shelf. When a patient is ready, they'll perform the procedure, they'll bill for it, they'll collect payment and they'll keep the procedure fee for themselves and they'll remit the remaining product fee back to Senseonics. We had a very strong first quarter Q1 for our industry typically has seasonality. So we see declines there with deductibles resetting, higher patient assistance utilization. We also had the commercial integration that we needed to do as we brought on the Ascensia organization, and we still overperformed. And that overperformance was certainly a result of the revenue share being eliminated with the Ascensia partnership, but also some of that shift in sales mix to the bundled pay and then really just the continued execution. There was minimal disruption with the commercial integration. Margins were really good. We're very excited about that. Some of it's with that sales mix. A lot of it was because we're now manufacturing a 365-day product globally. So for the launch of 365 in Europe. And then also, we did see this onetime benefit, right? So it wasn't quite 58%, back that out, 54%, still stronger than we thought. I think that led us to our guidance for 2026. We increased our revenue guidance to $60 million to $64 million, representing more than 80% growth year-over-year in revenue. We raised our gross margin guidance, 55% to 58%, and we're able to keep our operating expense and cash utilization the same. And I think this really sets us up for the future. We do expect to continue to see significant growth with our current product, but also the Gemini and the Freedom products, that Freedom product, having a single sensor for a year with no on-body component, eliminating some of the components. And at scale, we do see margins growing beyond 70% with that product. And that will allow us to be both EBITDA and cash flow profitable in the next several years. I think you've heard from everybody today, Tim outlining the corporate strategy from Fran talking about the very strong data that our product has, Dr. Ahn talking through the patient experience, Brian's commercial strategy and our product pipeline. We're really excited about where we're headed. This year is really just the beginning. So with that, I think I'd like to open it up for Q&A.

Thanks for hosting this event. Very informative. Appreciate it. Josh Jennings from TD Cowen. I think first, Brian, you mentioned just seeing the data at ATTD and again here today that as a commercial guy, that's exactly what you're looking for, what you need. Just wondering, just with the 12-year -- excuse me, 1-year data on the tape in the real-world experience now, I mean, was there any friction or just, I guess, patient hesitance or physician hesitance in terms of that real-world data? And now that it's in place, could that just help the commercial effort? I mean I think the answer could be I don't know if it's obvious, but yes. But I think the other angle is just with the pump partners seeing that 1-year data, giving them more confidence to move forward with the partnership. So 2 different channels, but same question.

Yes. I think, Josh, I'd say apprehension was there. And I think on our behalf as well, we saw in the clinical trial, but wasn't going to work like that in real life. And so when Fran presented that in Barcelona, it was one of the happiest days in my life because it wasn't just good data, it was great data. And so we're able to say that more confidently now in our conversations with our physicians. And we never get pushed on their performance, but was it going to survive? Are we going to have to explant and put new ones in, and we saw really good performance in the first year of the product. Yes, talking to the pump partners, this certainly helps that our product is working and the data from the Sequel product, the Twist product is helping and the success we're having is helping my conversations to say the least. So all of it is on the upside.

And also the data is coming in a time where there's been some reliability and accuracy issues within the field with some of the other CGM players and their technologies. But I was hoping to just -- I think we had a discussion yesterday. I just wanted to build on it, just about quality assurance steps, what your competitors' quality assurance program is versus Senseonics. I think my new understanding is that I think every Eversense 365 device goes through some sort of testing before it's released and that may be different and a higher level of quality assurance than some of the competitors.

Yes, Josh. So one of the big differences in our technology is that every sensor goes through the quality assurance and instead of doing a batch processing at the end, like every other manufacturer does, we have a sensor that gets calibrated. So each sensor has its unique calibration, sends the data from manufacturing onto the cloud, and that's what we retrieve and take back, right? So that's how we start. That leads to higher accuracy, right, because now they are tailored to each sensor, gives us much more control on the quality of it. It's never good when anybody goes through in the industry when others go through those quality issues where it erodes the confidence of the patient and the provider. So that's not good for any of us. But we do make sure that we try to stay clear of it.

