Tandem Diabetes Care, Inc. (TNDM) Earnings Call Transcript & Summary
November 16, 2022
Earnings Call Speaker Segments
Mathew Blackman
analystAll right. Good afternoon, everybody. Thank you again for participating and joining us here at the Stifel 2022 Healthcare Conference. I believe this is the final session of the day. You've made it through. I hope it's been productive. And we're going to go out with a bang. We've got a great final session for you. I've got Tandem Diabetes, senior management. John Sheridan, President and CEO on my left; and my far left, Leigh Vosseller, Executive Vice President and CFO. As always, if you folks have questions, please don't hesitate. Raise your hand, and we'll incorporate into the conversation. And thank you both for [indiscernible].
John Sheridan
executiveAbsolutely. Thanks for having us.
Mathew Blackman
analystYou made a very long trip.
John Sheridan
executiveIt's been a great day. We had a lot of great conversations all day long.
Mathew Blackman
analystGood, good. Well, hopefully, this is the final.
John Sheridan
executiveLet's just say there's nothing that you're going to ask us that we haven't already spoken about today [indiscernible].
Mathew Blackman
analystWell, good, then there are no surprises. I thought we'd sort of break this up in sort of different sort of themes and topic threads.
Mathew Blackman
analystAnd maybe we'll start, and we'll talk about sort of what happened in the second and the third quarter and the 2022 outlook and how it sort of all rolls up. But maybe just to start, take a step back, the one final pump company to still report, but we don't get a ton of information from them. Just your sense of the overall market dynamics in the U.S. just from an underlying growth standpoint. Anything to call out? Some market growth sustained relative to what was in the past has taken a step down. Just anything to frame what you're seeing just in the U.S. market to start?
John Sheridan
executiveYes, sure. I think that if you look over the last couple of years, we've definitely seen accelerating growth in the MDI conversion to pump therapy. And I think that the driver really has been new technology from us, from our competitors and from our partners. And our whole deal is, it's all about ease of use drives adoption. And I think there's a burden that people have to overcome to consider wearing a pump for 24/7. And so if you make it easier and you provide a great therapy, there is a lot more willingness to do that, and that's what we've been finding. So as I said back in maybe back in '17, there was about 25,000 people coming over annually. We've seen the number go up to 35,000 to 45,000. We think last year, the number was about 70,000 people. Now in our guidance this year we assume that, that was going to be the same number, 70,000. And I think that it's difficult to say exactly what's going on because most of the demand, most of the activity really occurs in the fourth quarter. So we really have to get through this quarter to say it. But I would say that when it comes to how is it being split up, historically, I think it's basically, we share it with Insulet. And so it's the 2 companies that take the lion's share of the MDI conversion.
Mathew Blackman
analystAnd the European market? I know it's not a single European market, so it's hard to paint it all with a single brush. But just any changes in the backdrop in Europe? Obviously, they're feeling the same sort of competitive -- not competitive, the consumer pressure is maybe more intense than we are here. Any change in sort of demand patterns in Europe?
Leigh Vosseller
executiveYes. Nothing really to speak of in the markets outside the U.S. In fact, the challenges that we see here in the U.S. really aren't there so much. We have the lingering COVID effects of access to physicians and patients in that regard and just accessibility there. But from an economic perspective, because so much of it is covered by the government systems, we don't have that same dynamic of people feeling the strain of a recessionary environment.
Mathew Blackman
analystAnd not seeing any impact on that. I assume the coverage is also on the supply side as well. So you're not seeing any impact of the people?
Leigh Vosseller
executiveThat's correct.
Mathew Blackman
analystOkay. Maybe sort of look back to the second quarter and the third quarter and sort of 3 disruptive dynamics maybe that is sort of best phrased, particularly in the U.S., this competition. Inflationary macro pressures on the consumer, and then we'll call them pandemic-related pressures, COVID case rates and staffing. Maybe just first, if you could, we'll punch through a few things that relate to these 3, just for rank order, the intensity of those headwinds? I assume competition's first? But I don't know, maybe you tell me different when we think about which is the most intense and the least intense of those 3.
