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

I'd like to start these sessions by just giving you the floor kind of state of play, update us on the quarter. I think, John, maybe to give you a specific prompt, you kind of called the current period of transitional time for Tandem. When do we -- when does the transitional period for Tandem end?

Starting right now. I mean I'd say we've had some pressure from the last 18 months. Certainly, we've had some competitive pressures, some economic, hasn't been acting in our favor. I'd say, over the last several quarters this was stabilized. And we're about ready to enter this period of time where we have this wave of innovation that's going to be available for [ Tandem ]. And I think in my mind, it's the most exciting pipeline of diabetes today. We have 4 products that we're introducing, they are all going to be introduced in the next several weeks [ back ], I'd say. And the good news is that it's not a potential, it's actually happening. And I think that when you talk to our employees, when you see the people in the organization, they sense it, they see it. They hear the feedback and the people who are using these new devices. And it's all been amazing. So I think that as we enter 2024, they potentially all be on the market. And I think that the -- it's going to drive interest. It's going to drive growth in the business. I think that the areas where we have been -- I guess hampered or pressured has been MDI conversions. I think we expect to see that return possibly took where it was before, but at a minimum improvement, and I think '24 is going to be a transformational year for us, and we're all very excited about.

Good start. Maybe start with -- kind of put some financial context around the transition out of the transition you've set a bar for 2024. A 10% -- at least 10% revenue growth. So just at a high level, kind of unpack that for us, what does that goal or aspiration consider in the U.S. and OUS for patient starts conversion? And how does it all roll up to get there for now?

Sure. And I'd like to start by not calling it our aspiration. Let's just say it's a baseline for next year. And as John just talked through the challenges we went through in the past 12 to 18 months, we thought it was important to put this baseline out there, so people could understand what were coming off of and what we could grow to even in the absence of an inflection in the business. And so to your point, the various building blocks that support that are at first, if you think about our large installed base. We have almost 450,000 people worldwide who are using our product today. And so you have the natural growth of supply sales going into next year. You also have, out of that base, our own renewal customers. So these are people whose warranties are expiring, and when you go from the number of new warranty expirations this year in '23 to next year, it's stepping up by about 40%. And I think it's been a really bright spot in the business these last 12 to 18 months because even with the challenges and the pressures that we've seen, we've actually been capturing renewal customers at our highest rates ever, and it's been very consistent. And so I think if you take those 2 building blocks, you can see a very predictable trend of revenue into 2024. And then what happens with new pumpers, where we've seen the pressure. In the absence of any changes in the environment, it would assume that new pumpers are about as equal to what they are this year, maybe even decline slightly, and we could still get to that 10% growth number. And like I said, that's before the aspiration of what the new products can offer to the business. That's just a baseline to put out there just to get people started. And when we get to our year-end earnings call, we will give our traditional guidance numbers at that time, with as much information as we have factored in about the new products at that time.

Good. I'm going to zoom back out. I want to talk about Mobi. I want -- the question asked this way. What about Mobi -- so when I look at the pump market, there's some share to take, of course, it's competitive. But numerically, the biggest opportunity is converting MDI to [indiscernible]. What about moving to this helps with -- the pitch to the MDI patients?

