Tandem Diabetes Care, Inc. (TNDM) Earnings Call Transcript & Summary

Hi, everyone. This is Steve Lichtman, Medical Devices Analyst at Oppenheimer. Welcome back to the Oppenheimer Fall Healthcare summit. Very happy to have with us up next Tandem Diabetes, a leader in the insulin pump market. With us today are John Sheridan, President and CEO; Susan Morrison, EVP and CIO, and Liz Gasser, EVP and Chief Strategy Officer. This will be a fireside format. If you have any questions, please submit them, and I'll get them over to the management team. I am going to turn it over to John for a few opening comments. And then again, we'll go right into questions. Thanks John.

Sure. Steve, it's great to be here. It's good to see you. We're looking forward to these meetings being in person in the future. I just want to start off by saying that we are continuing to see great momentum with Control-IQ in the market. And in the US, it's been in the market now for approximately 18 months. We were actually able to get a significant number of people updated using the Tandem Device Updater. And so we saw in the first quarter or two, 50,000 to 60,000 people update their pumps. And as a result, the physician community got to see just how well this product works. It helped them, I think, really gain confidence and trust in the product. And when they heard the sort of the reports back from their patient populations, it was extraordinary. And I think it really has helped us gain momentum in the US market. We are now in the sort of the early stages of rolling Control-IQ out in France and Germany, 2 of the largest markets in the 20 or so we're in. And so we anticipate that we're going to see great growth, similar to what we saw here in the states, OUS. The market in the OUS countries we're in today is over twice as large as it is here in the states. And so there's a great opportunity for us there. I think you've seen the early results in the first and second quarter, we were very happy with the performance. The third quarter is -- it's different that in the European countries, it's typically very holiday centric, but we're looking forward to getting back into the fourth quarter and looking for a strong finish to the year.

Great. Thanks, John. Yes. I want to ask about Delta, I understand, obviously, we're towards the end of the quarter here, but just to the extent, you can -- the comments you're able to share on how Delta has impacted the pump market, particularly in the US?

Sure. I mean, we talked about this on the second quarter call. And we factored into our guidance, the effects that we're seeing today in -- from COVID. And you know what was happening is as we -- as people -- more and more people became vaccinated, we saw the market just opening up. It was almost returning to normal. Physicians were inviting us back into their practices, we were doing a lot more face-to-face training. And again, it just appeared as if things were going to the point where it was going to return to normal. And then as we mentioned on the call, in the June time frame, it was almost like -- now that things appear to be back to normal, if you will, people just started taking holidays. And it wasn't just the physicians, it was the patients as well. So there was this period of time when people just started to take holidays and just take advantage of the fact that they've been locked up for the past 18 months. It's obviously something that was -- it was -- everybody was due to have that happen. And I think that what -- it seems like it's abruptly changed. Right now, there's been a lot more concern about the Delta variant. And we have seen just on different geographies, some geographies have remained the same, where they really still remain open, but there are a number of them that have been more conservative and things have become more restricted. But like I said, this is factored into our guidance. It's pretty much what we anticipated seeing. And it's playing out the way that we thought it would.

And has the experience of course of last year and how you guys pivoted to remote helped inviting those reasons have got unexpectedly hit during the quarter as well in terms of your interactions with customers?

Yes. As you said, we were able to pivot very quickly, and we have a lot of practice doing that from -- back in the 2000 time frame. We feel very comfortable going back and forth between in person or remote. And our sales organization has great relationships with physicians. And so in those areas of the country where there have been more restricted protocols implemented, we still have the ability to call and have remote Zoom calls with physicians. And so things are, as I said, going pretty much the way we expected.

That's great to hear. As we pivot to some of the pipeline, if anyone else has to say questions on this, let me know but if we could pivot to the pipeline, can you -- I think you mentioned maybe the other day that on mobile bolus, you have responded to FDA. Can you try to lay this thoughts on the timing there, you still expected by year-end and especially with COVID having picked up and FDA obviously focusing there. Any change in your thoughts on your end?

