#1697 Que Dallara, EVP & President at Medtronic Diabetes
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Scott talks with MiniMed leader Que Dallara about her refugee-to-CEO story, Medtronic’s spin-off, new MiniMed name, 780G automation, upcoming sensors and pumps, and the dream of hands-free diabetes tech.
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Scott Benner Hello, friends, and welcome back to another episode of the Juice Box podcast. Today's podcast episode is sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed seven eighty g system and their new sensor options, which include the instinct sensor made by Abbott. Would you like to unleash the full potential of the MiniMed seven eighty g system? You can do that at my link, medtronicdiabetes.com/juicebox. While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise.
Scott Benner Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Welcome, Hugh. How are you?
Que Dallara I would be better. How
Scott Benner are you? I this has been a good morning for me so far. I appreciate you asking.
Que Dallara It's Friday. So
Scott Benner That that is why it's Yes. Been a good Exactly. I'm just I'm doing this and one other thing, getting my passport renewed. I can't imagine a more boring afternoon, but at least I won't be sitting at my desk for a couple hours. I thought it'd be cool to have you on and get to know you and to find out a little bit about what's going on at what we're, I guess, not gonna be calling Medtronic diabetes anymore.
Scott Benner Can you first let me know a little bit about yourself and maybe how you got into this position?
Que Dallara Absolutely. Well, since you asked, I'm gonna bore you a little bit about myself.
Scott Benner Please.
Que Dallara I don't know if you remember the, you know, the pictures of boat people in the late seventies, you know, escaping Vietnam after the fall of Saigon. Mhmm. Well, I was one of those bird people. I was five years old, and our family was making this, you know, grand escape on really a rickety riverboat in the South China Sea, so not really a seaworthy boat at all. And we got shipwrecked.
Que Dallara We got rescued by on this tiny island in the Filipino archipelago. And my parents and my my three year old sister were on this journey. So we were in this refugee camp for, I don't know, eight months, something like that. And then luckily, we got granted asylum in Australia, so that's why, you know, you hear the speech impediment that I have now. But we grew up super poor in Sydney.
Que Dallara Character defining moment, if you like. And, you know, I really believe that, you know, life gives you the tools depending on how you, you know, you you get brought up. And when you grow up really poor, you get a lot of tools. Yeah. So, you know, what Ben followed was kind of, you know, twenty years of, you know, poverty in Australia, and my mom was she was a single mom.
Que Dallara She actually was pregnant during this whole time. And when we arrived in Australia, like, two weeks later, my my younger sister was born. Wow. So we have four kids, newborn baby. You know, even though she was a trained lawyer, spoke three languages, you know, she worked as a postal worker on the night shift.
Que Dallara So I work you know, grew up taking care of my three younger siblings.
Scott Benner Right.
Que Dallara So we couldn't afford a lot. It was really rough. I worked on you know, I sewed things for a dollar apiece for a T shirt, and, you know, I I learned to cook, you know, even woodworking, becoming really self reliant. So so I have a, I guess, a lot of deep empathy for people who struggle, you know, trying to get out of poverty for really half my life. And, you know, that's kinda how I started, and I worked for everything.
Que Dallara So how I got to Medtronic, it was really happenstance, you know, kind of it's never a straight line, Scott, and I don't have diabetes, but I have a lot of people in my life that do. I mean, frankly speaking, you really can't go very far to find people who know someone who really suffers from the disease. And so my background's in software and tech. You know, previously, I was at Honeywell, and Honeywell works on a lot of things that kinda control problems. Mhmm.
Que Dallara Like, you can have, you know, how you regulate temperature in a building or autopilot in an air aircraft. That's a controls problem. And actually, what diabetes is is a controls problem because you're sensing glucose, and then you gotta do something about that. And so there's actually a lot of software in it. So given my software background and manufacturing background and sort of consumer background, and given that I knew a lot of people in my life that had it, it just was a perfect marriage to, you know, to to join Medtronic and and lead the diabetes business.
Que Dallara So that's how I kinda randomly got here. Obviously, it was not very planned.
Scott Benner So with your background and what you just explained about control, what do you think the people who hired you were thinking when they hired you? What do you think they thought the future was, and how could you shepherd towards it?
Que Dallara I think it was largely driven by the consumer experience I had with software, software and services. Because a lot of this is, yes, you've got the medical device, but there's a lot that gets involved you know, that is involved in managing diabetes. It's like how you get supplies, how you manage all the admin associated with, all the software tools for the caregivers. And so I think they were probably attracted by that in my background. And I've always been worked in areas where I love building things, building products.
Que Dallara I've worked in launching a lot of products. And so given the innovation cycles in diabetes technology, I think the people at Medtronic felt that that was a that was a good fit. It was a it was probably a bit of a, if I'm honest, a very unorthodox selection. But in some ways, given the state of where the business was when I joined with, you know, some of the challenges, especially in The US business, having fresh legs and fresh eyes are probably a good thing.
Scott Benner Yeah. Where would you assess Medtronic as as being in this landscape before you got here, and where is it that you're trying to take it to?
Que Dallara Well, I think to be candid, I think it you know, the business lost its leadership position in The US and, you know, fell behind. And I think at the time, there was the the warning letter had just, you know, landed on the doorstep. And so while there's a 41 history in the business of many firsts, the first portable sized pump, the first CGM that physicians use, the first seven day infusion set, the first CareLink, and the first AID system. There's a lot of firsts. That's the heritage of the business.
Que Dallara That was always there, but the business hit some troubles, to be fair. And so I think I don't mind struggle. Like, you know, that's a bit of my background, and I saw something that was so important. And if we care about choice for people living with diabetes, you know, and all the innovations that came out of MiniMed, I saw that there, and and so I was very energised to be part of restoring that heritage.