Well, I'd say I'd start off by saying that diabetes is not a one-size-fits-all condition, people have different -- there's different segments. People want to wear it differently. They want to control it differently. They want the flexibility of being able to move [ position of the body ]. And I'd say that having a portfolio [ of price ] is the way to address the different needs of the open marketplace. So Mobi is one additional step. We have obviously [ piece ] them in the market, Mobi is the next step. We intend to have Mobi Tubeless and then also we [indiscernible] and so with those 4 form factors, I think we do a much better job of addressing the various segments that are out there. I'd say that the thing about Mobi that's particularly compelling is it's so light and flexible. I think that we knew it was going to be a positive introduction. We knew people are going to be excited about it. But people who are using it today, it's just kind of off the charts. I think we've been -- or taken back by just the amount of enthusiasm that people have expressed in using it. And I would say it's because the first thing they say is it is so small. They can't believe how small it is and that small size of it gives you this great flexibility to wear it anywhere on your body. It comes with an adhesive patch and a very small infusion study. And so it's so light that people forget that they got it on, and that's a big compliment at this point. We had a woman who ran the New York Marathon with it last week, she did quite well. So got a personal best and the system worked perfectly. And we have hundreds of people wearing it right now and the response and feedback has been very, very positive. The other thing that is controlled entirely by a mobile app. And so the benefit of the mobile app is that it's very convenient, you can -- when you want [ bolus ] you can basically just open up with mobile app, basically give yourself a bolus whenever you want wherever you want, and nobody know you're doing that. So in addition to convenient, it's discreet and I think people really care about discretion when they're managing diabetes. So I think that the combination of the size, the flexibility, the ability to take it off if you want [indiscernible] want to jacuzzi with friends or take a shower or something like that, those are all really important things for people with diabetes. And with other products in the marketplace, you just can't do that.

You have a [ fearless ] -- or like just set aside new patients, your base. You have an expectation in 3 years, how many folks might opt for, let's not even get to [ Tobi ] or the patch, you're selling t:slim platform in Mobi, like what the mix will be?

We have definitely modeled it. We have our own assumptions, we haven't shared them. I will just say that we anticipate that Mobi will be a meaningful part of our overall [ growth ].

I guess, what would be a reason a t:slim loyalist when it want to?

Some people have concerns about mobile apps to join with a medical device. And so I think that could be reason. I think that other reasons that people just like the fact that they can interact with the device on it as opposed to using another. I think that there's people out there that just -- they really do like -- we actually -- we have -- we were just talking to somebody and his partner, who's also an analyst, has a daughter who work -- she plays field hockey. And we were talking to him specifically about using Mobi, he's going probably not. She wears the pump on her back and when she's out on the field, she can actually take that really quick and look and see where her blood sugar and put it right back in. And I think with Mobi, you'd have to have a cell phone just to do that. And she probably wouldn't have a cellphone on the field. So there's a lot of different new ones out there in terms of how people wear it or use it. And I think that it's really going to be [ always ] personal preference. I think providing choice is the most important.

I'll put numbers out and see how you react because you're not going to say the numbers. But like in 3 years, 50-50?

A lot.

A lot. Okay. All right. Well, a lot of 50-50 would be a couple of hundred thousand patients. I guess the other piece of it -- and look, I appreciate that, hey, you want to serve a variety of patient preferences, the portfolio approach totally get it. I think the math would suggest -- margin to you might be better on Mobi, producing touch screen. And so I guess, just pulling on the thread one more time. You have a financial incentive to make Mobi -- Mobi is a bigger carrot for you as a company than t:slim?

You're exactly right. I mean I think it would be ideal if everybody used it. I think that when you see Mobi, it's product cost. The manufacturing cost is about -- 15% less for the pump and the cartridges, it's about 20%. There's going to be margin benefit from moving to Mobi as a company. We anticipate that and have spoken about it. We expect that Mobi is going to be a significant portion of our improvement getting from where we are today, which is our goal of [indiscernible]. So the more people that use them better, I think it's just -- I think it's difficult to put a finger on it exactly at this point.

I could be wrong on this. I noticed that Mobi will come out initially with only iOS, which is great. Is the Android part of the process?

It's a fast follow-up. When you look -- the whole idea was let's go to market place and when you look at our current installed base, we have roughly 400,000 people. The mobile app is available today in the U.S. in both Android and iOS. And the majority of people -- significant majority of people use iOS. So our expectation is, let's get it out there. Most of the people who currently use t:slims will have access to it if they want to use that device and then we'll just ask to follow.

And then just walk me through the timing of Mobi, it sounds close?

