德康醫療 (DXCM) 2017 Q2 法說會逐字稿

Welcome to the DexCom Second Quarter 2017 Earnings Release Conference Call. My name is Karen, and I will be your operator for today's call. (Operator Instructions) Please note that this conference is being recorded.

歡迎參加 DexCom 2017 年第二季財報發布電話會議。我叫 Karen，將擔任今天電話會議的接線員。(接線員指示) 請注意，本次會議將被錄音。

I will now turn the call over to Matt Dolan, Vice President of Corporate Development. Mr. Dolan, you may begin.

現在我將把電話交給企業發展副總裁 Matt Dolan。Dolan 先生，您可以開始了。

Thank you, Karen, and welcome to DexCom's second quarter 2017 earnings call. With us today is Kevin Sayer, DexCom's President and CEO; Steve Pacelli, our Executive Vice President of Strategy and Corporate Development; and Kevin Sun, our Vice President of Finance and Interim CFO.

謝謝你，Karen，並歡迎各位參加 DexCom 2017 年第二季財報電話會議。今天與我們一同出席的有 DexCom 總裁暨執行長 Kevin Sayer；策略與企業發展執行副總裁 Steve Pacelli；以及財務副總裁兼代理財務長 Kevin Sun。

We will begin with our prepared remarks and then open the call up for your questions. (Operator Instructions) I'll begin with our safe harbor statement.

我們將先進行事先準備的發言，之後開放各位提問。(接線員指示) 我先宣讀我們的安全港聲明。

Some of the statements that we will make in today's call may constitute forward-looking statements. These statements reflect management's intentions, beliefs and expectations about future events, strategies, competition, products, operating plans and performance. All forward-looking statements included in this presentation are made as of the date hereof based on information currently available to DexCom and are subject to various risks and uncertainties, and actual results could differ materially from those anticipated in the forward-looking statements. The factors that could cause actual results to differ materially from those expressed or implied by any of these forward-looking statements are detailed in DexCom's annual report on Form 10-K, quarterly reports on Form 10-Q and other filings with the Securities and Exchange Commission. Except as required by law, we assume no obligation to update any such forward-looking statements after the date of this presentation or to conform these forward-looking statements to actual results.

我們在今天電話會議中所作的部分陳述，可能構成前瞻性陳述。這些陳述反映管理層對未來事件、策略、競爭、產品、營運計畫與績效的意圖、信念與預期。本簡報中所包含的所有前瞻性陳述，均以本簡報日期為準，係基於 DexCom 目前可得資訊作出，並受各種風險與不確定性影響，實際結果可能與前瞻性陳述中所預期者有重大差異。可能導致實際結果與任何此等前瞻性陳述所明示或暗示者有重大差異的因素，已詳載於 DexCom 的 Form 10-K 年度報告、Form 10-Q 季度報告及向美國證券交易委員會提交的其他文件中。除法律要求外，我們不承擔在本簡報日期後更新任何此等前瞻性陳述，或使此等前瞻性陳述與實際結果一致的義務。

Additionally, during the call, we will discuss certain financial measures that have not been prepared in accordance with GAAP with respect to our non-GAAP cash-based operating results. The presentation of this additional information should not be considered in isolation or as a substitute for results or superior to results prepared in accordance with GAAP.

此外，在本次電話會議中，我們將就非 GAAP 現金基礎的營運結果，討論若干未依 GAAP 編製的財務衡量指標。此等補充資訊之呈現不應被單獨視為，亦不應作為依 GAAP 編製之結果的替代，或被視為優於依 GAAP 編製之結果。

With that, I'll turn it over to Kevin Sayer.

接下來，我把電話交給 Kevin Sayer。

Thank you, everyone, for joining us today. The first half of 2017 has been very positive for DexCom. Our revenues have grown 23% year-to-date, and we remain on track with our full year targets. More and more people with diabetes are adopting CGM as their primary tool to manage their condition, especially as we have seen a substantial uptick in the number of covered lives worldwide in the past 12 months. The CGM first message is being broadcast not only by DexCom but by a growing proportion of the clinical community, as the body of evidence supporting the value of CGM continues to build. This was a clear takeaway for DexCom leaving the American Diabetes Association meeting, the biggest diabetes conference of the year, which was held in our hometown of San Diego during the second quarter.

感謝各位今天加入我們。2017 年上半年對 DexCom 而言非常正面。我們的營收年初至今成長 23%，且仍按計畫達成全年目標。越來越多糖尿病患者採用 CGM 作為管理病情的主要工具，尤其是在過去 12 個月中，我們看到全球受保人數顯著增加。「CGM 優先」的訊息不僅由 DexCom 傳遞，也被越來越多臨床社群所倡議，因為支持 CGM 價值的證據持續累積。這是 DexCom 參加美國糖尿病協會（ADA）年會後的明確收穫；該會議是年度最大的糖尿病會議，於第二季在我們的家鄉聖地牙哥舉行。

The second key takeaway was that DexCom CGM platform continues to generate market-leading performance. Additional presentations from studies like DIaMonD and GOLD reaffirm that DexCom CGM systems can drive significant clinical outcomes in both MDI and pump patients. We left ADA with the strength and belief that CGM will represent the standard of care in intensive diabetes management over time, regardless of age or choice of insulin therapy by the patients.

第二個關鍵收穫是，DexCom 的 CGM 平台持續展現市場領先的表現。來自 DIaMonD 與 GOLD 等研究的更多發表，再次證實 DexCom CGM 系統能在 MDI 與胰島素幫浦患者中帶來顯著的臨床成效。我們帶著更強的信心離開 ADA：隨著時間推移，CGM 將成為強化型糖尿病管理的照護標準，不論患者年齡或其選擇的胰島素治療方式為何。

Our U.S. business is being driven by these dynamics, where an estimated 2/3 of our new patient additions were using multiple daily injections, and approximately 1/3 were on insulin pump therapy. This is consistent with our first quarter results and aligns with the underlying mix in the U.S. type 1 market. We continue to educate clinicians and patients about the benefits of making DexCom CGM the first tool prescribed for people with diabetes and it is working. Patient adoption in our international markets has also been robust with OUS revenue growing more than 50% in the first 6 months of the year.

在這些趨勢帶動下，我們的美國業務持續成長；估計新增患者中約 2/3 使用每日多次注射（MDI），約 1/3 使用胰島素幫浦治療。這與我們第一季的結果一致，也符合美國第一型糖尿病市場的基本結構。我們持續教育臨床醫師與患者，讓 DexCom CGM 成為糖尿病患者第一個被開立的工具之益處，而這項努力正在奏效。我們在國際市場的患者採用也同樣強勁，年初至今前 6 個月 OUS（美國以外）營收成長超過 50%。

We are seeing solid growth across Europe, led by Germany and the Nordic countries. To us, this validates our strategy to focus our commercial efforts on geographies where we have coverage for CGM. It is in these markets that patient adoption is rapidly accelerating.

我們在歐洲各地都看到穩健成長，其中以德國與北歐國家為首。對我們而言，這驗證了我們的策略：將商業資源聚焦於已具備 CGM 給付覆蓋的地區。在這些市場中，患者採用正快速加速。

Turning to Medicare. Since receiving the CMS ruling in January, we have taken several important steps toward beginning to provide therapeutic CGM devices to Medicare eligible patients in the United States, including receiving a local coverage decision and establishing a fingerstick supplier partnership. As of July 1, there are specific therapeutic CGM billing codes, eliminating the need for DexCom and our distributors to use miscellaneous codes to try and obtain reimbursement from Medicaid patients. Although we did not generate any material revenue from Medicare patients in the first half of the year, I am pleased to tell you that, in recent weeks, we have begun shipping our first Medicare bundles. I will provide more color on our Medicare roll out momentarily.

接著談 Medicare。自 1 月取得 CMS 裁定以來，我們已採取數項重要步驟，朝在美國開始向符合 Medicare 資格的患者提供治療型 CGM 裝置邁進，包括取得地方給付決定（local coverage decision）以及建立指尖採血（fingerstick）供應商合作夥伴關係。自 7 月 1 日起，已有特定的治療型 CGM 計費代碼，使 DexCom 與我們的經銷商不再需要使用雜項代碼，嘗試向 Medicaid 患者取得給付。雖然我們在上半年未從 Medicare 患者取得任何重大營收，但我很高興告訴各位，近幾週我們已開始出貨首批 Medicare 套組（bundles）。稍後我將就我們的 Medicare 推出進度提供更多說明。

Finally, during the quarter, we successfully raised $400 million of convertible senior notes with favorable financial terms. Although DexCom had already been in a strong financial position, we continue to see multiple growth opportunities ahead of us, both in the intensive and nonintensive diabetes markets. This capital infusion provides us with greater flexibility to leverage our CGM market leadership across a number of key initiatives, including the expansion of our manufacturing capacity to meet anticipated demand, growth and development in key international markets, support for our Medicare rollout and our efforts to make CGM an integral tool in the nonintensive diabetes market. We believe our strength and balance sheet better aligns our capital structure with the opportunities we see in front of us.

最後，在本季期間，我們以有利的財務條件成功募集 4 億美元可轉換公司債（convertible senior notes）。儘管 DexCom 原本就具備強健的財務狀況，我們仍持續看到多項成長機會，不論是在強化型或非強化型糖尿病市場。這筆資金挹注讓我們更有彈性，得以運用我們在 CGM 市場的領導地位推動多項關鍵計畫，包括擴充製造產能以滿足預期需求、在重要國際市場的成長與發展、支援 Medicare 推出，以及推動 CGM 成為非強化型糖尿病市場中的核心工具。我們相信，我們的實力與資產負債表，使我們的資本結構更能與眼前所見的機會相匹配。

With that, I will turn the call over to Steve for a review of our financials, after which I will provide a business update.