No. I think we're very pleased with the response. As we said, we got it in a little while ago. We're just anticipating interacting with the FDA here shortly. And just based on where we were in the process, based on the types of questions they had for us and based on the sort of thoroughness of our response, we feel very comfortable that this is going to be something that happens in the second half that we get the approval in the second half. And as we've said before, the mobile bolus feature really is the #1 requested feature for people who are using Control-IQ today. It turns out that with Control-IQ, the pump just operates in the background. And the only time anybody needs to interact with the system is really when they have to bolus for a meal. And so the ability to do that remotely from a mobile app is -- it provides a huge benefit in discretion and convenience. And so we anticipate that once it's available, we'll roll it out quickly to our US-based patient population first. And we anticipate that anybody who's using Control-IQ in the US will be using this app here shortly after it's available.

Great. On t:sport, I mean, it almost seems like that's kind of received in the background of investor consciousness, seems kind of pushed out a bit. But can you give us your latest thoughts in terms of what can that do for Tandem in terms of your patients that might be hesitant to go on t:sport. What does it open up potentially for you guys?

Well, it's about half the size of the t:slim pump, and it doesn't have a touch screen. That's really the way we were able to shrink the sizes by eliminating touchscreen. And it's also fully controlled by a mobile app. It will be android and it will be iOS. It is wirelessly charged, is waterproof, all the latest technology that's available in the system. And so I think when you look at what's going on in the market today, we're seeing this acceleration of penetration. And we believe it's driven by technology, technology from our CGM partners as well as technology from our competitors. But what's going on is that we're bringing new technology to market. It's improving the experience. It's reducing the burden of diabetes. And as a result, it's increasing adoption. And so we're seeing that accelerate and I think that there's clearly a threshold that somebody who's using a pen or a needle has to overcome to start to wear a pump, and we think we're reducing that. Now when we did market research on t:sport, the population that's most interested in t:sport is MDI, and we think it's going to continue to provide innovation to the marketplace. And that's going to continue to allow us to accelerate the penetration rate. We said, we think it can get to 50%, others think it get higher, but it's the innovation and new technology that we're bringing to market that's going to make those growth projections occur.

And in terms of -- you've been very clear on the pipeline that it's linear now in terms of global bolus and then submission of t:sport. What are you able to do sort of in the background with t:sport to make the time between those two approvals and launch of t:sport as tight as possible in terms of ramping production, in terms of other clinical work that perhaps would need to be done. I mean, are you able to use this time to speed things up on the back end?

Yes, of course, what we're doing is -- we have learned a lot from our interactions with the FDA so far. We believe there's more to learn between now and the time that the mobile bolus is approved. But we're working to incorporate those learnings into t:sport as we speak. We're also building out the manufacturing processes right now. We're building product. We're just refining the yields and all of the aspects of the manufacturing predictability. We are doing all of the necessary testing to submit information and prepare it to the FDA. So we're actively engaged in development of the product and the development of the systems to support its commercial launch. And I think that we just have to get through this mobile bolus approval. And I think we'll be able to be more predictive that when that's occurred on what the timing will look like for t:sport. But we want to be sure we have as much information as possible to make these commitments. We just -- we don't want to have that -- the lack of predictability, if you will, in any of the commitments that we make.

And then to the extent, you could talk about the Abbott system with Libre. Where are you guys at in terms of that development agreement? And what should -- I think you said 2022, any way to put a finer point on first half, second half or in terms of the potential on that?

Well, I mean, we're -- we have a great relationship with Abbott, and we've been working with them now for 3 or 4 quarters. And as I've said, there's a parallel effort here. Tandem is working with the Abbott engineering team to integrate the sensor onto our pump. And that's kind of what our internal initiative is. And in parallel, Abbott's internal team is working to address the vitamin C contraindication for its use and AID system. And so those are moving forward. Abbott's confident in their ability to resolve these issues to test it and prove it to the FDA. But we have to address both issues. I think it's difficult to predict because of obviously, there's the resources at the FDA. There's a lot of work that has to be done on both sides of this. We believe it's a 2022 product. I think that we just need to move further down the path in terms of our development before we'll be able to make specific commitments about the timing.