John Sheridan
executiveYes. I would say that there's a perception that competition is first. I would say that we anticipate competition as we actually put our guidance out for the year. We anticipated that there was going to be COVID factors and the competition. I think in the second quarter, we were surprised by how important the macroeconomic factors were in people's decision to choose the technology. And we basically learned by just talking to our sales organization. The sales team has -- there's an internal and external team, but they have very close connections with people who are in the funnel, if you will. And these are people who have indicated that they're going to actually select a pump. And so I think in the latter part of the second quarter, what began to happen is, I think that because of the inflationary effects on gas, on groceries and things like that and the potential fear of recession, some people in that funnel just said, hey, listen, we're going to pause. We're not sure what's going to happen. We're uncomfortable. I mean it's a lot of money for us. And we want to wait and see what happens before we actually pull the trigger and make the decision. And so that was the unexpected thing that happened in the second quarter. And I think as we go on, we continue to see them. If you want to rank them, I would say that the COVID-related factors we've been dealing with now for a year. And so it's not as significant as competition and the macro factors. But I would say -- and it's difficult to pick which of those 2 really is the most important one. At this point, it's just -- it's difficult to pick one and say that's more of dominant factor.
Mathew Blackman
analystSo it's not any single one, it's the aggregate of all 3 at the same time.
John Sheridan
executiveYes. Aggregate of those. And I would say it's not just affecting us.
Mathew Blackman
analystWho else would you say it's effecting?
John Sheridan
executiveI would say -- I think that pump companies in general are going to be impacted by this.
Mathew Blackman
analystAnd you just -- we may not have seen it yet.
John Sheridan
executiveThat's right.
Mathew Blackman
analystOkay. That's the point you're trying to make. Maybe so this is the first time you've really faced competition. We're going to stay on the competition thread. And maybe we can sort of really -- we were talking about it's you've been through a lot worse, but maybe reflect back to sort of the 670G launch from Medtronic and what that did to your business. But that's not what we're seeing, right? I mean that was a real sort of hard stop on the entire market. This seems a lot more measured and much smaller. Is that a fair way to characterize it?
John Sheridan
executiveAbsolutely. I mean what happened when 670G came to market as a -- I mean they received approval before they anticipated they would. And it took them about 3 quarters to get ready to actually deliver the product. And when they got approval, the FDA called it the artificial pancreas. And so I think that the entire industry, anybody with diabetes thought, oh my God, here is the solution. And so people waited. They waited till it came to market.
Mathew Blackman
analystAnd so as you think about -- I mean so COVID is probably not going away, but it is what it is, frankly, it's sort of the new normal. Are you seeing anything different? And you've -- when we think about sort of pressure on the consumer, you've added and maybe expanded some of your patient access programs and financing programs. Maybe just talk to a little bit what sort of initial reception you're seeing to some of those programs? Some of them have been around for a while, some of them maybe are newer. Just anything in terms of what the initial uptake has been so far?
Leigh Vosseller
executiveSure. I'll point to the payment plan program that we've recently launched. And I say recently launched, to your point, we have a payment plan offering in place for many years, but it was more on the back end of the process. So it wasn't well known or advertised that, that option was available for people. So late September, we launched a rebranded program, which is now front and center in the conversations. And it makes a really big difference from the position of our sales reps as they go out in the field now. Anyone who has any sort of consternation over how much it might cost or the offering, they can now direct them to have those conversations with us internally, where before they weren't really able to talk about them. And it's also helpful in an environment where we're hearing about where we have competition, who's talking about different business models. And so this helps in a way, sort of stimulate that type of offering where you can pay along the way.
Mathew Blackman
analystAnd so what -- and I'm going to transition now and actually, [indiscernible] online, let me -- before I move on. Historically, what -- is there a way to frame what type of uptake there was of the payment program, 5%? I'm just trying to frame. If I recall in our conversations, there wasn't a tremendous amount of uptake in those and just any baseline for us to think about?