接下來，我將把電話交給 Steve 進行財務回顧，之後我會提供業務更新。

Thanks, Kevin. Before I dive into the numbers, I would like to make our audience aware of an addition to our reporting as of the second quarter to help with your models.

謝謝你，Kevin。在我深入數字之前，我想讓各位聽眾了解，我們自第二季起在揭露上新增了一項內容，以協助各位建立模型。

Specifically, we are providing more details on our revenue performance, including a geographic breakdown of U.S. versus OUS as well as revenue by category, divided into our sensor consumables, transmitters, receivers and other revenue. For comparison purposes, we have posted figures for these revenue categories on a quarterly basis back to the first quarter of 2016. You can find this historical data in a supplemental document on the Investor Relations portion of our website.

具體而言，我們將提供更多營收表現的細節，包括美國與 OUS 的地理區分，以及按類別劃分的營收，分為感測器耗材、發射器、接收器及其他營收。為便於比較，我們已提供自 2016 年第一季起按季度列示的這些營收類別數據。您可在我們網站投資人關係（Investor Relations）專區的補充文件中找到這些歷史資料。

Now back to the second quarter discussion. DexCom reported revenue of $171 million for the second quarter of 2017 compared to $137 million for the same quarter in 2016, a $33 million or 24% increase. Sequentially, revenue for Q2 was up approximately 20%. This result was consistent with our expectations as the U.S. business typically rebounds from the Q1 seasonality we experienced due to resetting insurance deductibles. In addition, as we stated on our last earnings call, because of the January CMS ruling, we were, again, prohibited by law in Q2 from billing our existing cash pay Medicare eligible patients. We have also seen another good uptick in our international business and remain optimistic about our OUS growth prospects.

現在回到第二季的討論。DexCom 2017 年第二季營收為 1.71 億美元，較 2016 年同期的 1.37 億美元增加 3,300 萬美元，增幅 24%。以季比來看，第二季營收約成長 20%。此結果符合我們的預期，因為美國業務通常會在第一季因保險自付額重設所造成的季節性影響後，於第二季回升。此外，如同我們在上次財報電話會議所述，由於 1 月的 CMS 裁定，我們在第二季仍依法不得向既有的自費且符合 Medicare 資格的患者開立帳單。我們的國際業務也再次出現良好回升，我們對 OUS 的成長前景仍保持樂觀。

Our second quarter gross profit was $118 million, generating a gross margin of 69% compared to a gross profit of $86 million and a gross margin of 62% for the same quarter in the prior year. We do remind investors that in Q2 of 2016, we took a $3.5 million inventory write-down, which negatively impacted our gross margin in that period. Our gross margin rebounded year-over-year and sequentially due to an improvement in our warranty rate, primarily within our receiver line.

我們第二季的毛利為1.18億美元，毛利率為69%，相較於去年同期毛利8,600萬美元、毛利率62%。我們也提醒投資人，2016年第二季我們認列了350萬美元的存貨減損，對當期毛利率造成負面影響。由於保固率改善（主要來自我們的接收器產品線），我們的毛利率較去年同期及較前一季均出現回升。

Some final thoughts on our revenues and gross profit. Our mix between durable and consumable products was within our normal historical range in Q2 at approximately 30% durable and 70% consumable. On the durable side, we note that receiver sales continue to be a less significant component of our overall revenue, as patients increasingly rely on their smartphones. As anticipated, the ASP for our hardware has remained stable, and average sensor pricing came in at around $70.

關於我們的營收與毛利，最後補充幾點。第二季耐用品與消耗品的產品組合落在我們歷史正常區間內，約為30%耐用品、70%消耗品。在耐用品方面，我們注意到接收器銷售在整體營收中的占比持續下降，因為病患愈來愈依賴其智慧型手機。如預期，我們硬體的ASP（平均銷售單價）維持穩定，而感測器平均定價約為70美元。

Finally, our international business showed continued year-over-year growth generating $30 million in revenue during the quarter, up 69% from last year and 14% sequentially. This now represents 17% of our total revenue.

最後，我們的國際業務持續呈現年增成長，本季營收達3,000萬美元，較去年成長69%，較前一季成長14%。目前國際業務占我們總營收的17%。

Research and development expense totaled $45 million for Q2 of 2017 compared to $36 million in Q2 of 2016, down approximately 6% sequentially.

2017年第二季研發費用合計4,500萬美元，較2016年第二季的3,600萬美元增加，較前一季約下降6%。

Selling, general and administrative expense totaled $86 million in Q2 of 2017 compared to $69 million during the same quarter in 2016, with the increase due primarily to year-over-year increases in headcount in our field sales and customer support organizations, including support for the initial phase of the Medicare launch as well as a ramp in our patient-focused marketing expenses and our OUS expansion. SG&A was flat sequentially due to the absence of share-vesting payroll tax expenses and onetime charges that we incurred in the first quarter.

2017年第二季銷售、一般及行政費用（SG&A）合計8,600萬美元，較2016年同期的6,900萬美元增加；增加主因為我們外勤銷售與客戶支援組織的人力編制年增，包括支援Medicare上市初期階段，以及以病患為導向的行銷費用提升與我們的美國以外（OUS）擴張。SG&A較前一季持平，原因是第一季發生的股份歸屬薪資稅費用與一次性費用在本季未再出現。

Our GAAP net income was $3 million or $0.03 per share in the second quarter of 2017, which included a $17 million noncash tax benefit related to the issuance of our senior convertible notes in May. Excluding the noncash tax benefit, non-GAAP net loss was $14 million or $0.16 per share for the second quarter of 2017. Absent $37 million in noncash charges, primarily share-based compensation and noncash interest expense and excluding the tax benefit, our non-GAAP cash-based net income was $23 million for Q2.

2017年第二季我們依GAAP計算的淨利為300萬美元，或每股0.03美元，其中包含與5月發行高級可轉換公司債相關的1,700萬美元非現金稅務利益。排除該非現金稅務利益後，2017年第二季非GAAP淨損為1,400萬美元，或每股0.16美元。若再排除3,700萬美元的非現金費用（主要為股份基礎給付與非現金利息費用），並排除該稅務利益後，我們第二季非GAAP、以現金為基礎的淨利為2,300萬美元。

We ended the second quarter with $497 million in cash and marketable securities on our balance sheet versus $124 million at the end of 2016. During the quarter, we raised $400 million in gross proceeds from our convertible notes offering and paid down the $75 million outstanding on our $200 million credit facility.

第二季期末，我們資產負債表上的現金及有價證券為4.97億美元，相較於2016年年底的1.24億美元。本季我們透過可轉換公司債發行募集4.00億美元總收益，並償還我們2.00億美元信用額度中尚未償還的7,500萬美元。

With respect to 2017 guidance, we continue to expect global revenue of $710 million to $740 million. And for Q3, we anticipate a mid- to high single digit increase sequentially, roughly consistent with 2016.

就2017年財測而言，我們仍預期全球營收為7.10億至7.40億美元。而就第三季而言，我們預期較前一季成長中到高個位數百分比，與2016年的走勢大致一致。

With that, I'll turn the call back to Kevin for a business update.

接下來，我把電話交回給Kevin，請他進行業務更新。

Thank you, Steve. At the mid-year point, DexCom has made great progress, and we expect our global priorities will drive continued strong growth through year-end and beyond. In the U.S., our total new patient pipeline continues to be robust. And obviously, our launch into the Medicare population is at the forefront of our commercial efforts. We had originally planned to leverage our existing distributors in an effort to accelerate our ability to service Medicare customers. However, this advantage was diminished by the administrative complexities we outlined during our last earnings call. As a result, we made the decision to build a direct capability to service Medicare patients. And our utilization and distributors will therefore be more limited.

謝謝你，Steve。在年中時點，DexCom已取得很大進展，我們預期全球優先事項將推動今年底及之後持續強勁成長。在美國，我們整體新病患的潛在客戶管線仍然強勁。而且很明顯地，我們切入Medicare族群的上市推進，是我們商業化工作的首要重點。我們原本規劃運用既有經銷商，以加速我們服務Medicare客戶的能力。然而，這項優勢因我們在上次財報電話會議中提到的行政複雜性而被削弱。因此，我們決定建立直接服務Medicare病患的能力。因此，我們的利用率與經銷商的角色將會更為有限。

Last month, we initiated our first shipments of the therapeutic CGM bundle to initial group of Medicare eligible patients. The timing of our Medicare rollout is tracking with expectations, and we are working through the implementation process to ensure we put the right pieces in place to support the billing and fulfillment activities. This is a complicated endeavor and will take time to scale up. Assuming our initial reimbursement claims are successfully adjudicated, we will roll out our Medicare program more aggressively over the course of the second half of the year. The response to Medicare coverage in the field continues to be amazing, and our expanded field team is attempting to manage the significant demand we have experienced, along with customer expectations. By the end of the second quarter, we had approximately 20,000 new Medicare eligible patients in our pipeline, and we reminded you that we have not yet started to promote availability to this segment of the population.