Scott Benner Mhmm.
Que Dallara And I think you've seen some of the innovations coming out that we are thinking differently, we are moving faster, and, you know, it just was a shame to not, you know, to let it sort of atrophy. So that's so despite the fact that there was a warning letter, I saw a waterfront property.
Scott Benner It's interesting the way you're talking about it because I didn't expect this today when I got on with you, but I see a a lot of similarities between what I do and what you just said because I I struggle every day with this idea that I've built this thing that I know helps people. I watch it happen all the time, but then how do you talk another person into giving it a try or get it into their attention, like, so they can even consider it? Like, that's most of my life. Most of my life is spent, like, trying to serve it to people. And it's a very, very frustrating aspect.
Scott Benner And you don't have the same you were candid earlier. Like, Medtronic had a stranglehold for a long time. Right? Like, doctors just prescribed Medtronic. So, like, you were ahead.
Scott Benner You probably had first movers on a lot of things, and that doesn't exist anymore. So now, I'm I'm excited because now what I'm hearing is you're gonna have to deliver stuff that helps people that works because that's gonna be your only growth opportunity, I would imagine.
Que Dallara Absolutely. And look. We wanna earn it. Like, it's not gonna it's not an entitlement. We wanna earn it, and we're gonna do that because we listen to patients, and we're gonna work on great ideas.
Que Dallara We have unbelievable a great team at MiniMed. I mean, about roughly twenty percent of our employees live with the disease, and more than seventy percent have a personal connection. So they're related to someone that has the disease. And so it's very personal for us. Like, we don't like not being number one.
Que Dallara We think we have the best therapy on the market, and we have hundreds of thousands of people in over 80 countries who use our solutions here. And so we absolutely wanna earn it. Actually, the first thing that I did when I joined Medtronic was I met with employees that have diabetes. And I wanted to understand, like, you know, what were we doing well, what weren't we doing well. And so they gave me a lot of insight, I think, you know, we've been on the path now to you know, obviously we got out of the warning letter in fourteen months.
Que Dallara We've got an unbelievable quality system. Obviously, that's in the news too. It's important that that's a core foundation. We didn't cut any corners. We've also rejuvenated our innovation pipeline, which I'm sure we'll get to talking about.
Que Dallara Yeah. Which just leads to awesome senses into the market. And so, hopefully, the other signs that we are, you know, on that trajectory, we're not there yet, but we are absolutely gonna win back, the hearts and minds of people with diabetes.
Scott Benner How long have you been in the position?
Que Dallara Three and a half years.
Scott Benner Three and a half years. Okay.
Que Dallara Seems longer, though.
Scott Benner What led to the name shift? Right? I mean, I've been saying Medtronic diabetes forever, but now that's not the case anymore. Tell me what the shift how did it come to be, and why do you think it's important?
Que Dallara As you know, we've announced that we're going to we're in the process of separating from Medtronic. And while our products were still called MiniMeds, it's MiniMed seven eighty g and so forth, we need to have our own name so we can't be called Medtronic diabetes anymore. And so it made perfect sense to go back to the original mission of MiniMed, which really was the original category creator of diabetes technology with the five zero two pump that was portable and small versus what was there at the time back in 1983, actually. You know, we picked MiniMed because we wanted to recommit ourselves to the original mission. I mean, we we only serve intensive insulin users in type one and type two.
Que Dallara We're not going after wellness. We're not going after prediabetes and things like that. This is our sole focus. And when you look at the history of the business, it's been the pioneer of many, many firsts in setting the standard for that. And so while in recent years, you know, we lost a little bit of our footing in The US, we continue to be super strong outside The US, and we're regaining a following back in The US as well.
Que Dallara Mhmm. And so that's what that's what's behind the name MiniMed, and we wanna live up to the forty one, forty two year heritage for the next forty one, forty two years or until until old cure is found.
Scott Benner Being a a smaller unit now, how is that gonna help you accomplish that, or or is it gonna make it more difficult? Because I know sometimes when this happens when companies, you know, kinda sell off or separate a little bit, it's not always easy to take the I hate to say it like this, but sometimes the good the good talent doesn't go with you, And sometimes it does, like, right? So you've gotta look at the entire reporting tree again and start over. Right? So I it's a great opportunity if you can put it in place.
Scott Benner So I imagine you've been doing that for a while. Like, do you feel like that kind of structure exists now, and and how do you think being leaner will help you?
Que Dallara Well, a couple of things. From a talent standpoint, the good news is we have had no trouble attracting talent into the business because people are very motivated and energized by the mission Mhmm. To help people. Because, as I said, most of our employee a lot of our employees have a personal connection. So it's very personal.
Que Dallara Like, we we hear the feedback. We respond to it. I mean, we're not we're not very far away from the the patient. So that's not been an issue. The other thing I would say is the leadership team that's gone through a lot of adversity together, restoring the business back to growth, are part of are going as part of this separation of with Medtronic.
Que Dallara So with it's not like we have a brand new team. We have the same team that have been executing this. You know, there's a lot of IPOs in medtech, but one other thing that people don't realize is we're almost a $3,000,000,000 business in revenue, and that puts us as a top 20 med tech company by revenue.
Scott Benner Okay.
Que Dallara So we actually have a lot of scale. And I would also say that we are in over 80 countries around the world. We support 26 languages. Yeah. We have twenty four seven, you know, tech support, and we have hundreds of thousands of people in our therapy globally.
Que Dallara So we are really not that small.
Scott Benner Mhmm.