One of the very timely things, so I called Mukul the other day, said, what happens if somebody steals some of our sensors in shipping? And unfortunately happens. Well, the reality is -- those sensors are turned off in the cloud. So even if you got access somehow to an expired or stolen Eversense sensor, you're never going to be able to activate it because each individual sensor is controlled through linking to the cloud. So just a fundamentally different technology.

Jon Block with Stifel. Maybe Dr. Ahn to start with you. Just at a high level, have you seen the awareness increase from your patient base around 365 as the company has leaned in a little bit from a DTC perspective. And then I'm just curious for those that are not aware and you broached the subject, call it, maybe talk a little bit about what you're seeing in terms of success or the conversion rate over to 365.

Yes. I think one of the things that I've been excited by as someone who wants more options for my patients is just I'm a very online person for better and worse. And I think just the public discourse that I see on different -- whether it's Facebook, whether it's Reddit, whether it's Instagram and TikTok, I think there's -- in the comments, if you look at pretty much any complaint thread of transcutaneous sensors, there will always be people now popping up saying like, either I've tried Eversense or I'm thinking about Eversense. On the Twist user groups, I think there's a lot of like clamoring for Eversense. And so I think it's starting to get that kind of like, oh, what is that other sensor that we are hearing about that seems to have less issues. And so -- and I'm saying that in my practice, too. Before, I'd kind of be like, hey, here's the Eversense and people are like, okay, okay, let's get to the real ones. But now it's kind of like, oh, okay, like I can see why no pressure lows is a really good benefit. So I think I think it's -- the public perception seems to be improving and the awareness is really going up. I think both as a combination of direct-to-consumer marketing and also some of the struggles that other sensors are going through.

That's great. Maybe just a follow-up. I'm not going to ask on the pump integration side, the timing, Brian, don't worry, I won't go there. But I'm just curious, for Gemini and Twist, when you guys next year release Gemini, what needs to be done from that integration standpoint, if anything? And then when we think about additional pump providers coming on board, as you guys talked about, you're closing in on Gemini, you seem to have a good line of sight for the trials. Do you just sort of -- should we be thinking this is an additional partnership is likely post Gemini with other players rather than pre?

I think I got this one. For Gemini, nothing would change for integration with AID because we'll keep the similar same transmitter, right? So it will only transmit and talk to a pump when the Bluetooth is on, on the transmitter, right? In the flash mode, you're not really transmitting to the pump. So nothing is changing with Gemini. With Freedom, with the Bluetooth coming from the sensor will change, right, because now we'll be different Bluetooth protocol trying to conserve all the power. And so those will have to be updated.

Anthony from Mizuho. Thanks for the Analyst Day and all the updates. Maybe for Dr. Ahn, when you think about just an inflection point for 365 implantable center, we have Gemini and Freedom coming. How much of a big deal from just patients that you're hearing would be to get rid of the on-body sensor? Is that a key inflection point? Gemini itself obviously has better connectivity and communication directly with phone. So how big of a leap step for users is connectivity with the phone and lack of an on-body transmitter in the next 2 years? And then I'll have a follow-up.

Yes. I think my area of interest is type 1 diabetes. I think in the type 1 diabetes population, removing the on-body system is massive. I think like that cannot be understated. I think Freedom is really groundbreaking, and I think that will be really exciting when that happens. I think -- but I think -- I've been thinking about it a lot over the past 24 hours. I think Gemini could potentially be very exciting for the type 2 population because I think one of the things I'm noticing in the -- with these over-the-counter systems that I think people might have expected to maybe have more market share is that I think people don't want things to be visible. You know what I mean? And if you have type 2 diabetes and you can just flash your CGM data, I think that could be a very appealing opportunity for people. So I think in the type 1 population, I think removing the transmitter all the time is huge. But I think in the type 2 population, that could make it a real big unlock. Yes. Does that make sense?