上個月，我們開始向第一批符合Medicare資格的病患出貨治療用CGM套組。我們的Medicare推廣時程符合預期，我們正推進導入流程，以確保建立正確的配套來支援請款與履約作業。這是一項複雜的工作，需要時間才能擴大規模。假設我們初期的給付申請能順利完成審核裁定，我們將在下半年更積極地推動Medicare計畫。第一線對Medicare給付的反應依然非常熱烈，我們擴編後的外勤團隊正嘗試在管理大量需求的同時，也管理客戶期待。截至第二季末，我們的管線中約有20,000名新符合Medicare資格的病患；我們也提醒各位，我們尚未開始向此族群宣傳可用性。

Beyond Medicare, as I stated earlier, new patient opportunities remain strong. New MDI patients are driving our U.S. growth in patient additions. Consistent with our first quarter, we have seen continued weakness in new patient additions from pump patients. We believe this is primarily driven by the various challenges encountered by 2 of our commercial pump partners in recent quarters. Despite this, we believe interconnected diabetes management systems, with both pumps and smart pens are an important component of diabetes care in the long term. We have a number of promising strategic partnerships in progress that will deliver highly differentiated DexCom-enabled solutions. Outside the U.S., our year-over-year growth once again accelerated sequentially, fueled by broader reimbursement in Germany as well as continued strength in Europe and growth in our direct channels in the U.K. and Canada. Globally, we still expect to exit 2017 with an installed base at or above approximately 270,000 patients worldwide as we communicated earlier this year.

除Medicare之外，如我先前所述，新病患機會仍然強勁。新的MDI（多次每日注射）病患正推動我們美國新增病患數的成長。與第一季一致，我們看到來自胰島素幫浦病患的新病患新增仍持續疲弱。我們認為這主要是因為我們兩家商用幫浦合作夥伴在近幾季遭遇各種挑戰所致。儘管如此，我們仍相信互聯式糖尿病管理系統（同時包含幫浦與智慧注射筆）在長期糖尿病照護中是重要組成。我們正在推進多項具前景的策略合作夥伴關係，將提供高度差異化、由DexCom賦能的解決方案。在美國以外，我們的年增成長再次較前一季加速，動能來自德國更廣泛的給付，以及歐洲持續強勁表現，並且我們在英國與加拿大的直營通路成長。在全球範圍內，我們仍預期2017年年底的裝機基礎將達到或高於約270,000名全球病患，如同我們今年稍早所溝通。

With respect to our product pipeline, we continue to have regular interactions with the FDA. Our G6 pivotal study is complete, and we plan to submit our PMA by the end of the third quarter. As we have referenced in a number of our recent updates, because of the progress we are making on our G6 submission, we have assessed our launch timing for the new applicator configuration with G5 compared to a full G6 launch, and have made the decision to withdraw our FDA filing for the new insertion system in the G5 configuration. The gap between the launch of this G5 configuration and G6 continues to narrow, reaching a point where the operational strain associated with the launching a new applicator and sensor platform less than a year apart no longer makes strategic sense.

就我們的產品管線而言，我們持續與FDA保持定期互動。我們的G6關鍵性研究已完成，並計畫在第三季末前提交PMA（上市前核准申請）。如我們在近期多次更新中提到，基於我們在G6送件上的進展，我們重新評估了G5新型施用器配置的上市時程相較於完整G6上市的安排，並決定撤回G5配置下新插入系統的FDA申請。此G5配置與G6上市之間的時間差持續縮小，已到達一個程度：在不到一年內相繼推出新的施用器與感測器平台所帶來的營運負荷，已不再具有策略上的合理性。

We remain very excited about bringing G6 to the marketplace. Not only by delivering this new applicator and form factor to patients but also because of G6's improved performance and feature set.

我們對將 G6 推向市場仍然感到非常振奮。不僅是因為把這款新的施用器與外形設計交付給病患，也因為 G6 在效能與功能組合方面有所提升。

On the app front, we launched our Android platform in the U.S. during the second quarter. Our user numbers are rising steadily, and so far, it has been well received by our customers. With the availability of DexCom CGM on a number of iOS and Android handsets, more and more patients are choosing to use their phones to view and share their CGM data.

在 App 方面，我們於第二季在美國推出了 Android 平台。我們的使用者數量穩定上升，迄今也獲得客戶良好回饋。隨著多款 iOS 與 Android 手機可使用 DexCom CGM，越來越多病患選擇用手機來查看並分享其 CGM 資料。

Turning to our nonintensive strategy. Based upon our research to date, we believe a highly accurate, real-time, calibration-free disposable sensor system offered at a lower cost will change the way type 2 patients can be managed. We continue to make progress with our first-generation device to serve this market, and our collaboration with Verily. Right now, our regulatory team is very focused on the G6 submission. And because G6 is a sensor platform that drives the first Verily device, we will give you more detailed update on the timing of that device on our next call following the G6 submission.

接著談我們的非重症策略。根據目前為止的研究，我們相信：以較低成本提供高度準確、即時、免校正、可拋棄式的感測器系統，將改變第 2 型糖尿病患者的管理方式。我們持續在第一代裝置（用以服務此市場）以及與 Verily 的合作上取得進展。目前，我們的法規團隊非常專注於 G6 的送件。而由於 G6 是驅動 Verily 第一款裝置的感測器平台，我們會在 G6 送件後的下一次電話會議中，提供該裝置時程的更詳細更新。

As the development of our first-generation Verily product is beginning to mature, we have shifted significant resources to the second-generation system. Beyond our product development efforts, we are also formulating our commercial strategy for the nonintensive diabetes market. Our early experience further supports that DexCom CGM is intuitive to patients and has the potential to deliver significant value to the health care system. As we have stated previously, we anticipate a new business model for the nonintensive market and have seen early interest from prospective payers, providers and employers. We will continue to update you on our nonintensive strategy as we make progress towards commercialization.

隨著我們第一代 Verily 產品的開發開始趨於成熟，我們已將大量資源轉向第二代系統。除了產品開發工作之外，我們也正在擬定非重症糖尿病市場的商業策略。我們的早期經驗進一步支持：DexCom CGM 對病患而言直覺易用，並有潛力為醫療照護體系帶來顯著價值。如同先前所述，我們預期非重症市場將採用新的商業模式，且已看到潛在付款方、醫療提供者與雇主的早期興趣。隨著我們朝商業化邁進並取得進展，我們將持續向各位更新非重症策略。

I would like to finish with an update on our CFO search. In conjunction with our earnings release, today we announced that Quentin Blackford has been appointed DexCom's next Chief Financial Officer, beginning in September. Many of you will be familiar with Quentin from his previous role as CFO at NuVasive, where he played a key role in driving the company during a phase of aggressive global growth and improvements in profitability. We look forward to welcoming him into the DexCom family in September.

最後我想就我們 CFO 的尋覓進度做個更新。配合我們的財報發布，我們今天宣布 Quentin Blackford 已被任命為 DexCom 下一任財務長，將於 9 月上任。許多人對 Quentin 並不陌生；他先前擔任 NuVasive 的 CFO，在公司積極的全球成長階段以及獲利能力改善方面扮演關鍵角色。我們期待在 9 月歡迎他加入 DexCom 大家庭。

I would also like to acknowledge the excellent performance by our Interim CFO, Kevin Sun, and the rest of the finance team, who stepped up during this transition phase and will continue to play an important role in our organization.

我也要肯定我們的代理財務長 Kevin Sun 以及其餘財務團隊的優異表現；他們在這段過渡期挺身而出，並將持續在我們組織中扮演重要角色。

To wrap things up, I am very happy with the meaningful progress DexCom has made through the first half of 2017. Globally, we are on track to achieve our major goals for the year, all while making significant headway on the Medicare launch. The message leaving this year's ADA meeting was extremely clear. CGM will become the standard of care, and DexCom CGM has set the performance standard for the industry.

總結來說，我對 DexCom 在 2017 年上半年取得的實質進展感到非常滿意。在全球範圍內，我們正按計畫達成今年的主要目標，同時也在 Medicare 上線方面取得顯著進展。今年 ADA 會議傳遞出的訊息非常清楚。CGM 將成為照護標準，而 DexCom CGM 已為產業樹立了效能標準。

As we make our systems more convenient and easier to use, we believe we are only scratching the surface of our CGM opportunity. I would like to thank our team as we work tirelessly to capitalize on the potential we see in front of us, both in the intensive and nonintensive markets. We are all driven by the impact we know our CGM technology has on people with diabetes, and we are energized by the many recent positive milestones we have achieved so that we can make DexCom CGM available to a much larger number of patients worldwide.

隨著我們讓系統更便利、更容易使用，我們相信我們的 CGM 機會才剛開始展露。我要感謝我們的團隊不懈努力，把握我們眼前看到的潛力，涵蓋重症與非重症兩個市場。我們都受到 CGM 技術對糖尿病患者所帶來影響的驅動，也因近期達成的多項正向里程碑而備受鼓舞，讓我們能在全球讓更多病患使用 DexCom CGM。

I would now like to open the call up for Q&A.

接下來我想開放電話會議進入問答。

(Operator Instructions) And our first question comes from Mike Weinstein from JPMorgan.

（接線員指示）我們的第一個問題來自 JPMorgan 的 Mike Weinstein。

Let me start with 2 questions. One, on your Medicare bundles, in terms of where you are on being able to deliver in large volumes to Medicare patients and how many you think you'll be able to get to by the end of the year. And then second, on Germany, specifically, where obviously you'll be able to progress this quarter. Where are you on your -- on the percentage of the market that is now covered? Are you at 50%?