Que Dallara We have a lot of scale behind I know of 8,000 people. So we have a lot of scale behind our product and our innovation. I'm actually excited because Medtronic is huge. Part of being huge, one of the downsides is you can be a bit slower in places, and we're gonna have the opportunity to move even faster than we are at the moment.
Scott Benner Right. No more turning the Titanic when you wanna make a decision. Right?
Que Dallara Exactly. Exactly.
Scott Benner I might be wrong. Right? But I'm an outsider who pays a bit of attention. So but I'm trying to understand, like, with what's going on now, new sensors, new systems, you know, thinking about algorithms, getting that all set. What happened in there?
Scott Benner How did you, like I don't know. It feels like you went out to, like, a first place lead and then coasted. Like, what happened to Medtronic? Like, how did you get how did they start so strong? Here's a sensor.
Scott Benner Nobody's ever had one before. You just got it. You start selling it. That becomes the the business instead of the innovation. Like, how does that gap happen, I guess?
Scott Benner Because you're would you describe yourself as as catching up? Or, like, where do you think of yourself as I guess, there's two questions here. Like, how does that gap happen, and where do you see yourself in the moment? Unlike other systems that will wait until your blood sugar is a 180 before delivering corrections, The MiniMed seven eighty g system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. Today's episode of the Juice Box podcast is sponsored by Medtronic Diabetes and their MiniMed seven eighty g system, which gives you real choices because the MiniMed seven eighty g system works with the Instinct sensor made by Avid, as well as the Simplera Sync and Guardian Force sensors, giving you options.
Scott Benner The Instinct sensor is the longest wear sensor yet, lasting fifteen days and designed exclusively for the MiniMed seven eighty g. And don't forget, Medtronic Diabetes makes technology accessible for you with comprehensive insurance support, programs to help you with your out of pocket costs or switching from other pump and CGM systems. Learn more and get started today with my link, medtronicdiabetes.com/juicebox.
Que Dallara I think, honestly, lots of companies go through it. I think it's called the innovator's dilemma. Right? You kind of you you're the innovator. You get to a position, and what's very natural is you lose sight of why you exist.
Que Dallara Mhmm. And, you know, hubris sets in, you don't think you're touchable. That's a very common cycle a lot of people a lot of companies go through, to be honest. I mean, there's many, many stories of that. Right.
Que Dallara Kodak, Intel. I mean, there's a lot of examples. So I'm sure we went through a little bit of that. I think the other part of it is when you're part of a big company, you fight for capital. Like, you you've gotta, you know, you've gotta be a better business case than another business.
Que Dallara And so, you know, when that happens, sometimes the investment moves in different parts of the portfolio. I mean, that's a bit of the focus thing. Now Medtronic gets to focus more. We get to focus more. And all we do is serve people on who need it, you know, in in need insulin.
Que Dallara So those two things, I think, contributed to, I would say, choices that were not optimal. And so, you know, and so you see some missteps, you know, especially in The US. But for us, I think I'm super excited by our innovation that we have in the pipeline. And, I mean, we we see ourselves as an AID company. We don't just do CGM.
Que Dallara We don't just do pumps. It's really about the automation that brings all of that together.
Scott Benner Okay.
Que Dallara And I think, you know, we are leaders in AID.
Scott Benner Why do you think that? What is it something special about your algorithm or your hardware coupled with it? What what do you think puts you in that position?
Que Dallara We invented AID. We were the first closed loop system with six seventy g back in 2016.
Scott Benner Mhmm.
Que Dallara We are with seven eighty, we are now in our second generation algorithm. It's really the only system on the market with, order corrections every five minutes. So if you miss at your bolus or you sometimes forget to bolus, the system can detect that you're eating and can give you the corrections and bring you back in range. And so we perform very well in the hyper range because we're able to bring you back in range a lot faster. It's a very aggressive algorithm and it's the lowest commercially available set point at one hundred milligrams per decilitre.
Que Dallara And we can do that and be aggressive without increasing risk of hyper. And that's why we have several hundreds of thousands of people in seven eighty around the world, and we've got incredible clinical data that says seven eighty is for many people, whether you're young or old, whether you're good at technology, whether you can good at math, if you're coming from different therapies. I mean, it is really a democratizing therapy. And we're working now on our third generation algorithm, which is gonna, you know, push the envelope even further on that front. So
Scott Benner How much can you talk about that? What are the goals for that algorithm?
Que Dallara Well, we we we really believe that the promise of AID is freedom, peace of mind, and safety. And so the goal is to have the automation take over the work so you don't have to. Mhmm. Today, to be honest, well, you know, we like our technology, and there's a lot of AID systems on the market. It's still work.
Que Dallara You still have to put in a lot of work. Seven eighty does push the envelope where you don't have to put in as much work, but the holy grail, I think, is not to actually do very much at all, and yet you can get above 70% time in range. I think that's really our goal. Can we help people who live with diabetes have more freedom? They don't have to make a trade off between glucose control and lifestyle choices and therapy burden.
Que Dallara We wanna solve all three.
Scott Benner Does that answer lie in the hardware or in the data or in how the data is interpreted? Where do you think holds us back from having more freedom?
Que Dallara It's actually in the system. So we are the only company that is commercializing CGMs, pump, or insulin dosing devices, and the algorithm around all of that. Mhmm. And so, you know, similar to if you use an iPhone, it just works, you know, because Apple tightly integrates the software and the hardware together. And we're not a company that has CGM data and insulin data.