Leigh Vosseller
executiveThat's correct. We've never publicly disclosed the percentage, but I can say it was a very low percentage, which is why it wasn't even worth talking about. And so we'll have to see if there's real uptake from actual usage of it or if it's just helpful to have the comption, so people will know if they call in there might be other alternatives or options as they think about their finance.
John Sheridan
executiveWith that being said, we did see in the first and second quarter of this year, the largest uptake and access to that.
Mathew Blackman
analystAnd did that continue in the third quarter or not?
John Sheridan
executiveWe haven't really said yet. I mean we actually didn't -- we haven't said exactly what happened yet.
Mathew Blackman
analystOkay. And I guess, sort of as you think about the competition part, it's been several years where you haven't had any new competition. And so how do you work your way out of it? Is it simple? You've got a pipeline, you've got new innovation coming, you wait for the pipeline and that sort of changes the trajectory? Or is there something deeper that you need to do? Whether it is -- you've already expanded the sales force? Do you need to do it again? Just ways for you to sort of counter some of the competitive headwinds? Because to be fair, there's -- if anything were coming potentially from more competitors over the next sort of 2 years. So how do you compete?
John Sheridan
executiveI think that the -- first of all, I think that we still have the best product on the market. I think there's something that's new out there that people are interested in, there's curiosity. And so it's all so easy to try. So people are certainly trying it. I think that in the short term, we definitely have increased our advertising and marketing. We have the mobile bowls feature that was just introduced. Now we have this payment plan program that gives the sales force ammunition to go and actually have conversations directly with the HCPs and with people who are considering the technology. And I think there's a lot of -- there's confusion about features and benefits and things like that. And so I think the clarification of what does our product actually bring and how -- what are the benefits. It's important to continue to get that out to HCPs as well as people considering the technology. So that's certainly one of the avenues. And I would say that clearly, I think we have an exciting pipeline. We have new products coming to market next year. We have Mobi coming to market. We anticipate that there'll be clearance prior to the -- in the first half. We also have the integration with Dexcom and Abbott that are both new products that are going to come to market. And so as you look at our growth as a company, it's never -- we never anticipated being linear. Here we are in a situation where there is a competitor in the marketplace. We're seeing more muted growth. And I think next year, when we bring new products out into the marketplace, we'd expect those to drive acceleration in our growth. So again, it's not going to be linear. We still have confidence in achieving our longer-term goal. And I think that's largely driven by our pipeline and just working to expand the market.
Mathew Blackman
analystMakes sense. Maybe, Leigh, take all this and sort of roll it up into the fourth quarter guidance that you gave, we'll talk about '23 in a moment. But so how this all rolled up into how you thought about resetting the outlook for the remainder of '22?
Leigh Vosseller
executiveSure. So one thing that we learned at the end of third quarter very quickly was that previous to that, we had been trying to predict the impact of each of those factors or those pressures in the U.S. and tried to make predictions on when and how they would relieve themselves. And very quickly learned that, that wasn't effective. And so it was really, as I think you mentioned earlier, it was the combination of all them together, that creates a different -- more unique environment than we've ever experienced before. And the trends we saw middle third quarter all the way into October further highlighted that point to us that we cannot rely on historical trends as we -- in order to predict. So what we did was we took a much more cautious approach in Q4. And we said, let's take these last few months with the combination of those factors that they're most intense, I would say, and let's just carry that through the end of the year. And so it does imply that renewals will continue to be strong. We've seen them seemingly unaffected by these pressures that we're seeing. And I think that says a lot about the loyalty of our customers, the commitment and how much the technology benefits them in their lives. It's really about the question around the new patient growth. And the guidance does imply that we still are expanding the market just at -- to John's point, much a little bit more moderated rate than we have up to now.
Mathew Blackman
analystOkay. And I know I'm sure you're very eager about fourth quarter trends, knock yourself out, if you want to. But just remind me again, I know fourth quarter is the biggest quarter, but it's also very back-end loaded as well as soon as we think about December being the biggest month, is that the right way to think about it?
Leigh Vosseller
executiveAbsolutely. That's exactly what happens just from the seasonal nature of our business. Every month usually builds with December being the top out point. And to the point of the unusual trends that we did not see as we went through from August to October, we saw a little bit of up and down. But it does still assume that it's heavily back-end loaded just like we've seen in the past.