Shifting to International. I guess, first, relative to your comments earlier about things in the US with Delta, how you played out so far, largely in line with your expectations, would that, I know it's very different dynamics for you guys Internationally, but would that sort of apply generally to Delta outside of the US as well?

I mean I would say that we see similar regional impacts in different countries. The other thing that's going on in the third quarter, of course, is typically the European countries take a significant amount of holiday. And that's another factor that's affecting us in the third quarter. But I think that we anticipate that -- we did anticipate that in the guide, and we obviously expect it to turn around here as we enter into the fourth quarter.

Great. And then talking about the opportunity, reminds us if you could sort of the opportunity in the newer countries, Canada, France and Germany and where you are in terms of Control-IQ launch.

So just taking a step back, there's about 4 million people living with Type 1 diabetes in the countries that we're in outside the United States. And there's about 400,000 pumpers in those countries. So Canada, France, Germany combined, they make up about half of that opportunity. So obviously, important market for us. Basal-IQ has been available in each of these countries since last year. And so we began the Control-IQ launch in Canada here in the second quarter, and we're in the early stages of launching in France and Germany now. So there's a number of steps that go into any launch, one of which is obviously being able to provide the software update to all of our current customers. And so we're going to be in the process of that, and that really benefits us because it starts to amplify the voice, the positive experience that people are having. And then they go in to see their healthcare provider, and they can demonstrate the improvement in clinical outcomes. So those are the types of things that you see that really start to build momentum to the launch. So overall, I'd say, early stages is what's to expect here in the back half of '21, but you'll really see the benefit in '22 as it's available for the full year.

Okay. And then in terms of the number of countries you anticipate being in by the end of the year, I think was 25%, is that right?

That's roughly correctly. Really, we're focused on penetration in these markets. Because if you think about it, when we went international in the third quarter of '18, our first focus was conversion of the Animas space. And then it wasn't until the fourth quarter of 2019 that we really started to expand our efforts and do more organic sales. And so then obviously, COVID hit. And so these markets are only 10% or 20% penetrated from a pump perspective. And so there's a lot of opportunity. We'll tuck in a few smaller geographies. And I think the primary focus here in the near-term is going to be penetration into these countries.

Speaking again on the pipeline, as I talked, of course, in the past of iterating the algorithm for Control-IQ. Some of the bigger changes you did note would be pushed out a little bit based on your interactions with FDA. I guess, first, can you provide some more color as to why those got pushed out? And what is going to be needed to achieve those?