Que Dallara And so and we've been more than ten years at algorithmic development. We have a lot of data with both, and so that allows us to innovate very fast on how the automation algorithm. And so now we're now third generation system in development, plus we've got two new CGMs and new form factors on the pump. So when you think about this the trifecta of are you getting the clinical outcomes you want, like, don't want hypo, you don't want DKA, you don't want complications, Our timing range is, you know, the highest amongst all the AID systems, and you can see that in over 200 publications in in peer reviewed journals. So then it's the second part of the trifecta is you got therapy burden.
Que Dallara So how much interaction do you have to do to deal with alarms, to deal with imports into the devices? Every AI distance has therapy burdens. And then you've got lifestyle. You know, what does it look like? You know, how does it affect food, sleep, you know, social, you know, embarrassment if your alarms are going off and things like that.
Que Dallara So we we want to solve we wanna solve for a very tightly integrated system that is kinda like self driving cars. You don't have to do very much, but you're getting outcomes. We don't want people to have to trade off. Hey. Lifestyle is very important to me.
Que Dallara Like, let's say, you're a teenager, and so I'm willing to give up on safety Mhmm. And glucose control. Or I don't wanna do the therapy burdens too much, and so I'm gonna give up on that and, again, not get the outcomes. We intend to solve for all three so that so you don't have to do very much. Put insulin in, wear the device, respond to alarms if there are any, and live your life.
Scott Benner So I'm what I'm hearing, I think, is that I shouldn't be expecting a mini med pump to work with a Libre ever since Dexcom, anything like that. You're gonna keep it your stuff is gonna just work with itself, or do you think you'll ever have interoperability with other CGMs?
Que Dallara We have a partnership with Abbott for instinct, so it's not interoperable in the sense of, you know, mix and match. And the reason why we do that is we're not stubborn ups, and we've heard the feedback around our senses, and that's why we're excited with Simplera coming out as well as Instinct. Mhmm. Because we really believe in not having technology be yet another thing you have to do.
Scott Benner Right.
Que Dallara Right? So and just as a very silly example, the Libre sensor doesn't have Apple Watch functionality.
Scott Benner Mhmm.
Que Dallara Right? But the instinct in our system does. Right? And so we want to curate a system that just works. You don't have to think about, does it work together, two phone numbers to call, companies pointing fingers at each other when you're troubleshooting.
Que Dallara Mhmm. We wanna be able to just keep it very simple. Yeah. The technology just works. The automation is seamless.
Que Dallara The devices look, you know, sexy and have a lot of appeal, and they're very designed with modern consumer electronics in mind. And you have one phone number to call if you're you know, you need support in whatever country around the world, in whatever language. Mhmm. The burden of diabetes isn't just a device. It's all the other things around it too that we wanna solve for.
Que Dallara Like, that's part of the peace of mind. If you happen to be on a holiday and your pump breaks or something goes wrong and you forgot to bring such and such, we'll airship it to you. And so we can do that with our presence and scale that we have around the world, and that's one of the reasons why people value the service we provide. That's why, I mean, it's a kind of a tidy cliche a little bit to compare ourselves to Apple. That's the experience that we're going for.
Scott Benner Yeah. And want it
Que Dallara to work. I think that's only possible when you tightly couple all the elements of an AID system with one eight hundred MiniMed.
Scott Benner Right. It just occurred to me that we should be a little clear about this. You're introducing two new CGMs, but one of them Mhmm. Is a MiniMed CGM, and one of them is an Abbott CGM. Mhmm.
Scott Benner They're both gonna work with your pump. That's right?
Que Dallara Correct.
Scott Benner Okay.
Que Dallara Correct.
Scott Benner Will the Abbott CGM work with anybody else's pump?
Que Dallara The Instinct, no. No. It wouldn't be it only works with our it only works with our system.
Scott Benner Same with the Simplera?
Que Dallara Same with the Simplera. Okay.
Scott Benner And where do they stack up as far as marred and lasting the full amount of time that you say? Like, how how do how have you seen that? Why did it and why did it takes it feels like it took long. Why did it take long? What were you doing?
Que Dallara Yeah. It's fair. It's no. It's a it's very fair. It's it's hard.
Que Dallara Look. Sensors are hard. CGM is hard to do. Mhmm. I can't even tell you how much we've invested to do this.
Que Dallara But, yes, it takes a long time because it it's actually technically a very sophisticated device. Mhmm. You gotta lot bring a lot of things together, not to mention going through clinicals and the FDA process, getting coverage. I mean, there's there's a lot I mean, I'm not making excuses. No.
Que Dallara It's it's way too long.
Scott Benner Yeah.
Que Dallara And it is a new platform for us, but future iterations will not take as long. But, look, SimpleraSync, the mod's about 10.2. It's pretty accurate, and it's very accurate when it comes to dosing. So, again, we're an AID company. We're really not in the standalone CGM business.
Que Dallara And so when it comes to dosing when you need to at the low and the high range, we are extremely accurate. It's in the middle where, frankly speaking, we tune the algorithm to it doesn't really matter because you're not gonna take a different action in in the euglycemic range. And that's, you know, you know, up to seven day sensor of with Simplirosync, and people really like pairing that with their weekly routine. So we have a seven day infusion set, and so people like sort of the weekly, you know, site set change and site change that they have to do there. Right.
Que Dallara The instinct is fifteen days, and it's got a mod of, you know, sim and it has a very similar experience to a Libre a three.
Scott Benner Okay. I'm gonna fumfer through this because I don't have the wording. But there's a thing with the FDA with devices. Right? Like, if somebody already has something similar on the market, isn't there, like, a, like, a a fast forward that you can use off of that, like, when you're bringing something else?
Scott Benner Am I out of my mind, or what am I thinking of that or maybe I'm maybe I'm crazy. You know what I'm talking about?