Mathew Blackman
analystAnd so there's a good transition to sort of take these variables as you plotted them for the remainder of '22 and then sort of talk about what you laid out in terms of a framework for 2023. And just a reminder to the audience, essentially calling for something like 11% to 12% top line growth. Can you just walk us through sort of the puts and the takes in there? And I think the one thing -- I'm going to sort of front run my own question here, it's interesting is 11% to 12% top line growth. You had, I guess, a tougher third quarter than people expected, but there were some onetime items in there. If I back those out, like distributors working down inventory, you actually still grew 15%, somewhere in that neighborhood in the third quarter. So I'm trying to sort of juxtapose that 11% to 12% top line with strong renewals. And that 15% number you just put up on the third quarter.
Leigh Vosseller
executiveSure. I'm glad you highlight that because we have still had some pretty incredible growth. I think that gets lost in the message because it wasn't necessarily where people expected it to be, and we do expect growth on the go forward. Ordinarily, we would not have communicated any sort of guidance for next year, this -- in 2022, thinking about how far away we are from it. But we feel like it was important to reset expectations because of where we were trending for the fourth quarter and also because the estimates out on the street were all over the place. And there was a question of, does this include new products or not? And what we did was we took a baseline approach. And what we wanted to do is say, this is what we can do in the absence of new products and based on what we're telling you about the environment and where we are today, we're going to carry through some of those trends. And so this is the starting point. So when you talk about the puts and takes, Normally, we kind of factor in both and we weigh them together. This is more on the take side, so this is more on the cautious side of the -- what could go wrong, what we're seeing today. And then we look for those upside opportunities being the new products. As some of the payment plan program, how much that can offset the economic pressures. Or as we think about the competitive environment, we see this as an evaluation period when that starts to unlock and prescriptions start happening at a more normalized pace again. And so really, it's a baseline for next year. But 2 main points is a bigger piece of our business is becoming more predictable than ever before. Supplies represent almost half of our sales right now. We have the renewal stream. We have the number of new opportunities growing by almost 80%. And our trends have become pretty predictable in the terms of how many people renew and at what rate. So those are factors that we thought about for next year, then again, back to it's a little bit of the question mark on what can happen from the new pump perspective. We've still factored in expansion of the market but at a more -- again, more moderated pace than before.
Mathew Blackman
analystSo slightly higher than 70,000 is sort of the way to think about the underlying patient adds and the market in '23?
Leigh Vosseller
executiveWe're refraining on making a comment yet on how many ads will be market-wide until we see how this year plays out. But we've set our own expectations in terms of how we can perform against what we usually attract to the market. And then the last piece I didn't mention at all. There is an unusual dynamic with our OUS business that plays into that thinking for 2023. And that's the transition to our distribution center. We just commenced operations in the third quarter to opening that center in the Netherlands. And what that does is it creates a dynamic where our current distributors on their shelves today have inventory, in some cases, exceeding 3 months because they've been juggling all the challenges with getting freight from point A to point B. They were trying to pick it up in San Diego and running into all kinds of hurdles. And so what we happening as we transition those markets and it's the European markets, in particular, they'll be whittling down that inventory to smaller levels. So what we've talked about is the fact that in aggregate, it's roughly the equivalent of about 8 weeks of inventory or 8 weeks of sales for our European business, which is about 70% to 75% of sales.
Mathew Blackman
analystAnd so if I sort of get that out in the 12% would be -- how much higher would that be the 11% to 12%?
Leigh Vosseller
executiveIt probably costs a couple of points on the growth rate, but we'll get through it. And I think the important thing is that the variability you've been seeing on our business -- so for instance, this year, we've seen our OUS shipments were basically flat year-over-year, but our demand has grown in the mid-teens. So what will happen is once we get through this transition period, you'll start to see better alignment of true demand with our actual shipments.