我先問兩個問題。第一，關於你們的 Medicare 套裝（bundles），就你們目前能否以大批量交付給 Medicare 病患，以及你們認為到年底能服務到多少人。第二，關於德國，特別是你們顯然在本季能有所進展的部分。目前市場覆蓋率的百分比到哪裡了？有到 50% 嗎？

This is Kevin. I'll take that one. On the Medicare side, we have just started shipping bundles in the past -- last 2 weeks of July. And quite honestly, Mike, we haven't been paid for any of the bundles that we shipped yet. So we're moving a little cautiously. Once we get going, we think we can process this quickly and move on. We will use some distributors in this process, but we're projecting right now to process the bulk of it directly. I can't give you numbers, how many we'll do by year-and. We're optimistic, we can meet most of the demand and push it out, and we will hire the people and make the investments necessary to do so. We're not going to let a customer opportunity go away. We just need to get the processes down before we go add a bunch of bodies running around, not really sure how to do this, but we are learning as we go. On the Germany side, we don't have 50% yet. We're very close to the 2 big contracts we talked about last quarter. What is happening in Germany is we grow as -- where we don't have an official contract, we're still getting payment after filling out more paperwork and doing a little extra. I think those bigger contracts we're hopeful to land those in the very near future. They haven't been quite as quick as we wanted. But again, we're still making progress and doing very well there. So we'll stick with what we have.

我是 Kevin。我來回答這題。在 Medicare 方面，我們是在 7 月最後兩週才剛開始出貨套裝。老實說，Mike，我們目前對已出貨的任何套裝都還沒有收到款項。所以我們的推進會稍微謹慎一些。一旦運作起來，我們認為可以很快處理並往前推進。在這個流程中我們會使用部分經銷商，但目前預估大部分將由我們直接處理。我無法提供到年底會做多少的數字。我們很樂觀能滿足大部分需求並把貨推送出去，也會為此招募人員並進行必要投資。我們不會讓任何客戶機會流失。我們只是需要先把流程建立好，再去增加一堆人手到處跑、卻不太確定怎麼做；但我們會在做的過程中持續學習。至於德國，我們還沒有到 50%。我們非常接近上季提到的兩個大型合約。德國目前的情況是：在沒有正式合約的地方，我們仍能在填寫更多文件、做一些額外流程後取得給付，因此我們仍在成長。我們希望在非常近期能拿下那些較大的合約。進度沒有我們想像中那麼快。但我們仍在持續推進，而且在那裡表現非常好。所以我們會先維持現有做法。

Okay. So it sounds like, Kevin, just not on the Medicare contribution this year, obviously, Medicare patients -- Medicare age patients were a negative to your first half performance. It sounds like still with where you are on the ability to fill and get paid, the contribution over the balance of the year will still be relatively modest, I would throw out, there's certainly less than $10 million.

好的。所以聽起來，Kevin，就 Medicare 在今年的貢獻而言，顯然 Medicare 病患——也就是 Medicare 年齡層病患——在你們上半年表現上是個負面因素。聽起來以你們目前的供貨與收款能力來看，今年剩餘期間的貢獻仍會相對有限；我猜測應該肯定低於 1,000 萬美元。

I -- Mike, that will depend upon how quickly we can get this thing going. If we can get these patients certainly in Q3, we don't see it as being a big factor if we get this thing up and running smoothly in Q4. And as we modeled and talked about last time, the startup revenue for Medicare patient for that first billing -- for that first month is going to be much less than what we get for a current commercial patient. So the Medicare plays a longer term and the subscription model that we have built. But we think it could contribute more than $10 million in Q4, but I can't give you a number yet. Let's see what we can get fulfilled.

我——Mike，那要取決於我們能多快把這件事推動起來。如果我們能在第三季就把這些病患納入，且在第四季能順利把整個流程穩定運作起來，我們不認為它會是很大的影響因素。而且如同我們上次建模並討論過的，Medicare 病患在第一次請款——也就是第一個月——的啟動期收入，會遠低於我們從現有商業保險病患取得的收入。因此 Medicare 是較長期的布局，以及我們所建立的訂閱模式。但我們認為在第四季它可能貢獻超過 1,000 萬美元，只是我現在還無法給你數字。讓我們先看看能完成多少履約出貨。

Okay. Last question and I'll let others jump in. But the third quarter commentary would seem to set a relatively low bar. You talked about mid- to high single digit sequential growth effectively in line with what you saw last year. Just recall that last year, you did have the recall and you had the loss receiver revenue. So the comparison to last year, shouldn't that be a relatively easier comparison? And shouldn't we be thinking about something, maybe, a little better than mid- to high single digit sequentially?

好的。最後一個問題，然後我讓其他人加入。不過，第三季的評論看起來似乎把門檻設得相對低。你提到中到高個位數的季對季成長，基本上與你們去年看到的情況一致。請回想一下，去年你們確實有召回事件，也有接收器（receiver）營收流失。所以與去年相比，這不應該是一個相對更容易的比較基期嗎？而且我們是否應該預期季對季表現可能會比中到高個位數再好一點？

No. I mean, a couple of things. If you look over the past several years, the trends are fairly similar, right. We see some slowdown during the summer months, both in Europe and in the U.S., so new patient additions aren't as robust. We got the Medicare issue that we mentioned is rolling out a little slower. And look, we decided to break out components of hardware just to let you guys know that receivers are becoming a much smaller component of the overall hardware mix anyway. So I don't know that the receiver even as of last year was not a significant contributor. So no -- I think -- I don't think we're sandbagging in anyway. I mean, the historical trend suggests that Q1 to Q2 sequential up is usually pretty good. It's a little flatter going to be Q3 and then we get the big bump in Q4. So I don't think there's much more to it.

不。我的意思是，有幾點。如果你看過去幾年，趨勢其實相當類似，對吧。我們在夏季月份看到一些放緩，歐洲和美國都是如此，因此新增病患的增幅沒那麼強勁。我們提到的 Medicare 問題推進得稍微慢一些。另外，我們決定把硬體的組成拆開來說，主要是想讓各位知道，接收器在整體硬體組合中的占比本來就越來越小。所以我不確定接收器即使在去年也不是一個重要的貢獻來源。所以不——我認為——我不覺得我們有在刻意保守。歷史趨勢顯示，第一季到第二季的季對季成長通常相當不錯。到第三季會比較平，然後第四季會有一個很大的跳升。所以我覺得沒有太多其他因素。

And our next question comes from David Lewis from Morgan Stanley.

下一個問題來自摩根士丹利（Morgan Stanley）的 David Lewis。

Few quick questions here. Steve, just following on Mike's question on the guidance, and Kevin's commentary of Medicare in the fourth quarter. So your third quarter guidance kind of implies similar growth trends to the second quarter this year. So is the way to get to -- you're still confident that you can get to the upper end of the 25% to 30% for the year? And is the way to think about that, it's all about Medicare, frankly, because my sense is we do over 30% in the fourth quarter, you do sort of the low end of 25% to 30%. If Kevin is right and you see $10 million plus in the fourth quarter, you could certainly get close to the mid- to upper half of the range. So at this point does it at all kind of come down to Medicare traction in the fourth quarter?

這裡有幾個快速問題。Steve，延續 Mike 關於財測的問題，以及 Kevin 對第四季 Medicare 的評論。你們第三季的指引似乎暗示今年第三季的成長趨勢與第二季相近。那麼，是否可以這樣理解——你們仍然有信心全年能達到 25% 到 30% 區間的上緣？而且是否可以說，坦白講關鍵就在 Medicare，因為我的感覺是，如果第四季我們做到超過 30%，你們就會落在 25% 到 30% 的低端。如果 Kevin 的判斷正確、第四季看到 1,000 萬美元以上，那你們確實可以接近區間的中段到上半部。所以到目前為止，這是否多少就取決於第四季 Medicare 的推進（traction）？

This is Kevin. I'll take that. Certainly, some piece of it does, particularly as you get to the upper ends of the range, which is why we kept the range where it was. We think that the Medicare will help. I'll give another perspective on the Medicare side. While it is a help in the fourth quarter, quite frankly, for the first couple of quarters, it's made our lives much more difficult. As you go out into an office and visit with a physician, many of our executives, we've got out on trips, we hear very similar theme, "Go get my Medicare patients taken care of and I'll give you more." So while it is a long-term accelerator, it's been a short-term disruptor, and it will put us in a better place. So David you got all those things factoring against each other, and that's why we kept our year-end guidance where it is. We always have a much bigger fourth quarter with ordering patterns from our existing patients and new patients as they get reimbursed and they get to the end of their deductibles. We don't see that changing. You add all those factors and that's why we look at it the way that we do.

我是 Kevin。我來回答。當然，其中有一部分確實如此，特別是當你要達到區間上緣時，這也是我們維持該區間不變的原因。我們認為 Medicare 會帶來幫助。我再從 Medicare 的角度提供另一個觀點。雖然它在第四季會有幫助，但坦白說，在前一兩個季度，它讓我們的日子更難過。當你到診所拜訪醫師時，我們很多主管出差時都聽到非常類似的主題：「先把我的 Medicare 病患處理好，我就會給你更多。」所以，雖然它是長期的加速器，但短期卻是干擾因素，而它會讓我們處在更好的位置。所以 David，這些因素彼此拉扯，這也是我們把全年指引維持在目前水準的原因。我們第四季一向會更大，因為既有病患的訂購模式，以及新病患在獲得給付、並接近自付額（deductible）用完時的行為。我們不認為這會改變。把所有因素加總起來，這就是我們看待它的方式。

Okay. And maybe just two more quick ones. Kevin, strategic one for you on just Medicare. I think going direct is the right strategic move for the company clearly. An issue you talked about in Medicare patient per month revenues of kind of $250, maybe $2,800, $3,000 for the year. Now that you're going into REC, can you just talk to us about, just very generally, how you think about those revenues on a per annum -- per annual, per patient basis? And how you think that profitability relates relative to third-party payers now that you sort of can -- are direct, but you also have the bundle?