Que Dallara Yeah. Yeah. No. Understand what you mean. I think, look, I think there's a myth that, you know, at least in The US, the the regulatory pathway with ICGM and the special controls Mhmm.
Que Dallara Means it's fast. It's not like a USB stick where you can just plug and play. Because, look, we dose insulin, and you dose wrong, it's dangerous. Sure. So the regulatory process was actually not not long.
Que Dallara I mean, we announced Abbott the deal with Abbott in August 2024, and we we started taking preorders in, you know, kind of late September. It's thirteen months. If you look at the other integrations that have happened, it's taken years. We took thirteen months.
Scott Benner Let's let you do this quick. People have been telling me about how great their Medtronic pumps have have been for, like it it feels like I've I've been hearing it for a couple of years where people are like, but this new algorithm is great and you blah blah blah, but I it's always somebody from overseas. And I maybe that is why it feels a little longer to me, if I'm being honest.
Que Dallara You know, having a warning letter warning letter didn't help us get $7.80 in the market. It probably was late by a couple of years.
Scott Benner Okay.
Que Dallara So I know how, you know, a lot of people were frustrated by that. But since it's been here, and we've got hundreds of thousands of people on the system. Mhmm. And so I mean, you know, you can look at social media, but, you know, it's for a lot of people, it's changed their life because they have to do less.
Scott Benner Right.
Que Dallara But, yes, I I I wouldn't fault the regulators here. I think FDA has really made it easier to get new innovations out. But to make it work, say, integration with with Instinct and Abbott, it takes work. And what's what we're really proud of is whether it's our own sensor, Simpler, or with Instinct, you're still gonna get the great outcomes. You're still gonna get the minimum work needed.
Que Dallara The meal detection technology still works. Yeah. So while there are different slight differences in CGM experience, the same easy insertion process, it's actually the algorithm that delivers the ease of use and the outcomes.
Scott Benner Right. Right. How do you get over so my daughter's 21. She's been wearing an Omnipod since she was four. If I came to her today with a tube pump and I said, hey.
Scott Benner This will be better for you. It'll be easier. She'd say, no. Thank you. I I mean, how do you deal with that?
Scott Benner That it's a it seems like a real issue. Like, I can see in the in the community, there are people who are like, I don't want tubing. There are people who are like, I don't care about it either. But, like, how do you, you know I mean, how do you broach the subject with those different groups?
Que Dallara Well, I think there's a couple ways.
Scott Benner Mhmm.
Que Dallara I think look. There's preferences. And so we believe in choice. Not it's not gonna be one side, one thing for everyone, and that's why we have the broadest portfolio. So we have two CGMs to choose from depending on your preference Right.
Que Dallara With Sinclair and Instinct. We have a tubeless option today. It's called InPen. So if you don't even wanna wear a pump at all, but you can have a bit of help with technology, we have InPen with our CGM. We're working on our next generation tube pump called flex, MiniMed Flex, and then we also have a patch pump in development that we call MiniMed Fit.
Que Dallara So some people are gonna want a patch pump, and some people are gonna want a a tube pump, they they like being able to detach from their pump or not having such a large surface area. If you look at the size of the infusion set versus size of a patch, infusion set's tinier on your body. Mhmm. So there's gonna be preferences. So we believe in in actually having a portfolio so people can maybe want a pump holiday or they can pick the pen the impen for that.
Que Dallara But we actually do get a lot of people who who aren't in good control. They're not doing well with the patch pump or our competitors' systems. And so we offer trials, and people can trial our system, and it is a different experience. It it's a bit like until you really get on our system, it's hard to you you go, well, it must all be the same, but it isn't. We don't think AI systems the systems are the same.
Que Dallara No. And so we encourage people to try our system, and we actually get a lot of people converting from patch and seeing, actually, the algorithm, how the system work makes it worth it. But some people won't, and that's okay. And that's why we have a patch in development.
Scott Benner I want people to have choice. I think it's incredibly important. So you see the space as tubed, patch, and tubeless? Like, is that are those kind of the options there, and you're gonna jump into the other spaces? I mean, what's the time frame on that?
Que Dallara Today, again, we serve people who are on intensive insulin therapy. Mhmm. And if you look at that cohort, say, in the developed world, there's about ten million people. So one and a half million of those are on tube pumps today. They like it.
Que Dallara And you've got about half a million who are on patch pumps. But then the the vast majority are on MDI. Yeah. And we think those people should have the benefit of a bridge between just pretty low tech where they've gotta do all the work Mhmm. And a bit more software to help them do better.
Que Dallara And so that's where the InPen system we call it MiniMed Go. The InPen system comes in. It helps you not stack insulin. You know, if you don't maybe you forget when you when you dosed insulin last time. Yeah.
Que Dallara It gives you data that your doctors have so you can have, you know, more a better discussion about your therapy and how you're doing things that you can do to be better. It helps time your doses more accurately. And so InPen has a lot of value for the, call it, six million people on MDI that don't have the benefit of technology, and we wanna help them too. Yeah. So we actually have a solution for all three cohorts.
Que Dallara And our goal is, again, the the trifecta of we want you to have if you're below 70% time in range and your a one c isn't good, we have the solution for you. Mhmm. And that isn't gonna raise your therapy burden and isn't gonna make you compromise on your lifestyle. Right.
Scott Benner Oh, it's awesome. Gosh. I've talked to a lot of people about Impens over the years, and I know a lot of people that use them and find them really valuable. They talk about it as having, like, a lot of the data functionality of a pump Mhmm. Without the pump itself.