Yes. It was approved in July, and it takes about 3 months to sort of deal with the request that you learned from the FDA in that process. You've got to basically update your manuals. You got to train your own organization, you've got to train the [ HCPs ], make sure all your systems are up and ready and running. And so that's really what we've been doing for the last couple of months. And we have begun putting it on people and limited launch [ of that study ] and so we have hundreds of people today that are wearing it. And as I said, just we said 2 people ran Marathon [ last week ]. And the idea now is let's make sure the product performs exactly as we expected. It's a brand-new pump platform. And the last thing we want to do is step on the gas before we're certain that there's no subtle nuance customer services that are out there with the product. So that's the first thing. The second thing is that we want to make sure that when we train people on it, we're doing a good job. We address the issues that come up. And so we have -- again, people are using it, calling into our customer service lines. We're looking at the data that's out there. And so we're learning from it, so that there's the opportunity to optimize the training process, and there's also the opportunity to optimize the customer service. And so this is going to probably take us to the rest of this quarter to get to the point where we're comfortable with it. We'll begin to put our foot on the gas in the first quarter. We would anticipate that at the end of the first quarter, early second quarter, we will move to our [ first pool commercial ]. And when it's currently only using the G6, but when it goes to [indiscernible].

That was my next -- so say 2Q, Mobi [ G7 ] integration available when you're...

All customers.

Got it. Maybe shift gears, I think as I've watched the pump market, there's certainly kind of product stories and then there's a commercial story and kind of -- you've been focused on the medical benefit, the HME channel. One of your competitors has had a lot of success moving into the pharmacy. Last night, coincidentally, this wasn't on the list, but one of -- newer pump company has announced that they have an agreement with a large PBM to be in the pharmacy channel. And I guess I'm curious for your reaction to that. I seems novel. Any idea how it is going to work? And then my question for you, and this was a big threat I wanted on like -- what's the path for Tandem to leverage the pharmacy channel, meet the patient may be where easier to meet the patient over time?

If you had asked a year ago about the pharmacy opportunity, we were saying we would pursue it. We weren't sure if it was possible with a standard traditional DME pump trying to get a new place in the pharmacy channel. And so now that we have Mobi approval available, we have been going out and talking to the different payers on the pharmacy side of the house, the PBMs and the payers and we're being very deliberate about it. And what we're learning is that there is an openness to it. And I think that announcement you saw yesterday solidifies that. It says -- it's not necessarily a barrier because it's considered a pump that belongs in the other channel. And it's important to us to improve access for customers. And so it's been -- it's a great initiative. And with Mobi, we feel confident that we can move the needle on it. I would just point out, it probably still will be a multiyear initiative because it's hard to turn on that light switch overnight. You have to negotiate the contracts. There are different time points with certain of the payers. They only add people to formulary, let's say, on January 1st of every year. So there will be those types of limitations, but we're super excited about the opportunity because we think it can make a big difference to the business. We think it also opens up the door for variations in the business model where we've been in that very fixed structure on the DME side with the high upfront for the pump and the lower reimbursement for the supplies. And so stay tuned on that. We'll have more color in the coming quarters on what that really looks like for us. Mobi was supposed to be sort of our trial into the pharmacy. And then really, it was about developing the infrastructure and the relationship so that when Sigi comes to market, it can go straight into the pharmacy channel.

This is interesting. I mean I was going to ask like, theoretically, what might a model look like, not a software analyst, but it sounds like license to subscription conversion. I guess you see it elsewhere in diabetes CGM has gone through it. What could it look like for you? In terms of the -- how does the upfront sale work? Is it amortized into a higher kind of [ UI ] or a little less upfront and then -- some upfront but less than you get through HME and the delta there goes into the recurring, I guess, what are the -- what's the model look like?

Yes. I think what you just said, all possibilities are on the table. It opens the door for structures that we haven't had the ability to pursue before. And so we're going to be very thoughtful. Again, most importantly is better access for the patient. And whatever can drive that, we will be interested in pursuing.