Sure. Well, I mean, I'll say that we have a great relationship with the FDA. They're really a partner of ours. And I think that they -- we both intend to bring products to market to improve experiences that people with diabetes have. I would say that one of the things that they've encouraged us to do over time is to look at creative ways to provide data to them that just either can get products through to review faster, potentially that don't require as much clinical data. And that's what we did in this first submission, which we made back in the fourth quarter. We provided simulation data and we provided real-world data. There was a risk associated with doing that, but they had encouraged us to do it and we just tried. Once we had a chance to sit down with them, they just -- they said there's more information that's needed, and you're going to have to do some clinical testing in addition to what you've got to collect that data. And so it's -- that's kind of how and what happened. I would say that when you look at the changes, though, that we had submitted there, those changes, I would call them modest. These are changes to improve access, but a lot of broader population of people that get access to Control-IQ that has been approved originally from the algorithm that was developed at UVA. So that's kind of where we're working right now. And we're going to see the opportunity. We're running these clinical studies on the 2 to 6 year olds. We're also doing a Type 2 study. These other studies are going to allow us to collect that data, and that will help us with this submission. So I would say that's kind of the first step. We are absolutely and have been working on many more significant changes to Control-IQ. And if you recall, we licensed it from Type 0 back in the '16, '17 time frame because we didn't have the resources internally to do that. But over the last couple of years, we've really built up the team of developers. Now we have a large group of people that are focused on algorithm developed at this point in time. And so the -- what's happened really is that we have been working to prioritize and simulate more significant changes to the algorithm, things that we've talked about in the past. And so once you simulate those and you have to -- you work with your clinical staff, you work with KOLs and you make a decision on what are you actually going to implement into the algorithm, we've done that. And then you actually have to go off and design and implement those changes into the system. And so we've done that. And so right now, we're actually -- we're beginning pre pivotal studies for some of these significant enhancements to the system. And that's another set of studies that are going on as we speak. And we've talked about this. We've talked about personalization, the ability for people to decide where they want their blood sugars to reside most of the time. That's important. We've talked about adaptability, simplification of the bolus workflow. And then just with the primary objective of improving time and range. And right now, if you carefully bolus for meals using Control-IQ today, people are -- they're seeing time and range in the high 80s and low 90%. In fact, we see people send us text all the time where they've been at 100% time in range for weeks on end. So it's possible to do that, but not everybody is that careful. And what we want to do is make it so simple that everybody can achieve those same kinds of time and range benefits because the system itself supports and facilitates that. So those are the kinds of changes that we're looking at next. When they are available, we intend, of course, to make these -- use the Tandem Device Updater to update pall the pumps that are in warranty now in the US and also OUS. So these are really cool changes. We're excited about them. And it's great to have Jordan Pinsker on our team now, who's leading our clinical efforts, and he's really doing a great job in providing focus and just helping us execute on these initiatives.

As we think obviously, the biggest concern from investor being the pending competition, I guess, first, have we seen -- it hasn't certainly be seen in the first half, but any sort of freezing of the market as a result of these pending launches? Certainly, that wasn't the case with quick Medtronic years ago, but wondering what you're hearing and seeing from the ground with respect to that at all.

I mean, when you look back in the '16 and '17 time frame, Medtronic, the 670G approved probably earlier than they expected. And when it did get approved, they marketed, advertised it as being the end all be all the artificial pancreas. And so there wasn't anything else in the market that was competitive to that. And so there was a reason that people were waiting because they really thought they were going to get the artificial pancreas at that point in time. Well, it didn't work out as people had expected. And now I think when you look at the products that are being brought to market, if anything, that they're just -- there's -- the algorithms have similar performance to what Control-IQ was able to do in our pivotal studies. So I don't think there's this huge differential in expectation that there was back in those days. And I think that -- I would say that we haven't seen anything specifically yet. I think the fact that both of the products, because of a variety of reasons have been pushed out in terms of their availability. That's probably one factor. But I also think that the differential between what's already available in the market and what these new products are going to bring isn't anything like it was before. And I think that -- and as I said, we still feel very confident that Control-IQ in its current implementation on t:slim, will be very competitive in both cases. In the case of the tubed pump, the improvements to the two technology from Medtronic, really are incremental algorithm improvements. It's the same pump, and it's the same sensor. So we're competing effectively today against that device in Germany. And I think that we expect that when it does come and is available to the US will compete effectively against it here. And I think that when the Omnipod 5 is on the marketplace, it still comes back to the tubeless discussion. And we think there's a -- I mean, right now, there's roughly 70% of the people who choose a pump, choose a tubed pump. And we think that, that is a decision because of flexibility, because of the ability to take the pump off, take a holiday, the size and the variety of options that you have in your cannula and your -- the infusion site with the infusion set. There's just a variety of different benefits you get from those. We think that's going to continue to be the primary driver of -- when people make a selection for a pump. So I think that competition is good. We're all making improvements to the products and technology. We think those improvements are going to continue to drive growth in the MDI penetration. And because of that, I think there's a lot -- there's going to be an opportunity for everybody to be successful when these devices come to market. And so I think that the concerns people have are overblown, and I do believe that Tandem will continue to compete effectively in the market when -- if anything, we'd like to see the products on the market now.