Scott Benner I wonder about this all the time. Those numbers you just said about there's certain amount of people on pumps, certain amount of people a lot of people just shooting MDI still. Mhmm. Are those people reachable? Are they missing it because they have bad advice from physicians, insurance, because they don't have education?
Scott Benner Like, what do you think is keeping them from pump therapy?
Que Dallara I mean, you said it. It's it's a lot the lot of it is just knowledge and education of what's out there. And, you know, people may be comfortable. Like, they may say, I don't wanna wear a pump because they don't have experience of wearing one, and so they think it's it's yet another thing you have to do. That's why there's so much to do in a day.
Que Dallara If you have diabetes, it's hundreds of decisions. We don't want technology to be yet another thing you've gotta
Scott Benner do. Right.
Que Dallara So if you take seven eighty g with Instinct as an example and our seven day infusion set, it's six perks a month compared to 12 to 16 with other AID systems. Mhmm. People used to care about finger sticks. You don't have to do that anymore. We got six perks, and so that matters.
Que Dallara And that's why our male detection technology is important. The automation is important because we don't hey. You don't you know, perfect at bolusing? No problem.
Scott Benner Right.
Que Dallara Seven eighty g has these auto corrections. It's really the only system on the market with this meal detection, and so people find that liberating. You know, I had patients tell me I you know, I was that they had a day where they were doing graduations. Meals were all over the place. It wasn't their regular routine.
Que Dallara At seven a, the automation just kicks in and delivers that the insulin they need. You know? And so I think education is part of it. I think it's also people's preferences. And so we wanna make people where they are.
Que Dallara We don't wanna go, well, you should be on a pump if you don't want to be. That's why we have InPen. Yeah. But we do believe that we can help you and get you a little bit better. So you have to do less work.
Que Dallara And, actually, a lot of time when people come into our ecosystem, say, on on MiniMed Go, they then say, actually, this is good. Maybe I'll I'm willing to try a pump now. Mhmm. Maybe I want more automation. It's education.
Que Dallara And then, you know, as you know, there's a shortage of endos around the world. Yeah. So a lot of it is primary care. They don't always have the latest and greatest in terms of what's available. And so we have to do a better job, honestly, you know, the industry to, you know, get the word out.
Scott Benner You gotta educate the educators and make the
Que Dallara Exactly.
Scott Benner I think too, making the algorithm such that a doctor can feel comfortable not understanding it, but still prescribing it. Yeah. I mean, how do you decide then? Like, there's only so many hours in a day. Right?
Scott Benner Like, there's and there's a lot of things to do. You've gotta get your pumps and your CGMs around the world. You've gotta improve algorithm. You try to make your hardware smaller. Mhmm.
Scott Benner How do you prioritize what to do next and what's most important? I mean, there's gotta be a big road map. Right? But how do you figure out which is which?
Que Dallara Well, we think of it in generations. So, you know, we were first with the six seventy g system. Mhmm. Seven eighty was a second gen system that's really five years now in the market, and we're very, very close in getting our third generation system out. So that's come from a lot of feedback and interactions with all of our with our customers.
Que Dallara I mean, it's hundreds of videotaped videos to figure out features that we wanna invest in, and so we've been hard at work. Like, we can't always talk about what we do, but we've been hard at work every day getting this third generation system out, starting with the CGMs last month with new form factors on the hardware, and then, of course, our next generation algorithm, which we're super excited about. I think really, Scott, if I reflect on how we as an industry are doing, I think the fact that the penetration of AID, which is superior to MDI, it has such low penetration in The United States and around the world is because technology is a burden. Mhmm. That's our goal.
Que Dallara We got to make technology not a burden so you actually don't have to do much, and not a burden also on busy clinics, you know? And so with seven eighty g, a clinician just has to really know the insulin to carb ratio. That's really it. We don't have a lot of dials you need to turn. If you go with our recommended settings of two hours and a set target of 100 or 110, All you have to figure out is the person's individual insulin to carb ratio, and you're off to the races.
Que Dallara That's seven eighty g. In the future, it's gonna be even less than that.
Scott Benner You said something a minute ago that I just got back from I don't wanna say the company, but I just went out and gave a talk to a a a pretty big organization. Right? Because they help people with diabetes all day long. Mhmm. But a very small percentage of the people that work there have diabetes or know somebody with it.
Scott Benner Mhmm. In their minds, it's a, you know, it's a widget. Right? It's a thing I do every day. I cut I get to work.
Scott Benner I work on code. I don't know. The code says this about that. Like, it doesn't matter to me as long as it works in the end. I've heard you say a couple of times, like, we brought people together and we asked them, like, what are we doing?
Scott Benner Where are we missing and everything? Can you talk about some of the things that those conversations brought to light? What did you say to yourself, this is what's important? Because I know what I think is important. I think that meal detection technology is a huge thing for me.
Que Dallara Mhmm.
Scott Benner Right? Like, you should be able to miscount a carb or forget for five seconds and not end up with a blood sugar of two fifty. Mhmm. You should be able to fall asleep without waking up at 300, like, that kind of stuff. I think that's huge.
Scott Benner I think sets working well, not having to be changed all the time, really great sensors that don't fail, that report accurately, that make people actually comfortable using AID. Like, that stuff's really important. Like, the I don't know what I wanna call, like, on the ground, like, actual lived experience stuff, I think, is what's most important. But I'm wondering, you coming from an outside perspective and then hearing those people talk, like, what struck you in those conversations?
Que Dallara Well, typically, our process is we always involve our customers. We always. And we don't go to them and say, would you like this feature? We ask them what problem would they like to solve in their life. And it's based on that that then we go through a very complicated process to figure out how do we innovate to solve that problem.