Mathew Blackman
analystFair enough. I guess one of the other interesting dynamics that we haven't talked about. We talked a little bit about it earlier in the year, and I'm wondering if it's baked into '23 at all, is you're getting a little bit of a mixed tailwind in the U.S. from a more exclusive distributor -- more direct distributor sales, which gives you a higher ASP. Is that -- first of all, did you see that same sort of dynamic in the third quarter? And is that all baked in? Is that sort of a tailwind we should be thinking more about as we think and model the next several years out?
Leigh Vosseller
executiveSo we have seen some great benefit this year. In the third quarter, we talked about it in the U.S. to the tune of almost 3% is of pump pricing improvement year-over-year. And it is a contribution from all of the years of market access work we've done to get these direct contracts and to continue to shift more to the direct side of the operations. And so it will continue to build. I wouldn't necessarily build in 3% every year, but I think you should expect that as part of our gross margin.
Mathew Blackman
analystAgain, that's mixed. It's not like you're taking up price?
Leigh Vosseller
executiveThat's correct. It's -- we are -- I'll say this, we are getting better pricing, too. So as we contract with the payers, we're getting contracts in place. And with the contracts we've already had in place, we've been using our Control-IQ data where we show them pre and post outcomes for their own subscriber base, and it's been beneficial in terms of getting price increases.
Mathew Blackman
analystThose things -- are those contracts renewed annually? Or is that...
Leigh Vosseller
executiveIt's all over the board. I mean...
John Sheridan
executive[indiscernible] I mean I think with -- when we first got started, we have a very small installed base. We have questions about our ability to actually stay in business for 4 years. And it's a much different situation right now. We have 400,000 people worldwide using the product. We've got tremendous clinical data. And so we kind of -- we're talking to the right people in these organizations today that make decisions. And so we're making progress, and we'd anticipate that this is going to ultimately -- I mean, I believe this will ultimately result in higher ASPs from these payers as they share the benefit that they're seeing in terms of cost reductions from tech.
Mathew Blackman
analystThere was some conversation discussion before Control-IQ was actually launched that maybe you'd be able to get a premium upfront.
John Sheridan
executiveThey're slow in bureaucratic.
Mathew Blackman
analystBut the opportunity is still there just on the back end.
John Sheridan
executiveStill there, absolutely. And we're working it. We have people in the organization that are very focused on this.
Mathew Blackman
analystI want to ask a little bit about the pipeline. So let me just clarify and be absolutely certain. So the '23 guide or guideposts maybe -- it's not sort of explicit guidance, but that does not include the pipeline? Or it does? Or if it does, does it include it in the second half? Just any help on sort of these incremental opportunities potentially.
Leigh Vosseller
executiveYes, it does not include the benefit from new products. So you can see that as upside opportunity. And that's typical. We typically don't include new products in guidance until we have more certainty on the regulatory timing in the actual commercial launch.
Mathew Blackman
analystJust out of curiosity. I mean, obviously, the FDA over the last couple of years, particularly the diabetes division it's been a slog. No doubt, improved at all you're seeing?
John Sheridan
executiveWhat we've heard is that -- I mean, we really haven't had I think, under review for a while now, but what we've heard is that people are coming back into the diabetes division. But they're not the same people that we've worked with for the last 10 years. And so there's a learning curve that's going on with a new group. I think that, obviously, we've indicated that we think that Mobi is going to be approved in the first half. There's definitely a buffer in that assuming that there's going to be some of these unpredictable issues going on.