好的。再來可能還有兩個快速問題。Kevin，給你一個關於 Medicare 的策略性問題。我認為改為直營（going direct）顯然是公司正確的策略動作。你提到 Medicare 每位病患每月收入大概 250 美元，也就是一年約 2,800 到 3,000 美元。現在你們要進入 REC，你能否非常概括地談談，你如何看待每位病患按年（per annum／per annual）的收入水準？以及在你們改為直營、但同時又有組合包（bundle）的情況下，這樣的獲利能力相對於目前第三方付款方（third-party payers）會是如何？

The gross margins will not be as good with the Medicare patients. We've talked about that before because we have the bundle where we have to add the strips and the other supplies. And as we said earlier, we're accepting the Medicare pricing. We'd like to get better, but it is what it is, and we'll take it. We are hoping that if we can develop an efficient process that may be the operating margins on the Medicare patients will become lower because this will be something routine, and we can just do it in lockstep. The other thing is we look forward to the future in all candor, as you get to a G6 system, for example, that's a 10-day approved sensor. Now we're down to 3 sensors a month instead of 4, and we're hopeful we can have the same fixed monthly charge. So we've designed our systems in the future to be very successful in this type of environment assuming we can keep the monthly charge at a reasonable level. So future, I think we're very fine with this model. I think there will be a little pain upfront with patient as we add them because you're going to get a receiver, the Medicare price for the receiver and that first billing is like $250, and that's not a whole lot above our costs. So margin there won't be great. And you get a transmitter with your first bundle, which are only getting billed, again, the recurring amounts. Then month 2, there is no; transmitter. Month 3, there is no transmitter. So in the early phases, profitability will be pretty tough, but over time, we think it will be fine. And it's our job, quite frankly, to get to the cost of the devices down to whereby we can make money there, and we will.

Medicare 病患的毛利率不會那麼好。我們之前談過，因為我們有組合包，必須把試紙（strips）和其他耗材加進去。而且如同我們先前所說，我們接受 Medicare 的定價。我們希望能更好，但現況就是如此，我們會接受。我們希望如果能建立一個高效率的流程，Medicare 病患的營業利益率可能會變得較低，因為這會成為例行作業，我們可以按既定節奏同步執行。另外，我們也坦白期待未來，例如當你進入 G6 系統時，那是核准 10 天使用的感測器。那麼我們每月只需要 3 個感測器，而不是 4 個，我們希望仍能維持相同的固定月費。因此，我們已在未來的系統設計上，讓我們在這種環境下能非常成功，前提是我們能把月費維持在合理水準。所以就未來而言，我認為我們對這個模式是很有把握的。我認為在前期、隨著我們新增病患時會有一些痛苦，因為你會拿到一個接收器，接收器的 Medicare 價格，而第一次帳單大概是 250 美元，這比我們成本高不了多少。所以那裡的毛利不會很好。而且你在第一個組合包會拿到一個發射器（transmitter），但計費仍然只是循環性的金額。接著第 2 個月，沒有發射器。第 3 個月，也沒有發射器。所以在早期階段，獲利能力會相當吃緊，但隨著時間推進，我們認為會沒問題。而且坦白說，我們的工作就是把裝置成本降到我們能在那裡賺錢的水準，我們會做到。

Alright Steve, maybe I'd just quickly jump in one last one, I'll jump back in queue. But Steve, the highlight for us obviously this quarter was the international business was very strong. And Germany has not sort of fully kicked in yet. So can you just give us a sense relative to the first quarter, some of the factors that contributed to that strong report here in the international markets? You talked about some pricing experiments in the first quarter, but just sort of what drove the strength here in the second?

好的，Steve，也許我最後再快速插一句，之後我會回到隊列裡。不過Steve，對我們來說本季的亮點顯然是國際業務非常強勁。而德國那邊還沒有算是完全發力。所以你能否相較於第一季，給我們一些脈絡：有哪些因素促成了國際市場這份強勁的表現？你在第一季提到過一些定價實驗，但第二季的強勢主要是由什麼驅動的？

Yes. I mean, obviously, it's reimbursement, right? And it wasn't in just Germany. I mean, as Kevin mentioned in his closing remarks -- in the prepared remarks, the Nordics have done quite well, where there is robust reimbursement, but the U.K. has done well, Canada has done well. We've quickly moved into a leadership position in Australia. What I would tell you is in the markets where we have robust reimbursement, we're competing quite favorably against any other potential competitors out there. And so we're even seeing -- take Abbott in particular, in the markets where we are paid for, we're seeing quite a few Abbott customers shifting over to the DexCom platform. So it's really nothing more than superior performance. We've always said clinical data clearly demonstrates that our sensor is just much more accurate than anything else available on the market, and that resonates with patients, particularly when they're receiving reimbursement.

是的。我的意思是，顯然是給付（reimbursement），對吧？而且不只是德國。我的意思是，正如Kevin在結語——在事先準備的發言中提到的，北歐表現相當不錯，因為那裡有強健的給付；英國表現也不錯，加拿大也不錯。我們也很快在澳洲取得了領導地位。我要說的是，在那些我們有強健給付的市場，我們與任何其他潛在競爭對手相比都具備相當有利的競爭力。因此我們甚至看到——以Abbott為例，在那些我們有給付的市場，我們看到不少Abbott的客戶轉向DexCom平台。所以這真的就是更優異的表現而已。我們一直說，臨床數據清楚顯示，我們的感測器比市面上任何其他產品都更精準；而這點會引起病患共鳴，特別是在他們能獲得給付的情況下。

And our next question comes from Jeff Johnson from Robert Baird.

下一個問題來自Robert Baird的Jeff Johnson。

Kevin, wondering when might you know when those initial CMS claims are adjudicated cleanly? Is that something we should get some clarity on that over the next few weeks? Is that something you would openly discuss then as we try to build that model? And then SG&A levels have been holding kind of around 50% for the last 6 quarters or so, give or take a little bit, I guess. But as you go the direct model in CMS, where should we be thinking about those SG&A levels going maybe over the next 12 to 18 months?

Kevin，我想請教，我們大概何時能知道那些最初的CMS申請（claims）是否能順利完成審核與裁定（adjudicated cleanly）？我們是否會在接下來幾週內就能更清楚？當我們嘗試建立模型時，你是否會公開討論這件事？另外，SG&A水準在過去大約6個季度左右一直維持在約50%上下，可能有些微波動。但當你們在CMS採用直營模式（direct model）後，未來12到18個月我們應該如何看待SG&A水準的走勢？

Let's start with your expansion questions. As we looked at our direct costs for going to Medicare, we modeled that out, and we hope that our overall percentage won't increase very much. Because as we continue to grow revenue, we do have money we can continue to invest on the SG&A side. And a lot of that will be done on building out the Medicare platform in doing that, but we can update you on that -- on that further. Now I'm -- and I'm suffering from amnesia. Your first question...

我們先從你關於擴張的問題開始。當我們評估轉向Medicare的直營成本時，我們已把它建模出來，我們希望整體占比不會增加太多。因為隨著營收持續成長，我們確實有資金可以持續在SG&A端投入。其中很大一部分會用於建置Medicare平台來推進這件事，但我們之後也可以再向你更新——進一步更新。現在我——我有點失憶了。你的第一個問題是……

Just on when those initial claims potentially get adjudicated cleanly and we can move forward.

就是關於那些初期申請何時可能會順利完成裁定，然後我們就能往前推進。

No. I can tell you, I walk down to Kevin Sun's office pretty much every morning and say, "Have we got paid yet?" Yes. So we were out a few weeks on the first one, and we're not even 3 weeks out of first ones. Once we get that first adjudication and find out, then we'll hopefully kick it up a little bit. But these will be the first thing ever paid with a CGM code through the Medicare system. So it -- and it will be a big deal for us. We won't issue a press release or anything, but we'll inform you guys how long it's taking and how it's going on the next earnings call.

不。我可以告訴你，我幾乎每天早上都走到Kevin Sun的辦公室問：「我們收到款了嗎？」是的。所以第一筆我們晚了幾週，而現在距離第一批申請送出甚至還不到3週。一旦我們拿到第一個裁定結果並弄清楚狀況，之後我們希望能把速度再拉快一點。但這將會是Medicare系統中第一次用CGM代碼支付的項目。所以——這對我們來說會是件大事。我們不會發布新聞稿之類的，但我們會在下一次財報電話會議上告訴各位需要多久、進展如何。

All right. And then my follow-up question just on, you made some pump comments about 2 of the pump companies out there that are obviously struggling a bit at this point. Between those 2 companies and with the Bigfoot news, I guess, my question is, where do you think your pump relationships need to go? Is it getting to a point where may be you need to go with some exclusive arrangements, you need to do something to tie-in some of these other pump players more tightly to your business on a go-forward basis? Just as that pot maybe dwindled a little bit of different pump companies out there.