And not to ask you to comment on this private company, but I guess, is it may be helpful for them that since they're just starting that they can -- you're in the HME you have a big business, converting shifting is not an easy process. But if you were just to start from scratch, streaming up your perfect business model, maybe the pharmacies answer maybe not. Does it help that they're new that they can just go straight into the pharmacy and don't have to manage down a large base both patient-wise and economically?

It's hard for me to say. I don't obviously know any of the terms of their contract and the relationship that they've set I would say for us, it was important to have something different to transition into there. So to your point, having Mobi maybe is the reason that it makes it easier for us now, it would have been harder with the entrenched product that we already had.

Okay. And as you, I guess, -- as you move down the road map, Mobi and then X3 and then Tobi and then Sigi. Do any of those products make this transition easier for some reason?

I think building the capability with Mobi will make the transition much easier for Sigi. And that was the ultimate goal is to make sure that Sigi could go straight into the pharmacy, so we can build up this capability. And if Mobi doesn't get us 100% of the way there, that's okay, we're going to have a lot of learnings for how to do it with Sigi when it's available to come to market.

One more on Mobi. And when you talk about full commercial launch and call it the second quarter, then it takes some time to ramp that up. Maybe by the end of '24 on a kind of -- from a manufacturing perspective, would you expect to be able to -- you're looking at your base, serve all the demand for Mobi conversions? Or are there some supply constraints that will just take time to...

We modeled it and we modeled obviously upside, and I think that right now, today, we have the capacity [indiscernible] so I think we feel good about it. I think that -- yes, we're prepared. And I'll also say it's not -- it doesn't take -- I mean it takes -- automation takes time. We're obviously thinking forward to take that -- automation [indiscernible]. The pump itself is more of -- it's more of a microelectronic devise [indiscernible] required. So I think we're very well prepared to [indiscernible].

How about the upcoming CGM integrations. I think G7 [indiscernible] here this morning -- well, I didn't get to sit through the whole meeting, so I shouldn't speculate. But I mean, look, G7 is great product. And I guess what I -- the question for you is, certainly, G7 for a Tandem user, whether they choose t:slim or Mobi, that's their choice. And then moving into G7, like it's going to delight them. I can't imagine it won't. That's great. So satisfaction rates go up. Does it help with the MDI conversion piece, do you think?

Yes. I think I mean, first of all, I'll say that we rolled it out to our internal employees a few weeks ago. I have to be at a sales meeting, and one of the sales [indiscernible] started -- did the update that comp did all the work they are on. And it was really cool to see it. It's -- as you know, it's got a better form factor, you have a much faster warm-up period. So certainly, it's a big improvement from [indiscernible]. So I mean I think that there's -- and we draft off [indiscernible]. I mean they have a great product and there's lot of people out there very interested in it. And so their success [indiscernible] we benefit. So I think that certainly, we think that there are people out there that are going to be attracted to MDI users are expected to using the G7. I'll say that the way it works really is that people are typically put on CGM for -- they wear it -- they've got wear now a device 24/7, but they get accustomed to the customers of core systems, the access to the technology and the innovation that -- and then they become more willing to consider wearing something else as a pump. So I think that, that's typically how the process works -- as they make improvements to their product [indiscernible].

What about -- as the Libre is -- forgive me if I've forgotten this. G7 is like end of the quarter?

G7 is happening right now and we have thousands of people. And by the next few weeks, we'll have full commercial access. And then with Libre, we're kind of just in the beginning phases of getting people on it and just making sure that the system is working, as I said, properly that the system supporting it. And we'll probably be more -- it will be more front-loaded into the first quarter to get to the [ fourth ] quarter.

That's my question. So Libre has gone through a different journey to kind of get the dosing claim and to be an AID enabler. I would assume if you launch Libre integration, you are confident at a very high margin of safety that it works. It helps your pump be as good as it is with Dexcom?