Mathew Blackman
analystAnd when I think about the wild cards and the pipeline, I guess, are the biggest wildcards for next year, Mobi and then, I think Libre integration in particular. I mean, obviously, G7 is great, but the opportunity to maybe go after some of those Libre patients, I think, is huge. Maybe a little bit -- I guess one of the areas I struggle is trying to figure out who the patient is for Mobi specifically? And maybe just help me walk me through that. Obviously, shorter tube, tubes are a problem. But you talk to some patients, you talk to some docs and they say, a tube's a tube, but it doesn't matter if it's long or if it's short or I actually like a long to, I don't understand that one. But just help me understand who the patient is? And is it a true tennantite someone that you could pull off the sidelines from a toehold or these are patients that were going to go to Control-IQ anyway. So help me to sort [indiscernible]
John Sheridan
executiveI mean I think diabetes, it's very segmented. I mean it's not one size fits all condition. Many different preferences, many needs for that just the general community. And so we've done a great deal of market testing for Mobi. And typically, the way we've done it is we've looked at what the competitive devices would be today on the market. It's going to be the 780, it's going to be the Omnipod 5. We assumed that it would be Beta Bionics. We assumed it would be Bigfoot. And then when we analyze this, we -- let's see how t:slim with Control-IQ does in that particular marketplace, and it did quite well. We then did the exact same thing and also evaluate how -- what is the preference share improvement when we see just t:slim. And it also did quite well. It was competitive with all the products. But we put both products in that same group. And we look to see what was the competitive share increase. And we saw -- basically, we had 50% of the preference share when they had both products in the market. And I think it's just indicative that there are people out there that prefer having the touch screen on the device. There are people out there that prefer small, discrete mobile technology. They're more comfortable with mobile technology. Some people aren't. And so I think that, that -- it's just -- I think it's very indicative of the fact that it is a segmented market. And there are different needs. And I think that both these devices are going to provide meaningful improvement for people. When you think of the end of the year next year, -- there's going to be 4 devices on the market and 2 of them are going to be Tandem products.
Mathew Blackman
analystMakes sense. And then maybe help us with the Libre opportunity. I think -- do you have a good sense of the number of patients, the type 1s that are on Libre? And we think it'd be sort of skewed to Europe versus the U.S., but any sort of framing of that opportunity?
John Sheridan
executiveYes. First of all, I mean, we have a great relationship with Dexcom, and we've certainly drafted off them over the last 4 or 5 years. We really benefit from having them as a partner. And I think right now, with Abbott, they don't have a pump integration. So it's really open to it. We believe there's approximately 300,000 people with type 1 in the U.S. using the Libre technology. So I mean it really just -- we have the same opportunity there [indiscernible] to draft off the people. And I think when you look at with Dexcom, what we've seen is that people come to see CGM technology, the therapy, they have been -- MDI, they've never had anything on their body for that period of time. And they see the benefits of the technology, combined with the fact there's an organization out there that's supporting them. So I think that kind of lowers this hurdle I've mentioned that now people are willing to consider trying pump therapy at that point in time. And that's really what happens is lower this hurdle. People tried the therapy, they try the technology, and it provides amazing therapy. So we don't -- we anticipate similar opportunities with Abbott, both in the U.S. and OUS markets.
Mathew Blackman
analystMaybe, Leigh, sort of last question on this section, and we'll move to just a discussion about market penetration. I know you've given some top line framework for the top line. We didn't talk about margins. But I guess one of my concerns is in an environment where things may be a little bit more challenged, you may feel compelled, or not, to pull back spend. And maybe just sort of think about or sort of talk to us about how you're thinking about spending in general, I would think you would continue to spend, whether it's on R&D or whether it's on selling and marketing. But as I think about sort of maybe next year being a slightly down year in terms of the growth that you're used to and maybe there's some pressure on profitability you might feel compelled to change your spending trajectory. Just how you're thinking about that in general?
Leigh Vosseller
executiveWell, I'll start with it, John, if you want to chime in. But I would start by saying this year we had a pretty significant step-up in operating expenses, and that was by design. It was a year of investment for us. And it was really about building the depth of expertise in our R&D teams. It was about the increased requirements from the FDA in terms of getting new indications. So we've had to spend a lot more in clinical trials, I would say, than we've had past. And we continue to build out our support teams for our large base. So as we grow, we need to add more people to support the ordering process, the technical support processes. And so that will be a significant step up this year. We already -- by design, we're planning to start to turn the corner there and not have a significant growth. But in this different kind of environment, we're thinking even harder about prioritizing what are the critical investments. And I think you hit the nail on the head. It truly is we need to invest in R&D because we don't want to sacrifice anything that we have in the pipeline for top line growth. And we also need to make sure we continue to have high customer satisfaction and the best customer experience because I think that has really contributed to our renewals and how well we've progressed there. And so those are the areas we'll continue to focus in spending what we need, but we'll also look for savings opportunities being thoughtful of trying to achieve our profitability objectives in the longer term.