好的。那我的追問是，你提到市面上有兩家胰島素幫浦公司目前顯然有點吃力。在這兩家公司以及Bigfoot的消息之後，我的問題是，你認為你們的幫浦合作關係需要往哪個方向走？是否到了某個程度，你們可能需要採取一些獨家安排，或需要做些事情，讓其他幫浦業者在未來能更緊密地與你們的業務綁定？因為外面的幫浦公司選項可能正在變少。

Yes. I mean -- this is Steve, I'll take that. Still of the mindset that we don't believe we need own a pump. As we mentioned, in the last couple of quarters, we're -- 2/3 of our new patient additions have been MDI patients and so. Particularly outside of the U.S., the MDI patient population is where our biggest source of growth will come in. I look at -- let's take a couple of pump partners. Animas hasn't been adding a significant number of patients. Tandem besides from their potential financial was -- is doing reasonably well in terms of new patient additions. But keep in mind, the vast majority of pumps that Tandem is selling today are the X2 pump, which is the appropriate pump for them to be selling because as soon as we receive FDA approval for the X2 G5, we'll be able to upgrade those patients immediately and they can become Gen 5 patients. Then as Tandem moves down the path to field GS system, and ultimately, to a hybrid closed-loop system, those patients will be able to retain the same hardware and field upgrade through software changes, field upgrade their pumps to accommodate new and better technology. So they're going about at the right way. It's just resulted in a couple of quarters of softer competitions on our end from Tandem. We also are seeing great additions from Insulet. I think Insulet has been the big winner here. We continue to move forward on the development side with Insulet. I think we're making great progress there. And as Kevin mentioned in the prepared remarks, there are a number of other initiatives that we have ongoing that, frankly, we can't disclose yet. We'll -- hopefully, within the next to 6 to 9 months, we'll be able to have some more to tell you about some of the other things we're working on. So it's not time to jump into the pump business by any stretch. I think we've got the right relationships in place and we're just going to keep pushing forward.

是的。我的意思是——我是Steve，我來回答。我們仍然認為我們不需要擁有一個幫浦業務。如我們提到的，在過去幾個季度，我們新增病患中有2/3是MDI（多次每日注射）病患，所以。特別是在美國以外，MDI病患族群將是我們最大成長來源。我來看——我們談幾個幫浦合作夥伴。Animas並沒有新增大量病患。Tandem除了他們潛在的財務狀況之外——在新增病患方面表現還算不錯。但請記住，Tandem目前銷售的幫浦絕大多數是X2幫浦；這也是他們應該賣的產品，因為一旦我們取得X2 G5的FDA核准，我們就能立刻為那些病患升級，他們也能成為第5代（Gen 5）病患。接著當Tandem沿著路徑推進到GS系統，並最終走向混合式閉環系統時，這些病患將能保留相同硬體，並透過軟體變更進行現場升級（field upgrade），把幫浦升級以支援更新、更好的技術。所以他們的做法是對的。只是這導致我們這邊在與Tandem相關的競爭上，有幾個季度相對偏軟。我們也看到Insulet帶來很好的新增量。我認為Insulet是這裡的大贏家。我們持續與Insulet在研發端推進。我認為我們在那裡取得了很大的進展。而如Kevin在事先準備的發言中提到的，我們還有許多其他正在進行的計畫，坦白說目前還不能揭露。我們——希望在接下來6到9個月內，能就我們正在做的其他事情，提供更多資訊。所以無論如何，現在都還不到要跳進幫浦業務的時候。我認為我們已經建立了正確的合作關係，我們會持續向前推進。

I guess one thing I'd add, Jeff, to your comment, would we consider unique relationships with these partners going forward than something different what we've done? Yes, we would. If it benefits the patient, if it helps us expand the market and get more people on DexCom sensors, we'll look at a number of business models going forward, and we'll look at them in very creative ways.

我想我會補充一點，Jeff，針對你的評論，未來我們是否會考慮與這些合作夥伴建立獨特的合作關係，採取不同於我們過去所做的方式？是的，我們會。如果這能讓病患受益、如果能幫助我們擴大市場並讓更多人使用 DexCom 感測器，我們未來會考慮多種商業模式，而且會以非常有創意的方式來評估。

And our next question comes from Matt O'Brien from Piper Jaffray.

下一個問題來自 Piper Jaffray 的 Matt O'Brien。

This is JP on for Matt. I think in the prepared remarks, you said that you've got one MAC who put out in LCD. So where are we with the other MAC's? Or how many more do we need? I mean, I guess throughout the mandate, you've got to get all the Medicare covered?

我是 JP，代替 Matt 發問。我想在事先準備的發言中，你提到你們已經有一個 MAC 發布了 LCD。那其他的 MAC 目前進度如何？或者我們還需要多少個？我的意思是，我想依照這個規定，你們必須讓所有 Medicare 都能涵蓋？

That process is done.

那個流程已經完成了。

That's done.

已經完成了。

There's only the 2 region -- there's 2 MAC's that cover the 4 regions. So we're done there. It's really -- from a logistics and processing perspective, it's really making sure that we're submitting claims with the appropriate paperwork to support the medical policy established by the MAC's. And we -- we're running test -- as we mentioned in our prepared remarks, running some test cases and making sure that we get those processed and paid before we start to turn on the flood a little bit, because we want to make sure we're submitting a bunch of claims that are just going to be denied by the MAC's. So the pieces are all in place, now it's just kind of finalizing some of the logistics.

其實只有 2 個區域——有 2 個 MAC 覆蓋 4 個區域。所以那部分我們已經完成了。真正要做的是——從物流與處理的角度來看——確保我們在提交理賠申請時，附上適當的文件，以支持 MAC 所建立的醫療政策。而且我們——正如我們在事先準備的發言中提到的——正在跑一些測試案例，並確保這些案件能被處理並獲得給付，之後我們才會稍微把量開大一點，因為我們想確保我們不是提交一大堆最後只會被 MAC 拒賠的理賠申請。所以所有環節都已就緒，現在只是把一些物流細節做最後定案。

Got you. And then on the pipeline, you're at 20,000 new patients up from 10,000 in Q1. Do you have any good, kind of, historical data of when you actually do start promoting aggressively? I think that -- is it historically, when you start promoting aggressively to those patients it goes from doubles in size, to 40,000 or even triples 60,000? Or does your strategy need to be different with how you attack these Medicare patients from a promotional standpoint?

了解。那再談到 pipeline，你們的新病患數是 20,000 人，較第一季的 10,000 人增加。你們是否有一些不錯的、算是歷史數據，來看當你們開始積極推廣時會發生什麼？我的意思是——歷史上，當你們開始對這些病患積極推廣時，規模會翻倍到 40,000，甚至三倍到 60,000 嗎？還是說，從推廣角度來看，你們針對這些 Medicare 病患的策略需要不同的打法？

Our strategy for promoting to the Medicare patients will be different. We'll -- we, certainly, with our DTC campaigns, now have directed strategies to our young population, to are young adult population to adults and then the seniors, and we'll go to different markets for seniors. How quickly that will ramp remains to be seen. (inaudible) DTC campaigns, as they initially launch, obviously, they ramp faster and then some of the effect goes away and you've got to change. The most important thing for us before we launch the campaign is to fulfill the customers that we have, not only the 20,000 new but the other several thousand that we were shipping to before, who are paying on a cash basis. So we've got -- we've got a lot of work to do. And then we'll see where those promotions lead.

我們針對 Medicare 病患的推廣策略會不一樣。我們——當然——現在透過我們的 DTC（直接面向消費者）活動，已經有針對年輕族群、年輕成人、成人以及銀髮族的定向策略，而針對銀髮族我們會進入不同的市場。至於成長速度會多快，還有待觀察。(聽不清) DTC 活動在剛推出時，通常會很快拉升，之後部分效果會消退，你就必須調整。對我們來說，在啟動活動之前最重要的是先能履行我們現有的客戶需求，不僅是那 20,000 名新客戶，還包括之前我們已在出貨、以現金自費方式付款的另外幾千名客戶。所以我們還有——我們還有很多工作要做。接著我們再看看這些推廣會帶來什麼結果。

(Operator Instructions) And our next question comes from Danielle Antalffy from Leerink Partners.

(接線員指示) 下一個問題來自 Leerink Partners 的 Danielle Antalffy。

I'll try to limit it to one and one follow-up, like you guys asked. So just a question, Kevin, for you on the higher-level strategy here, especially now that you know who the next CFO is going to be. As we approach the type 2 market, you provided some color in the prepared remarks, but just wondering if you could give any more color on the go-to-market strategy there, how the business needs to change to facilitate supply for such a massive market opportunity.

我會盡量只問一個問題再加一個追問，照你們要求的方式。所以我想問你一個問題，Kevin，關於這裡更高層次的策略，特別是現在你們已經知道下一任 CFO 會是誰。當我們切入第二型糖尿病市場時，你在事先準備的發言中提供了一些說明，但想請你再多補充一些 go-to-market（上市/商業化）策略的細節，以及為了支應如此龐大的市場機會，業務需要如何改變以促進供應。

The first thing we have to do, Danielle, is develop the proper model. For example, we know that all of our type 2 patients aren't going to wear sensors 24x7, 365 days a year. So identifying how many patients wear 1 sensor, how many get 1 a quarter, how many go on a 10-week program where they learn to manage their condition better. And we're running studies to validate those assumptions and validate that model. Ultimately, some of your type 2 diabetes can control their condition through adjusting 3 factors: exercise, diet and their meds. We're finding that CGM has an impact on all 3. Very frequently, we find patients who, when they go on CGM, a very simple example I can give you, that they just change the time they take their metformin pill. And we saw 1 patient's average glucose, in 3 weeks, go down from 190 to 110 simply by changing the time of day they took their metformin. No change in diet or exercise. We see things like this all the time as we get on more patients. And so we need to develop the models and figure out a way to put these into the system. You've got a number of patients, who don't spend that much money on their care. So this is not going to be the revenue model for patients that we have with our existing business. We need to make a revenue model that works for the payers as well and is easy to administrate by the clinicians. It's something that we're going to be thoughtful in developing, but our first step is to obtain a bunch of clinical data to develop the proper models. And we'll share some of that data really in '18 as we develop these programs further, but it's going to start there. Our new CFO, we're really excited to have him. He's had a lot of medical device experience and experience on a number of fronts that we think helps round out our team and he'll be great addition. So we're very excited about that, too.