We're very confident and the device is safe.

Is there any nuance there? I've always like the science and then like -- because you had a signal algorithm -- and again, they've gone on a different journey in terms of accuracy and regulatory clearances. Is there -- roll this forward a couple of years, is there a discussion that Control-IQ is potentially better with G7 than it is with Libre or no?

I don't think so. I think it's -- the last thing we want to do is get involved in any of the competitive dynamic companies that they do come. I think we feel very confident that they provide a signal that actually works with Control-IQ, and that signal produces the same result. So I think that they're both great companies. They're great partners of ours. And I think that both products are going to be very appealing to people who are interested in that particular product. And what we're interested in doing [indiscernible] and they're both good products.

I'll ask one more here. I kind of gave the answer that I expect for this question, which is, it's a competitive market, right? The AID enabled patch is mainly having a lot of success. The other large competitor had some quality issues and is now competing again with the new product or in the U.S. And a new private company is dipping their toe into the water. I guess you've been consistent with this portfolio approach, not -- it's maybe such that -- the Street thinks -- it's an AID enabled patch world, but you see a lot of evidence to suggest that not all patients are going to go there. I guess I'm like answering the question for you, but you know the topic I'm asking about like...

Tube versus Tubeless?

Yes. What's underappreciated?

I think that, again, people have different desires on how they want to wear and hold the product. I think that -- I mean, again, there is -- we just talked about the daughter of the analyst. She has something specific about it. We have another analyst who -- her father has type 1 and her father uses our pump. And she's been trying to get her father to try the [ pod ]. And he said, "No, I don't want to." And he goes swim every afternoon and he loves just to be able to take the pump off and jump in the water and swim without -- and that's very important to him. So I think that there's definitely a need and an application for people using -- there's the first -- really, the first important factor is you can take it off. You can -- again, you can be with people -- take it off and nobody knows you've got that. I think it's very important. You can take it off just because you want to take a break, you don't waste the insulin that's in there. The other thing, too, is that we have multiple infusions -- as I said with Mobi, we've got a very small one, which fits into a patch, and it's almost like a -- people call it a pump in a pack. And but we've also got other infusion sets that have different adhesives. They have different annual materials. These things are all important depending on where you are? What stage of diabetes that you're in, what are you needing? And so the device gives you great flexibility and where you can locate it, but also having these different uses is important. And when you talk to [ endos ], they understand that, and they think it's definitely an important factor to have a tube system. But we also recognize that there's a market for people who want [ a dual ] system. That's why we're working on with the tubeless [indiscernible].

Shift gears jumping around. This question has been asked in many different ways to a lot of companies and -- but it's the GLP-1 question, and there's obviously a large data set out over the weekend. You're 95-plus percent type 1. So this is a discussion for now around type 2. I guess the question is, did your view on these drugs changed because of what you saw over the weekend?

No, I think it confirmed our view. And our view from the beginning has been, first, it's not going to affect [indiscernible]. Type 1 anchor stops were -- and when it stops working, you need insulin. And there's a honeymoon phase where you can use a little bit, and maybe in that phase, GLP-1 can reduce the amount you need. Ultimately, you're going to get to a point where you have to have it. That's -- so type 2 is really -- that's where the -- I think the question is served -- and type 2 is a progressive disease. You move from [ diabetes ], diabetes to insulin and some type -- and I think that over time, what happens is [indiscernible] you build up insulin resistance and so you need more. I think when you're on that progression, it's possible that these GLP-1s can slow it down. The question I think we have to answer and we can't do [ data was not available ] today is that -- what will be the adherence -- and how many people -- there's 100 million people in the U.S. that have type 3 diabetes, what percentage of them are actually going to get access to it? So I think that those are big questions. And what that does, it [ affects the model ]. And when you look at the current number of people that have insulin dependent type 2 in the market today, it's 2.3 million people. And so it's a large group of people today that have it. And we had Jordan Pinsker, who's our Medical Director on the all the earnings call. And one of the points that he is -- actually made this on the call, is that we have a feasibility we've done this year for type 2 and it's a study that's going to enable us to design the [ naval ] study, which we're running right now. And in that study, we had 30 or 40 people and roughly half the people use GLP-1. And at the base case before they started using feel like they were using MDI and they are using hundreds of units of insulin every day, using -- injecting and that's a lot of insulin. And they still were not achieving their diabetes target. They still had very high. So when they got into the study, Control-IQ in combination with the GLP-1 produced the best results. We saw a 15% time in range improvement and a substantial reduction in A1Cs. So they finally met their glycemic targets with Control-IQ and GLP-1. So I think that when you're in that category of insulin intensive type 2s and you're using that much insulin, remission is probably not something [indiscernible], but we can improve the control by using the [indiscernible]. That's kind of what our position has been. And I think that again, the adherence question, how many people get access to this -- it's going to play out. But even if it does slow it down, we still have a large market, and it's even 2 or 3x that [indiscernible].