No, it does almost segregate. And I guess the follow-up is for Rick. When we look ahead, to models in that '27, '28, even '29 time frame now, you have reorders in there. You're going to have 3 options available. So how do you think about reorders once we get into that era?

So 3 options. I mean, I think we'll see which products are on market. I think the reimbursement is pretty consistent. And so I don't know if we'll be able to ask for premiums. So we'll certainly try. And then we'll use specific products probably for specific markets. When we get to freedom, I think that solves -- it can be a product for both type 1 and type 2.

Can you hear me okay? Just a couple of quick ones. One, I'd love your thoughts on ketones. Is it an opportunity? Is it a threat? Just general thoughts, ketone sensing.

Ketones is certainly something, Jayson, that we're going to -- we're absolutely looking at. We've actually done some of the experimental investigation to do that. Right now, as many of you know, we do actually have a multichannel analyte sensor. We've actually done the same thing for lactate. Ketones can be important. There's a lot of press on it right now in the type 1 space. And as another level of protection, I can see it having a role, especially in pediatrics. It doesn't really have the same benefit in the type 2 space, and most of our patients are type 2. So at this point, we're going to watch and to really see how the market accepted is up on it. For some of you may know, my background is actually out of Abbott. We produced the ketone strip there, but we could never really get any uptake on it. So I see it -- I see the safety value of it. I understand the reason why Abbott and Dexcom may be competing against it with their similar products, but we'll add it into our chemistry if it really makes sense and the clinical perception is there.

And then one for Dr. Kaufman. Just on the data you presented, I think it was 5,000 patients, patient or user characteristics, it was like 25% type 1, 50-some-odd type 2, and there was 18% not reported. And I don't know if that was just a general sampling dynamic or the real question is, are you seeing use outside of people with diabetes?

No, I think it's a reporting issue. We see the same when we ask them their gender, about 1/3 don't report. The age, about 25% didn't report. So I think it's just -- there's a group of people who just don't want to give up their own statistics.

I'm going to take the opportunity to ask a question that I get asked, David, since I noted your 350 sensor insertions removals. Your perspective, people say, geez, we put the sensor in. Does it ever move? Does it ever migrate? Where is the sensor on those 350 when you go to take it out?

Great question. Yes, it doesn't migrate. Yes, I get that question a lot. I know with like Implanon and Nexplanon, there's stories of migration, but I've never seen the sensor migrate. I mean it might tilt a little bit, but it's essentially the same spot. So I -- yes, I've never seen it migrate. Yes. So I mean, I was among one of the early adopters. It was a little bit of a -- there was a learning curve with removals more so than the insertions. But I have a clinician -- a physician in my office, and he just started doing his first removals in the past 3 months, and I was not involved in his training at all. And I was expecting kind of a call. I was expecting to like give him a pep talk, but I didn't even realize he was doing removals until after he had done like 5 or 6. And I was like, "Oh, I didn't even know you started doing removals, like how was it? And he was fine. So I think the -- I don't know if the training systems got better or if he's just really talented, but I haven't seen it come up. And so yes. I think so. I'm happy to talk to people and kind of give them my tips, but I've also -- they've been really good about gathering my feedback. So maybe they're incorporating what I would have told him to their trainings and hopefully, it's helped them out. But yes, I was probably among the first people to get trained and -- but that was back in 2018 literally. So yes.

Even with the Ozempic effect, I mean, we've certainly seen patients lose 50 to 100 pounds while that year duration, and it's still in the same place. It may be a little shaggier, but it's retrievable.

Anthony again from Mizuho. Maybe looking at the capital raise and the efforts on DTC, just to recap on where the dollars are being placed regionally in the country, which new areas are you looking to open up now that you're capitalized? And when you really make that push DTC into a local region, like what is the sort of turnaround factor or return profile of that as to when you actually see traction from a new patient implant standpoint?

Brian, do you want to talk about the audiences and targeting?