Danielle，我們首先要做的是建立正確的模型。例如，我們知道並非所有第二型糖尿病患者都會一年 365 天、一天 24 小時配戴感測器。因此要辨識有多少患者會用 1 個感測器、有多少是每季用 1 個、有多少會參加一個 10 週的方案，透過該方案學會更好地管理病況。我們正在進行研究，以驗證這些假設並驗證該模型。最終，你的一部分第二型糖尿病患者可以透過調整三個因素來控制病況：運動、飲食以及用藥。我們發現 CGM 對這三者都有影響。我們很常看到病患在使用 CGM 後——我可以舉一個非常簡單的例子——他們只是改變服用二甲雙胍（metformin）的時間。我們看到有一位病患的平均血糖在 3 週內，僅僅因為改變一天中服用二甲雙胍的時間，就從 190 降到 110。飲食或運動都沒有改變。隨著我們讓更多病患使用，我們一直都會看到這類情況。因此我們需要建立模型，並找出把這些納入系統的方法。你會有不少病患在照護上的花費並不高。所以這不會是我們現有業務那種病患的營收模式。我們需要建立一個對付款方也可行、且臨床端容易管理的營收模式。我們會審慎地來發展它，但第一步是取得大量臨床數據，以建立正確的模型。隨著我們進一步發展這些方案，我們會在 2018 年分享其中一些數據，但起點會是這裡。我們對新任 CFO 感到非常興奮。他有很多醫療器材經驗，也在多個面向有經驗，我們認為這能讓團隊更完整，他會是很棒的加入。所以我們對此也非常期待。

Okay. That's very helpful. And my one follow-up is just as it relates to as new products come closer to market, what you guys are seeing as far as the time for -- to convert a patient. We've heard pump companies talk about that. And I know right now you're the only stand-alone sensor on the market, but just as in ways around Abbott's Libre gets louder and regardless of whether the patient ultimately goes on a DexCom or a Libre, or what have you, are you seeing any sort of extended conversion cycle from a patient deciding to go on CGM and ultimately making the choice of what product they go on? Or is that sort of status quo?

好的。這非常有幫助。我的一個追問是，隨著新產品更接近上市，你們看到病患轉換所需的時間——也就是完成轉換所需的時間——有什麼變化？我們聽過胰島素幫浦公司談到這點。我知道目前你們是市場上唯一的獨立感測器，但隨著 Abbott 的 Libre 聲量越來越大，不論病患最後選擇 DexCom 或 Libre 或其他產品，你們是否看到病患從決定使用 CGM 到最終選擇使用哪一個產品之間的轉換週期有拉長？還是說大致維持現狀？

Danielle, I'll let Steve kick in if he wants to. We see a lot of that is dependent upon our reimbursement arrangements. If a patient has pharmacy benefit, for example, and could go to the drugstore and pick it up that conversion cycle becomes a couple of days, and it becomes very quick. If they require very little documentation, I think there is a direct correlation between the reimbursement criteria and the coverage criteria from the payers and the patients' ability to get on quickly. I'd say from an overall market perspective, so now I'm going to go much bigger and much more global, whereas in the past, our patient base, in my early years here, was very, very intensive people managing their diabetes. Today, as we've got more DTC campaigns and we're further extending into the patient base, you've got people probably not as committed to going on CGM as the ones we got 3 and 4 years ago. That cycle may affect the extended by them going "Yes, I saw this on TV and I've got an iPhone or I've got an android phone now, might be cool, but maybe" -- so we are getting to a broader base of patients that may, in fact, take a little more time. But at the end of the day, it's still pretty good.

Danielle，如果 Steve 想補充的話，我就讓他來說。我們看到其中很大一部分取決於我們的給付／報銷安排。例如，如果病患有藥局給付（pharmacy benefit），可以直接到藥局領取，那麼這個轉換週期就會變成幾天，速度非常快。如果他們所需文件很少，我認為給付標準與付款方的承保標準之間，和病患能否快速開始使用之間，存在直接相關性。我會從整體市場角度來看——現在我會把視野拉得更大、更全球化——因為過去在我剛來的早期，我們的病患族群是非常、非常密集地在管理糖尿病的人。今天，隨著我們有更多 DTC（直接面向消費者）行銷活動，並且進一步擴展到更廣的病患族群，你會看到一些人可能不像我們在 3、4 年前接觸到的那些人那麼投入要使用 CGM。這個週期可能會因為他們的猶豫而拉長——他們會說「是啊，我在電視上看到，我現在有 iPhone 或 Android 手機，可能很酷，但也許吧」——所以我們正在觸及更廣泛的病患族群，而他們確實可能需要多一點時間。但歸根結底，整體仍然相當不錯。

And our next question comes from Kyle Rose from Canaccord.

下一個問題來自 Canaccord 的 Kyle Rose。

So just kind of to dovetail off of Danielle's question there just now that we've got a few quarters of CGM adoption that's kind of in line with the broader MDI versus pump breakdown, just, can you talk about any changes or any differences in utilization or attrition in this new or more MDI patient population? And then just from a bigger picture perspective, when we think about your new products coming to the market, you obviously talk to the FDA a lot. You've done a lot of work with the G6 and it sounds like the first Verily product there. Can you just talk about where the FDA stands from -- with respect to a factory-calibrated device as well as going directly to a smartphone as the primary receiver?

我想延續 Danielle 剛才的問題，現在我們已經有幾個季度的 CGM 採用情況，大致與更廣泛的 MDI 相對於幫浦的結構拆分一致；能否談談在這個新的、或更偏 MDI 的病患族群中，使用情況或流失率是否有任何變化或差異？另外從更宏觀的角度來看，當我們思考你們的新產品進入市場時，你們顯然經常與 FDA 溝通。你們在 G6 上做了很多工作，也提到第一個 Verily 產品。能否談談 FDA 對於——就工廠校準（factory-calibrated）裝置，以及直接以智慧型手機作為主要接收器——這兩點目前的立場如何？

Sure. I'll take that one on. With respect to attrition or utilization, I think those factors are relatively similar based on what we see. Again, we never encourage patients to go beyond 7 days. Our labeling it 7 days, it's a 7-day sensor. The one anecdote I can tell you is in Germany where this is reimbursed, 7 days appears to be the norm, which is really good there. I think utilization attrition, again, oftentimes become a function of reimbursement. In the first quarter, since a lot of patients have bought a bunch of sensors in Q4, they will not be buying sensors -- as many sensors in Q1. And over time, as we look at our business models and we've gone to the phone, we learn over and over again we'll try to develop a model to determine which patients have quit. We'll then go make a bunch of phone calls. "Have you left us?" "No, we haven't left you." "Well, we haven't seen your stuff in our phone service." "I went back to my receiver for a while", or things like that. I think our attrition and our utilization models really, really require more development over time. And it's going to be -- and we'll learn it. Ultimately, if we are ever going to have a phone, we'll know a lot more. With respect to the FDA and no-calibration sensors and that type of technology going straight to the phone, in Europe, we have a configuration that does go straight to the phone that doesn't demand a receiver. And the majority of our new patients in Europe, quite frankly, are not buying receivers. They're buying the transmitters and the sensors. And it's reimbursed that way in Europe, so we're doing very well with that configuration. I think over time, the FDA, we could go directly to a phone and we could file that configuration do it. For Medicare right now since we have the receiver, we continue to sell it and have it part of the system. We have a new receiver we're launching here in the fall that will be good for patients. And so we'll see over time it does take cost out of the system, and it certainly is a feature we'll consider. With respect to no-calibration sensors and FDA discussions and where all that is, we've had preliminary and initial discussions. We don't have final confirmation on anything I can tell you. We will run and simulate our G6 pivotal data, the 300-plus patients, more like 340, and 30,000 matched payers. We'll have the opportunity to take that data and simulate it, and see how a no-calibration system would perform and have discussions directly with the FDA about that. And we think we can get clear guidance. And the Verily system will be based upon that algo-- the Gen 6 sensor on that sensor platform. So we'll have a very good indication of how that system is going to perform long before we launch it, long before we file it. And I think what -- it's our job to be very diligent over the next couple of quarters to make sure we present data to the FDA in the best possible manner, so we can get very clear rulings and guidance from them.