The follow-up is -- so let's just stick with 95.5, in terms of your mix -- type 2 is, therefore, a much larger penetration opportunity. When you're prioritizing all this and thinking about growing the company and developing the market, given that it's 5% of your base, like how much of your brain space does type to make up? Like is there a portion of amount? Or is it kind of you're developing products that have incremental appeal to both?

I'd say that it's probably the ladder right now, we're [indiscernible] that have -- we have roughly 20,000 people using Control-IQ and [indiscernible] and they have -- they get great results. And so I think that there -- as we get closer to having the indication for type 2, I think there's definitely the need to modify the product. And so those are probably longer-term initiatives for us. Today, it's really let's focus on getting the indication. I think Mobi with a cellphone controlled mechanism will be very appealing because discretion is hugely important for people. So small, flexible cell phone. That's the starting point. And then I think that there's simplification to the user interface. There's advances to the algorithm and then we get to fully close to the system. I think all of these things will be [indiscernible] and enter the type 1.

What about this -- so the question is, do you have a player development opportunity here. It's the carb count versus [ carboair ] story that I'm hearing about and instead of having to estimate how much you're going to have at a meal and do the math, that's all regular or big -- is there a path for you for that kind of patient interface?

I'm mean something we're definitely looking at. I would say that a larger priority for us is to go to a fully closed-loop system. It doesn't require any [ internet ]. And I think that's always the problem.

What scientific algorithmically or hardware perspective, how do you?

There's people testing prices like that today. So I think that we definitely are evolving our algorithm. We just got approval for an indication for trail -- for pediatric using a different version of the software that will also be the same software we use for people with Type 2. But there's -- we're making improvements to the system in time. But I think that point about reducing the amount of interaction you have with the system is important. Today, you have -- you do have to interact with the system, but you can make changes and you can optimize it. And I think people who are very careful are seeing time in range in the high 80s and the 90s, and many people actually report 100% time because they carefully manage it. So it's all about [ bolus ] for meals. And so I think if you do that carefully, you can achieve amazing results. But there's a group of people who don't. And so we want to make sure that they achieve similar performance. And so the simplification of the [ boluses ] for us is very important to us. And I think that -- the company you're talking to has made an effort to move in that direction. I think that's not something that we are definitely considering. But I think the way to solve the problem is to make it close to system where you set it, and I think technology exists out there to make [indiscernible].

I'm interested on Sigi. A lot of Mobi, Sigi is little down the road. When I look at it, what stands out versus Omnipod, I guess, is the semi durable nature. I just want to start there. What's the environmental math there? I think there seems to be a lot of waste with the patch. And I guess how would a Sigi platform improve on that?