Que Dallara So it's not about, hey. Here's 10 features. Pick the ones you like the
Scott Benner best. Right.
Que Dallara And so that's how we came up with meal detection technology. Like, it we have that with seven eighty g because no one counts carbs correctly. Nobody. Actually, it's estimation. It's no one actually counts carbs.
Que Dallara Sure. And so that's why this was being very liberating because you don't have to be exact at all and feel bad about that. And so you described seven eighty exactly. That's why in our portfolio, we think about the different preferences people have. So I'll give you an example.
Que Dallara Let's say with Instinct, why do we have Instinct and Sinclair? When we developed our sensor, we did that with insulin dosing in mind. One of the things that our loyal install base likes to do is they like to be in tight control. Right? They they we're known for, you know, very superior clinical outcomes and really tight control.
Que Dallara So they like to occasionally calibrate their sensor, right, because it just helps them just they wanna manage it more. And so it with Simplera, you can do that. You can if you want to, you can calibrate your sensor, get tighter control. With how Libre started, they started with as a diagnostic. It wasn't built with AID in mind in the very beginning.
Que Dallara And so now, you know, it's a great sensor, and it's can it be integrated into AID, but you can't do that. Now for some people, they don't care. Right. That's not important to them. But for certain people who want eye control, they do care.
Que Dallara And so that's what's behind the choice and why we have different sensor options and why we have different dosing options. We wanna be able to meet people where they are and not force people to, well, you need to do this. And that's what's behind all the investments we've made. We don't want technology to be a burden. We want it to be a companion, an aid, a tool, and the holy grail for us is if we can take away all that work and still give you the health outcomes you want, no fear of hypo, get your hyper back in range very aggressively and help you deal with long term complications.
Que Dallara If we can deliver that but not add to the burden but help you live your life
Scott Benner Right.
Que Dallara That's what we work on.
Scott Benner So how much ceiling is left in that algorithm? Like, how many more dials can you turn until it it's giving you that kind of like, is there a world in your mind where people could be 90% in range and never low for days at a time? Like, is there you know what I'm saying? Like, is there room in that algorithm for improvement, or does something have to be I don't know what I'm asking. Like, does something have to be invented before that's gonna happen next?
Scott Benner Like, are we at a at a peak right now, or are we still in a a version of learning about it?
Que Dallara Well, with seven eighty, I mean, in the real world, you know, we've got a lot of studies in the real world evidence of, you know, over 350,000 patients on seven eighty in this particular study, I can actually send you the the publication. If you're on our recommended settings on seven eighty, you're getting an 80% time in range without doing a lot to get that.
Scott Benner What's the range you're using?
Que Dallara 7070% 80% time in range using our recommended settings.
Scott Benner What is that range? Like, seven 70 to one eighty, or, like, where where do you set the range to do the measurement?
Que Dallara The range is 70 to one eighty, so the the, you know, consensus driven range. And then if you're talking about 70 to one forty, which is where Yeah. People who don't die have diabetes spend most of their time in, we're at 55%, what we call timing tight range.
Scott Benner Right.
Que Dallara So $7.80 already gets there, but we absolutely believe that where this is going is we shouldn't have any buttons at all, and you're getting above 70% time in range. That's really, you know, where we wanna push the envelope. But if you want to have even tighter control, because we have people in Facebook with seven eighty saying, I got a 100% time in range. And, you know, they're they're proud of, you know, you know, hitting sort of goals like that. Mhmm.
Que Dallara For people who do want even tighter control, we wanna be able to give them the option that if you wanna engage get more to control, you can do that. But you don't have to. If you don't wanna do anything, we wanna help get you above 70% time in range. That's that's where the future of the algorithm is gonna go.
Scott Benner Does that algorithm need to include some AI? At some point, I'm gonna be very, like, ham fisted about this. But are you gonna have, like, your own little AI agent inside your pump that's, like, looking at your food and decisions and helping adjust more than just what the math tells it?
Que Dallara We don't need to do that, Scott. We use a lot of AI in the development of our products, but think of it as a lot of AI requires you going to the cloud and having a lot of compute. Mhmm. And if you think about the pumps, we have our algorithms on the pump because you're not always gonna be connected. Like, you could be hiking in the mountains, in the wilderness Sure.
Que Dallara And not have an Internet connection. Our pump's gonna work. The algorithm's still gonna work. Right? It's not dependent on all this infrastructure.
Que Dallara So from a safety standpoint, we have to be extremely efficient how the algorithm works on the pump because it's not a supercomputer. You know? Right. It's a pretty smart device, but AI isn't used in the development. But we don't need you know, our algorithm is very good because we have had hundreds of millions of points of data on CGM and insulin over the last, you know, call it decade of algorithmic development that we don't need to have, you know, Gen AI working in the pump for us to deliver Mhmm.
Que Dallara An even better algorithm in the future.
Scott Benner So the math will handle it at some point better than I imagine it can. Yes. I've heard you say a couple of times no buttons. So right now, when I hear people talk about that, they'll say, well, that was great until I got my period, or that was great till my Mhmm. My kid hit a growth spurt, or, yeah, that was great until until until and then I need to set a temp basal.
Scott Benner I need to do this, like, etcetera. Is that a a long in the future idea to you? Like, we have a couple of stops to go before it's buttonless, or is that more of a way of thinking about, like, there'll still be buttons. I can make adjustments, but I just probably won't have to touch them very often.
Que Dallara We wanna be able to serve people who don't wanna do anything because you got a lot of those. Mhmm. But if you want to do something, we will provide options if you want to engage more. But that engagement isn't like many dials and buttons. It's super simple, but you're always gonna have a spectrum of people who they wanna be more active in managing their diabetes, and they like doing that because they wanna be super tight.