Okay. And yes, look, I want to touch it base on the second on market penetration, which is certainly what you're alluding to, John. But as you're bringing on these patients now with the competition still not on the market, talk a little bit about the digital strategy. I know it's been important to you the last couple of years and how that can help create stickiness with those patients? And then also as a potential other differentiator as the competitors come to market in the coming quarters.

Liz, why don't you take that one?

Yes, happy to. And I'm really glad you phrased the question that way because the way we come at digital is it's grounded in this idea of therapy management, and there's a holistic aspect to it. It is really -- it's really intended to drive and build value around our flagship pump portfolio across both t:slim and t:sport. And so as you think -- as we think about where it goes, there's a few different principles embedded in it, and I can speak to each of them. First and foremost, it's embodied through not just at for the portfolio of algorithms on device software and mobile and web interfaces. It's by design multi-platform, multi-stakeholder and it's engineered to reinforce itself as it scales. It builds value with scale. And so in terms of what we've done to date against those principles, clearly, we have data integrations with the CDM partners, which is reinforcing, driving our algorithm roadmap and John spoke to that. We then wrap around this idea of mobile apps, both as a control tool for the pump, which is the split roadmap between mobile bolus and full control, but also as a display and insights tool, right? It's the point of data visualization for a user of our pumps. And it's also an interface through which we can deliver additional insights, services, features and capabilities. And then once you have an application infrastructure, you obviously have a data infrastructure. And so that's where we think about the data management layer that sits behind all of that. And that really, for us, is something that is one, optimized for the patient but two, optimized to the physician themselves, right? It's a tool for the therapy management compensation. And there, we're really talking about how we migrate from our traditional data management infrastructure to connect to a product that we've been talking about of late called Tandem Source which is really built around modern data visualization intended to drive customizability of reporting and very much geared towards the need of a patient optimized therapy dialogue. Over time, all of that can be brought together to deliver additional capabilities, whether it's through reporting, decision support, insight tools. And so as you think about kind of the [ moatiness ] of it, if you will, a big part of it is built around this idea of leveraging that data scale. So today, with the deployment of Control-IQ, we currently have north of 30 million patient days of data -- therapy data both outcomes and insulin therapy in our system. That lets you do an awful lot in terms of feeding the innovation pipeline. So we come back to those algorithms, not only on the pump, but also off pump around how you improve usability, help with reducing the learning curve for users. It reinforces our trust base with the HCPS. They can see the outcomes, they trust the outcomes. They know what we're delivering from a product perspective. And then it can be utilized to really drive tools that can be used by the physicians and the payers to really reinforce those outcomes build their insights. And so that's a piece of it. And then the digital wrapper itself, it's in some ways a classical digital ecosystem type play because you're really thinking about how you drive ongoing engagement and interaction with the users of your product, such that you're knocking down those daily cognitive burdens of using the product, you're knocking down, but the commercial burdens of managing supplies and impacting the data and the day-to-day usability. And so we like to talk about the digital strategy. We think it's a really important piece of not just digital, but making the pumps and cells awesome too.

That's really helpful, Liz. I wonder -- when I think about and talk to investors, it becomes a little bit hard to quantify how much we differentiate a disease versus others? How do you stay ahead of others? Is -- would you say you guys have got at it earlier maybe to iterate maybe quicker as a result or what's sort of the competitive advantage that Tandem has this front?

There's a few pieces to it. Actually, it starts with updatable software. To date, we are the only pump company that has gone there, right? And John has been talking about it through our conversation here. That means rapid path to scale for new features. We don't have to wait for people to replace the device, to get those features in the hands of users. The other pump companies have said it's coming. They've yet to do it. And so we're building on multiple years of experience on our side in making that happen seamlessly for users. And I'd think the other piece of it is really to think about the multi-platform angle. Our portfolio today on the application side is Android and iOS. When we launch mobile bolus, it will be Android and iOS. Right? You hear other pump companies talking about first launches is Android, which for us is a relatively small portion of our base. And so that's not easy to do. Certainly, we look at the world of mobile devices, and we're familiar with these platforms. So there's assumptions that you can just structure regardless of the platform. It takes a meaningful investment and the teams to understand how to work with those platforms and to deploy software consistently across it. So that's the second piece. But I think you'll see us doing a little differently. And then the third piece is around that back-end data management platform. Medtronic has their legacy platform. Insulet doesn't talk a whole lot about what they've got. And so we really believe leaning into that physician tool and that physician platform is helpful to differentiate us. John, anything you would add to that?