Mathew Blackman
analystThis is probably a silly question, but we hear from some of your competitors -- we hear about some of your competitors having really poor customer service. How hard is it to build that type of infrastructure?
John Sheridan
executiveIt's definitely a cultural thing. I mean you basically have to get an organization that's focused -- everybody in the organization focused entirely on improving the lives of epti diabetes. And so it starts there. And I think that it's -- I think that when we talk to people in our customer service organization, talk to patients or people that are experiencing problems and need some help, they really represent the company. And we just help them understand how important their service is to the business. And I think when you've got that focus on the patient and you've got the sense of the fact that these people are probably stressed out because there's something going on with them that they just need help and they're confused. It's really, really important to help them. And I think that it's -- we've just really -- we've staffed the organization. We're trying to invest in technologies to make them more efficient and provide more of a consumer-oriented when it comes to dealing with the company. So there's a lot of technology that we're employing that will be -- we'll continue to improve the experience for patients.
Mathew Blackman
analystMaybe just the last 2 minutes, and if there are any questions before I monopolize all the time, let me talk a little bit about penetration. I think the first question, I think it's interesting because we've heard it from others as well, we had traditionally thought of the U.S. type 1 population being about 1.6 million in size, and there's a little increments of growth. At Analyst Day, you talked about it being a 1.9 million patient opportunity. Now Dexcom is actually talking about it being a larger opportunity. What happened? I mean the sort of underlying growth of the market didn't accelerate, but just what happened that got you from 1.6 million to 1.9 million on think about the denominator?
Leigh Vosseller
executiveYes. It's just continuing to get new data and information that support what the market size truly is.
Mathew Blackman
analystSo it's not like we saw a spike of COVID driving type 1 diagnosis?
Leigh Vosseller
executiveYes. No, nothing like that at all.
John Sheridan
executiveYes. I don't think so. I think there's been small...
Mathew Blackman
analystSo you're just finding new humans. Okay. And then how are you thinking still about the penetration, the peak penetration for type 1? Is it still 60%, 70% or north of that? Just help us. And maybe the context is probably at 30%, 35% now.
John Sheridan
executiveYes, we are 35% now, and we've been very clear about our longer-term objectives, and we think we can achieve a 65% market penetration rate. And as I said, when we started, it's largely driven by technology that reduces the burden of diabetes and improves the therapy. And it's just going to be Tandem, it will be Tandem. It will be our competitors and our partners that are doing the same thing. They're providing new technologies to the marketplace. When you think about today, I think that Basal-IQ when that came to market in was really the first product that reduced the burden in people's lives. Since then, we've had Control-IQ come to market, but it's only been our products. Now that Insulet's got a device in the marketplace, it's also going to drive people who otherwise would not have considered pump therapy. I think that that's -- they're going to help benefit and grow that market. So there's also -- I mean there's things that have to -- I mean we have to work to build the market also. There is sort of a -- some physicians have a bias in terms of prescribing the technology, and they think [indiscernible] people who are in control. The reality is people who don't have good control, see the very big, largest increases in time and range revenue. So there's a bunch of things out there that we have to do to help people understand the benefits of the technology, not just with the pipeline. But I think that -- I think all these companies together will be working to achieve that. And I think -- that's why we think it's possible to get to 65%. And we've also seen existence proof from the CGM companies who are now 70-plus as well.
Mathew Blackman
analystOkay. Fair enough. I've got 3 more pages of questions, but we need to get you guys to the airport. And so we'll end that -- we'll end this discussion here. Thank you so much [indiscernible].
John Sheridan
executiveAbsolutely. It was great talking to you. Thanks, everybody.
Leigh Vosseller
executiveSure. Thanks [indiscernible].
Mathew Blackman
analystAnd everybody, appreciate your attendance this year and great to see everybody in person. And we'll see you soon. Thank you.
John Sheridan
executiveThanks, everybody.
Mathew Blackman
analystThank you.
Leigh Vosseller
executiveThank you.
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