Anthony, we really do geofence our spend. And so we started with 50 miles from an existing inserter, and then we moved it to 75 and then in some markets, we move it to 100. Once you get past 100, we know that someone probably isn't going to drive 150 or 200 miles to get a sensor implanted. And if we start spending it in areas where we don't have inserters, we don't have reps to help the physician get onboarded, then we're just wasting our dollars. So as we can expand our territories, as we can expand our Eon Care facility, as we can expand additional insertion capabilities, then we do our DTC advertising on top of that. And our agency has every ZIP code, every -- it's all -- it's a pretty cool program that is used for it. We do try in certain areas to expand it a little bit. And certainly in rural areas, that helps a little bit more. Once we see success in certain markets, we actually put more dollars in those markets. I was with our biggest account from San Antonio last night. They want to see the data as to what they're benefiting from. So I can literally take it down to an account level. I can see every channel that we use. I can see every ad that we use. We can move them into different modalities, and we truly change things quite often. As soon as they start to get hot, we pour more on that particular ad, that ambassador, that 8-second clip. It's pretty high tech these days. Meta went down here about 2 weeks ago for about 36 hours, and you would have thought our company was ending because we had 50 people sitting inside with not a whole lot coming in, right? So that's how detailed that all gets. And our workable lead percentage is up because we can, to some extent, target those that are on insulin, those that are at the Medicare. Some of our ads are Medicare focused, for instance, and it drives a higher percentage in on a very profitable segment for us. So I could go on for hours and John Bradford is here, you want to stop by and get versed on what DTC looks like from an expert, come talk to my Head of Marketing. It's truly amazing.

And from an economic perspective, we spent about $13 million in the back half of last year. We learned a lot from that, and we're taking the same amount and spreading it over the entire year, and we're seeing improvements in the cost per workable lead, cost per opportunity. As leads come in, we categorize them as low, medium and high. The medium leads convert twice as good as a low and the high-quality leads convert twice as good as a medium. And so we're making the investments and the efficiency with the agency on getting more of those medium and high-quality leads. As Brian said, we're looking at where the appropriate regions are to turn up the DTC spend or add more to it.

And I'd just say lastly, our inside team is doing a great job. I've had almost no turnover in there. Ed Monis came from Medtronic with tremendous experience working for Jeff for several years, snagged a few folks from Tandem over and stuff and that team is really rocking right now. If that team isn't working, then you can do all the DTC in the world. And if it comes in and we don't handle it, then it's just a frustration to the patient. So we meter it by what we can do internally right now. And as we get to the second half of the year, we'll add a few more in there because we're going to dial it up a little bit. And so it is a finely old machine finely, and I'm really happy with what we're seeing.

And maybe just for the physicians, when you think of an implantable 1-year sensor, it certainly makes sense. There's a gating factor, obviously, the implant and explant. I understand that. But where do you think a well-oiled implantable CGM can be as a percent of your patients 5 years from now? I mean, can an implantable option be 10% of the market, do you think? Is that reasonable?

Yes. Yes, I do. I'm not good at doing these numbers of things. I'm just a clinician, but I mean, 10% to me sounds low. If you have -- like for a Freedom system, I mean, that's what people want, right? People want -- that's what people have been dreaming about, right? You want nothing visible. You want it to be all implant. You don't want -- yes, you don't want the disease to be visible. That's literally half of what we do in helping people with type 1 diabetes. And I think you see the same thing in type 2 as well. So yes, in my opinion, 10% seems low, but I'm just a clinician.

And when I show the data that we skew to an older population, it's because the device really is geared toward that. You get to the Medicare age range with maybe some dexterity issues or visual issues or cognitive issues. Having an implant one time a year makes a lot more sense than having to repeatedly change the sensor yourself or wait until your daughter comes to change your sensor. So I mean, the characteristics that we have, that on-body vibratory alert, which enables them if they're having hearing or visual deficit. I mean there's a lot of characteristics for the older population where I think the transcutaneous sensors just don't address their needs as well.

All right. Thank you, everybody, for joining us today. Enjoy the conference.