I would say that the -- I mean, there's -- it's all about the patient experience. And I think that you want to make it positive, a positive experience. You want to make it convenient. And you want to make it consistent with what people are used to dealing with today when they interact with other commercial devices and consumer devices. And that's really where we're focused. We think that Apple has built this amazing set of products and services around their phone. They can charge more for their phone now because they've done that because people just don't want to leave. And I think that we have a similar thought process about building data-driven products and services around our pump to create this experience that people just really appreciate and value so that they -- so when it comes time to renew, they renew it and more people come to Tandem. I think that -- we think that this is a differentiator. And as Liz said, there's -- I think we are out in front. And I think that this is going to have a meaningful positive impact on our growth in the future.

Great. Talking about the market itself. I want to focus more on Type 2 in our remaining time than Type 1. I think on Type 1, as you mentioned, John, you have still a lot more penetration potential ahead, and the trajectory has been good in recent years as a result of innovation and with more innovation, you should see continued upward trend there. On Type 2, one market and then get in to you guys specifically, what do you think is the biggest hindrance to be in terms of pump adoption in type two? Obviously, it can be prescribed, Control-IQ, can you prescribe off label, is it reimbursement that holds it back? Is the lack of awareness amongst the Type 2 community, what in your mind is holding it back from taking off quicker?

Liz, do you want to take that one?

Yes. It's a compound questions. There's a lot of pieces to it. Certainly, historically, in the Type 2 space, there have been some relatively high bars to meet, to qualify for reimbursement. Obviously, we talk a lot about the C-peptide test their requirement to be fulfilled in getting a type 2 on a pump. That's largely gone away on the commercial payer side at this point in time. So it's not too much an impediment there. It remains on the Medicare side. And so we and others in the industry are working to engage, to understand what it's going to take to remove those requirements because they're not necessarily grounded in great therapy logic, if you will. So that's an ongoing process there. More generally, I think on the type 2 space, certainly, as we look at the US market, we think it's about 5% pump attach among the insulin intensive type two population, which is about 2 million people. So 100,000-ish pumps in use. That can grow with automated insulin dosing and delivery in large part because it removes a significant cognitive burden from the therapy regimen. And so we see room for growth in adoption. Could go 10% in the forecast window that we're tracking, maybe a bit higher. I think to go much past that though, we probably only to really consider how we're serving the needs of this segment, which tends to be older, tends to be less technologically engaged, tends to be less well educated on some of the basics of managing therapy like car counting, it's challenging. And so where we're spending our time and thinking about type 2 is really considering where the needle has to move on the devices themselves potentially on these interfaces, on automation of things like settings, on the application layer, on how you support and onboard these patients. And I think to really unlock the space. As an industry, we probably need to move the bar a bit on what's the right product market fit for this group.

Great. And then on that front, Liz and John earlier this year, I think in one of our conversations at an earlier conference, you mentioned a potential more discrete type 2 dedicated product in the longer term pipeline. When do we hear more about that? Are there any additional details that you could provide around that potential product, perhaps dovetail with what Liz was just referring to?