Que Dallara But for other people, they don't wanna do anything at all. Right. And so we wanna accommodate both. But, yeah, the I think the holy grail is just not having to do Not having to do anything other than put insulin
Scott Benner And in your mind, is that the thing that opens you up to find those other millions of people?
Que Dallara Yeah. I think it will attract a lot of people and, you know, probably a lot of type twos Right. Because, you know, typically, they they're willing to do less. Mhmm. If technology is just in the background, you know, just imagine, like, a self driving car Yeah.
Que Dallara And you don't have to drive it, I think the adoption will go up. But if you still have to do a little bit of something, you know, for some people, it's not worth doing that versus what they're doing at the moment. So we wanna make it easy because we think that people will be healthier if they are on AID. Look at a one c's in The US. It's above eight despite the fact that CGM penetration is 80%.
Que Dallara Yeah. Pretty much if you need a CGM and you're, you know, you're on diabetes, you need CGM, you're get one. It's not good. So people need help with insulin dosing and diabetes management. Yeah.
Que Dallara But it's still too much work.
Scott Benner I talk about this a lot that it it could get easy to get into this ecosystem that I've created here and think like, oh, everybody's got, like, a six and a half or a five a one c or something like that. But the vast majority of people that are on insulin And eight I've interviewed people all day long that, you know, they have twelves they live with. They have complications in their thirties. Right? And they're not when you talk to them, what always strikes me over and over again that it is not a lack of they're they're not not concerned.
Scott Benner They're not not trying. It's just Mhmm. For reasons that are hard to kind of, like, compute, like, human reasons, just not working out for them well. Mhmm. And those are the people I think about all the time.
Scott Benner Also, those people often see their general practitioners about their diabetes on top of everything else. They need a thing that you can just go, look. Take this. This is how it goes on. This is how where you put the insulin.
Scott Benner Here's your a one c in the sevens. Like, that's life saving for a a huge swath of people who who need insulin every day. Anyway Scott,
Que Dallara I'm I'm with you. It's so sad.
Scott Benner Yeah.
Que Dallara Yeah. And that's why we really believe seven eighty can help people like that. Wow. Because, look, people try, and life gets in the way. And you got kids, you got a job.
Que Dallara I mean, it's not it's not easy. Yeah. So that's why we really believe if you're not doing well and, you know, if you're not in control and it's a lot of work, you're not getting the return on the effort. Mhmm. We think seven eighty.
Que Dallara Try seven eighty because it's we think it's for very little effort. You're gonna get great outcomes and feel better
Scott Benner Okay.
Que Dallara Every day.
Scott Benner So my last kind of question, it's gonna be a little jumble here. Seven eighty g, ready to go now. Lots of CGM options. You're gonna like it. Go give it a shot.
Scott Benner But you're working on other stuff too. Patch pump, tubeless option.
Que Dallara Mhmm.
Scott Benner I'm gonna ask you, how long do you think until people see those? And then my last last question, which I think you can dovetail into is, if you come back here five years from now Mhmm. We started by talking about, like, you know, where Medtronic started, you know, like, that old CGM people you know, people used to call that CGM a harpoon. Right? Mhmm.
Scott Benner So you've gone from there to, like, where you are now to where you're trying to go. So five years from now, I get you back on here and we're talking. What are we talking about? Where are you at at that point?
Que Dallara Great question. So for the first part, we got seven eighty g, two new sensors, give it a go. And on the new the new durable pump, the new patch pump, and then the new algorithm, for the durable pump, we said that we're gonna submit very soon on that in our fiscal year. Mhmm. In a month or so, I'll be able to share a bit more timelines on a bit squeezed with our process at the moment, from Medtronic to reveal too much.
Que Dallara In a in a month or so, we'll be able to say the timelines on those, but it's very we're getting to the tail end of those new products. So we're really excited to introduce that to everyone. But in five years' time, you know, I hope people will be saying that MiniMed just works. That's our goal and that it just fits into their lifestyle. They don't have to do anything.
Que Dallara They just live their life. That's what we want to be able to contribute to and that we've truly entered a hands free era, that you just put insulin in, it just works, you don't have to think about it. And so that's where we think our third generation system is gonna be there. And life was like diabetes is a little simpler, you can move on to other things. So that's what we hope.
Que Dallara And, you know, but I tell you what, Scott, I'll come back in five years' time on your podcast, and we'll have a discussion about it. Awesome. But that's what we hope. A free, a hands free era with MiniMed.
Scott Benner I hope too. Maybe you can come back a little sooner and tell me a little more about these new pumps when you're more free to talk about
Que Dallara the details. Do this.
Scott Benner Help you get. Also, I'd like to ask if you've ever owned a bearded dragon because you lived in Australia, but we don't have time for that.
Que Dallara I do. I do have a Rankin's bearded dragon.
Scott Benner You do? I do. Oh, they're the small
Que Dallara sort of Fizz.
Scott Benner Yeah. The smaller How old how old is it?
Que Dallara One year, actually. One year on Veterans Day.
Scott Benner Oh, wow. We don't have time now, but the reason you're there's a a green screen background behind me because behind me is my Parsons chameleon and, like, some other little things I keep in my office. So we'll find more time later. I'd love to know about your Rankin's Dragon. I'm not kidding.
Scott Benner Thank you very much for doing this. I really do appreciate your time. Thank you.
Que Dallara Yeah. It was fun. Thanks, Scott.
Scott Benner Awesome. I'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which, of course, anticipates, adjusts, and corrects every five minutes twenty four seven. It works around the clock so you can focus on what matters. The juice box community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox.
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