Yes. First of all, I think that when you -- I mean, Omnipod is a good product. They have an amazing process to build it in a reliable manner. But you throw it away for 3 days. And so I think that we did not want to have a [indiscernible] product. We wanted to have something that was differentiated. And I think when you look at Sigi, Sigi is a very different product. When you put 2 of those devices in front of you, you got to make a decision. And there's significant differences in the system that -- fortunately make that decision. And so we tested before we acquired Sigi [ our AMF ] Medical. We tested it quite a bit. And I think that when you look at the fact that it's rechargeable and you're not throwing away a device every 3 days. And it also has a prefilled insulin cartridge. We're very appealing, and it scored much higher than any device on the market as well as our own internal efforts. And I think that if you go to Europe these days, we just got back, people there are highly sensitive to [indiscernible] and I think that when you look at the younger population here in the states, they are the same way. And so I think increasingly, the environmental issues are going to be more and more important. And so I think having a device that's rechargeable is going to play in that -- it's going to take advantage of it plus the simplicity of [ changing the cartridge ]. I mean it takes just a few seconds take that out and put it back on. And so I think that's another aspect that's very -- I'll also say that one of the things that some of our competitors have been asked is it's really difficult to build a process, a manufacturing process to build a system that only lasts for 3 days economically. And they're right. It is very challenging to do that. But when you build a durable pump, you have more flexibility. You don't need to spend hundreds of millions of dollars on [indiscernible]. You can do with probably less -- much less than that and still produce a reliable product in the last [indiscernible]. And we've got experience doing that. And so the transition from -- I mean when you look at Mobi, Mobi is a little bit bigger than Sigi, but not a lot, and we know Mobi is a very reliable device. So we're -- we feel very confident right now that we can build another durable device -- patch -- reliable, it has Control-IQ on it and it has access to multiple sensor integration as well.

And base case for U.S. timing, just remind us?

We said it's a '26, '27 time frame at this point -- we acquired the company back in January. We've been working very closely with them right now just to -- look at their requirements for resources and equal and this go back in and really scrub the plans that they've got. It's a very talented team. They're all really strong engineers. They have a very strong focus on manufacturability. Many of them have come from Swiss companies that have high automation. I know how to do that. They also how to design products that work -- so it's a great team. We're very excited about it. And I think that it's going to be meaningful product.

I want to head on Europe. I feel like you have really easy comps OUS. Is that true? I mean we had the French reimbursement change, the distributor transition earlier this year. Those have served to limit this year's revenue. Within that 10% baseline for 2024, is it reasonable to think OUS is growing faster in line. Talk me through the puts and takes there and kind of what you expect from a launch market development perspective in Europe and like more?

Yes, I would agree. We certainly are set up for an easy comp when it goes in for the OUS markets going into 2024. There's still great growth opportunity outside the U.S. We have more than 4 million people living with type 1 diabetes and the penetration rate is so low in the 10% to 15% range. And so we're going to be very focused on continuing to develop those markets and drive the pump penetration there, much like we have in the U.S. And so we haven't given any breakdown yet for that baseline for next year. But it's fair to assume that just even law of large numbers that the U.S. growth rate would be lower than the OUS growth rate.

The other thing to consider is that the U.S. market is [ 1.5 million ] people -- the 25 countries we're in today, there's about [ 4.3 million people on pipeline ]. And U.S. is 35% to 40% penetrated and the OUS markets, maybe [ 10% to 15% ] so we intend to bring all the technology that we have here in the U.S. through our OUS country. And I think it's a large opportunity. And I think that we believe that the penetration rate can achieve ultimately what's happening here, it may take a little longer.

Good. I don't think we forgot anything major unless I'll leave the last word to you.

Yes, sure. Well, first of all, thanks for having us, to be able to talk about what we're doing in the company. Like I said, we're very excited with what's going on. We feel this next year of '24 is going to be a very transformational year for us to get back on to the growth rate that you guys are used seeing. And I have to say that our team is highly motivated. I mean, they've been working hard for a long time and they finally see these products have been used on people, and it's great.

That's good. Well, thanks for being here. Thanks for Tandem.