Yes. I mean, our focus right now is really to take advantage of the current products that we've got and get them approved for type two. Everything prior to Control-IQ is approved for type two. And with the control acute clinical study did not cover type 2. So we didn't get the indication. And our competitors won't get it either. So we're going to be required to do clinical studies to get that approval for control IQ. And once we have that, we think that Control-IQ on the T sport pump really is compelling and the size and the mobile capability, the discretion, the ease of use that comes along with that. And so that's kind of priority one. And as Liz described, it's a complicated situation, it's complicated, it's segmented. There's many different segments. There is opportunities to understand those segments and then drive feature enhancements. I think simplification is clearly something we know we have to do. I mean, right now, the current pump that is really designed for type one. And there's a lot of specific requirements that people with type 1 need and have to have. That is not nearly the case. That's not the case for type two. So simplification is a big factor. Another is the channel. And we have to figure out how to access PCPs in a way that's efficient for the organization. So there's a potential to use technology to use our mobile -- our digital health resources to provide access points to provide the ability to coach, train, support and address questions that the PCPs might have. But we're focused on what we can do today. We're doing a lot of research on these other areas. And I think that it's not -- in the next short period of time, a couple of quarters or so, I think we'll talk more about it. But I think that's where we're headed at this point in time. We think that, as Liz said, there is opportunity, and we think it's something that we definitely need to be researching and understanding more thoroughly, which is, I mean, largely why we made the investment secure. I mean, we did that because there's an opportunity to learn about segments we're not part of today and to learn about type 2 in general. So we're definitely building the strategy out, and I think we'll talk about more in the not-too-distant future.

Great. And in terms of greater outreach, whether it's for type 2 or even just within the core in your type 1 market, do you see a need or an opportunity to increase the commercial sales force today, getting ahead of the competitors who are coming to market. Is that still a runway for you or do you feel pretty good about where you're at on that front?

I mean, we're always assessing the sales force size and the sort of the demand in each of the regions. And it's something that we do just as a routine process. I think that as the company continues to grow, I would expect to see our sales force continue to grow as well. But it's something that we're always assessing. And I think that we're making incremental additions routinely to that team.

And then from a balance sheet, what opportunities do you see for use of cash, you mentioned the investment you guys made in secure. I mean, generally, what are you guys looking at for potential use of that cash?

Yes. It's a great position to be in. And we're looking at organic as well as strategic opportunities to really help advance our product pipeline and also just bring new innovations to people living with diabetes. In addition, as John touched on, we're also making investments that are further going to enhance our customers' experience with Tandem, both at the time of purchase as well as through their ongoing kind of care and services that we provide.

John, in terms of -- you talked about this a bit earlier, but with respect to competition, as you talk to investors, what do you think is sort of, in your mind, sort of the most misunderstood concern versus where you are and the confidence that you have?

I think that -- I think when you introduce a new product and you bring it to market, it doesn't immediately take hold. You have to establish a position, you need to get devices into the market, you need to show how they perform and you need to build the confidence and the trust of the physicians who are going to be prescribing it. With the Tandem Device Updater, we were able to do that in a very short period of time. And as Liz said, today, we have 30 million patient days and very positive patient days of data in our database. So we have in a very short period of time, established a large group of people who are using the technology and the physicians see it every day, they hear about the great results that people are experiencing. And so I think that for someone just to come on to the market and change that dynamic, it is just not -- in my mind, it's not -- it's just not going to happen like that. I think when you even look at the way our competitors have talked about rolling the devices out, they're going to move slowly for a variety of reasons. And I think that as you move slowly, I think that you just -- you don't have a chance to build that momentum. So I think that -- I mean, as I said, I think we've got momentum, we've got confidence of the physicians, people love our device and that is an important factor that I think we have an advantage over the devices that are coming to market. I also think that when you look at the technology itself, as I said, that one of the competitors has an incremental improvement to an algorithm. The other competitor, I think it's the first implementation of a device with Bluetooth connections and with an algorithm. And so I think that there's opportunities to continue to look at improving those things. I think what you experienced is just learning curve and the learning curve does present challenges. When you interact with those devices that have to be improved as more and more people start using them. So I think that it's really moment have we have. We have so much momentum. It really is hard to step into a situation and change that dramatically. And I think that's one of the things that people continue to -- they just -- I don't think they see that.

Thank you so much, John, Susan and Liz, for joining us today. Thanks, everyone, for dialing in, and have a great rest of the week.