好的。我來回答這題。就流失或使用情況而言，根據我們看到的，這些因素相對類似。再次強調，我們從不鼓勵病患使用超過 7 天。我們的標示就是 7 天，它是一個 7 天的感測器。我可以分享的一個例子是在德國，因為有給付，7 天似乎就是常態，這點非常好。我認為使用率與流失率，很多時候同樣會成為給付的函數。在第一季，由於許多病患在第四季買了很多感測器，他們在第一季就不會再買——至少不會買那麼多感測器。而隨著時間推移，當我們檢視商業模型、並且轉向手機端後，我們一次又一次學到：我們會試著建立模型來判斷哪些病患已經停止使用。然後我們會打很多電話。「你們離開我們了嗎？」「沒有，我們沒有離開。」「但我們在手機服務上沒看到你的資料。」「我有一陣子又回去用接收器了」，或類似情況。我認為我們的流失與使用模型，確實需要隨時間大幅持續完善。而且這會是——我們會學到的。最終，如果我們真的都走向手機端，我們就會知道更多。至於 FDA、免校準感測器，以及這類技術直接連到手機：在歐洲，我們有一種配置是可以直接連到手機、不要求一定要有接收器。而且坦白說，我們在歐洲的大多數新病患並不購買接收器。他們買的是發射器和感測器。在歐洲也是以這種方式給付，所以我們在這種配置下表現很好。我認為隨著時間推移，在 FDA 這邊，我們也可以直接連到手機，也可以就這種配置提出申請並執行。就目前 Medicare 而言，因為我們有接收器，我們仍持續銷售它，並把它作為系統的一部分。我們今年秋天會推出一款新的接收器，對病患會很有幫助。因此我們會隨時間觀察；這確實能降低系統成本，當然也是我們會考慮的功能。至於免校準感測器與 FDA 的討論、以及目前進展到哪裡，我們已經有初步與初始的討論。但我目前無法告訴你任何最終確認的結果。我們會運行並模擬我們的 G6 關鍵性（pivotal）數據，300 多位病患，更接近 340 位，以及 30,000 筆配對的 payers（付款方）資料。我們將有機會拿這些數據來做模擬，看看免校準系統的表現會如何，並就此直接與 FDA 討論。我們認為可以獲得明確的指引。而 Verily 系統將會基於那個演算法——在那個感測器平台上使用第六代感測器。因此在我們推出之前、在我們送件之前很久，我們就能非常清楚地掌握該系統的表現。我認為——接下來幾個季度，我們的工作就是要非常嚴謹，確保以最佳方式向 FDA 呈現數據，讓我們能從他們那裡得到非常明確的裁定與指引。

And our next question comes from Raj Denhoy from Jefferies.

下一個問題來自 Jefferies 的 Raj Denhoy。

Wonder if I could just start on the competitive landscape a bit, 670G has sort of cast a bit of a shadow over the space with these -- amongst investors anyway and they seem to be a little bit supply-constrained now in being able to put sensors in the market and get patients on that device. So I guess the question is, really, do you think we've seen the worse of that in terms of its potential impact on your -- what's your current thinking about 670G?

我想先從競爭態勢談起。670G 在這個領域上方似乎投下了一些陰影——至少在投資人之間是如此——而且他們現在看起來在供應上有點受限，無法把感測器投放到市場並讓病患開始使用那個裝置。所以我想問的是，從它對你們的潛在影響來看，你覺得最糟的情況是否已經過去了——你們目前對 670G 的看法是什麼？

I think with -- consistent with Medtronics' other launches, there is a lot of noise at the beginning and there's a lot of confusion. And some of that noise and confusion has gone away. I can tell you, as I talk to physicians in my personal conversations, I'm hearing a very similar tune over and over again that the majority of our patients really will get -- will do very well with CGM in shots. And that is the solution for the masses and that's where we want to be. I think -- if and when they launch the thing (inaudible) and can ship sensors, we'll have to see how it works. But we hear the same thing you just talked about, continued delays and continued patients not being happy, not getting the systems they signed up and paid for. So we'll just have to play it out.

我認為——就像美敦力（Medtronic）其他產品上市一樣，一開始會有很多雜音，也會有很多混亂。而其中一些雜音與混亂已經消退了。我可以告訴你，就我與醫師的私人對話而言，我一再聽到非常類似的說法：我們的大多數病患其實——在打針（shots）搭配 CGM 的情境下——會做得非常好。那才是面向大眾的解決方案，也是我們想要去的位置。我認為——如果、以及當他們推出那個東西（聽不清）並且能出貨感測器時，我們就得看看實際運作如何。但我們也聽到你剛提到的同樣情況：持續延遲、以及病患持續不滿，因為拿不到他們已經註冊並付費的系統。所以我們就只能讓事情繼續發展再看。

Okay, fair enough. And then maybe just my follow-up. We've heard recently that JDRF and the Helmsley Trust are going to be embarking on a bit of an advertising campaign to drive CGM utilization. I think they've stated the goal is to double the -- or get the penetration of CGM, I should say, the 50% of eligible users over the next year. I know that's (inaudible) but do you have any thoughts around that plan and whether it could impact your numbers?

好，這樣說也合理。那我再追問一下。我們最近聽說 JDRF 和 Helmsley Trust 將啟動一項廣告宣傳活動，以推動 CGM 的使用。我想他們表示目標是在未來一年內把——或者我應該說，把符合資格使用者的 CGM 滲透率提高到 50%，也就是翻倍。我知道那段（聽不清），但你對這個計畫有什麼看法？以及它是否可能影響你們的數字？

I'm really happy that they're going to advertise for us. I hope it does impact our numbers. I've had discussions with Helmsley Trust and JDRF to fund the program, and we're certainly happy to be involved and help any way we can. The tools we've given JDRF and Helmsley in this endeavor, when you look at the DIaMonD study, you look at the Gold study, you look at the COMISAIR Study over in Europe as well, for the first time ever, we've got a body of clinical evidence that truly shows that CGM is a great benefit to patients. And if you're going to invest in money that's going to improve care in a patient's life, there's nothing better to invest than in CGM. And I think they'll capitalize on that message and go. I think we need to combine their messaging that's going to patients and health care providers to the payers as well, and I think it's a three-pronged approach. It's not just 1 or 2. So we're happy to participate in that, and we will take any -- any efforts to increase awareness we're thrilled with.

我真的很高興他們要替我們做廣告。我希望這確實會影響我們的數字。我已經和 Helmsley Trust 以及 JDRF 討論過為該計畫提供資金，我們當然也很樂意參與並盡我們所能提供協助。在這項努力中，我們提供給 JDRF 和 Helmsley 的工具——當你看 DIaMonD 研究、Gold 研究，以及歐洲的 COMISAIR 研究時——我們第一次擁有一整套臨床證據，真正顯示 CGM 對病患有很大的益處。如果你要投入資金來改善病患的照護與生活品質，沒有什麼比投資在 CGM 更值得。我想他們會善用這個訊息並推進。我認為我們需要把他們對病患與醫療照護提供者的訊息，也同樣傳達給支付方，我認為這是一個三管齊下的方法。不只是 1 或 2 個面向。所以我們很樂意參與其中，任何——任何提升認知的努力我們都非常歡迎。

And our next question comes from Doug Schenkel from Cowen.

下一個問題來自 Cowen 的 Doug Schenkel。

This is Ryan on for Doug. Last quarter you noted Germany was 20% of international revenue. What was it in Q2? And as we look to the rest of 2017, is there any reason why international revenue wouldn't continue to increase sequentially?

我是 Ryan，代 Doug 提問。上季你們提到德國占國際營收的 20%。那 Q2 是多少？另外，展望 2017 年剩餘時間，有沒有任何理由使國際營收不會持續逐季增加？

You've got that, Steve?

Steve，你有這個數字嗎？

Yes. I think, if we -- I don't have the number in front of me. I think it was around 25% of International this quarter. And is there any reason to think it won't continue to increase sequentially on an absolute basis? Yes, of course, it will. We continue to grow reimbursement in Germany and other countries. There's no reason to think that international is going to continue to grow, but as we've noted directly and indirectly on the call, the U.S. business tends to do a little better in the back half of the year, particularly in Q4 as insurance deductibles are met and patients have a much easier financial means to obtain the product. So I don't know that International is going to continue to outpace, but it's going to continue to be a growth driver for us.

有。我想——我手邊沒有確切數字。我想本季大約占國際的 25%。至於有沒有理由認為它不會在絕對金額上持續逐季增加？當然會。我們持續在德國及其他國家擴大給付/報銷。沒有理由認為國際業務不會持續成長；但正如我們在電話會議中直接或間接提到的，美國業務通常在下半年表現更好，尤其是 Q4，因為保險自付額達標後，病患在財務上更容易取得產品。所以我不確定國際是否會持續跑贏，但它會持續成為我們的成長動能。

Got it. And then on G6, can you comment at all on the results of the pivotal trial? Were performance results in line with the preclinical data you've previously presented?

了解。那關於 G6，你能否評論一下關鍵性試驗的結果？其效能表現是否與你們先前展示的臨床前數據一致？

To the credit of my team, they've not shown me the results of the pivotal study. So I can't comment. And we wouldn't anyway. We'll submit it and it'll be published later. But we're very confident in that system. It's great sensor technology with a very strong algorithm.

要歸功於我的團隊，他們還沒有把關鍵性研究的結果給我看。所以我無法評論。而且我們本來也不會評論。我們會提交資料，之後會發表。但我們對那套系統非常有信心。它是很棒的感測器技術，搭配非常強的演算法。

And our next question comes from Margaret Kaczor from William Blair.

下一個問題來自 William Blair 的 Margaret Kaczor。

First question from me is, I think, at the beginning of the call, you mentioned you were taking a look at some of the timing for the Verily first generation product, and then that's based on the G6 platform. Are you guys looking at ways to accelerate the timing of that launch, whether it's the first generation or the second generation? And what kind of updates should we be looking for?

我的第一個問題是，我想在電話會議一開始你提到，你們正在檢視 Verily 第一代產品的一些時程安排，而那是基於 G6 平台。你們是否在尋找加速該產品上市時程的方法，不論是第一代或第二代？我們應該期待看到哪些更新？

I -- we are looking for ways to accelerate everything with respect to our G6 product and the first Verily launch, and as we look forward to our future products. And we're looking International, strategies where we can get combinations of those products out and really meet some unmet patient considerations over there. I think next quarter is where you can expect just a little clearer guidance from us. We need some more guidance with the agency. We need to run our data and our pivotal and see what our no-calibration data is going to look like for the Verily product and really have some good discussions with the agency. And they -- look, they've been nothing but cooperative with us as we reach out to them, but this is going to be a very good dataset for us to base a conversation on. We still have scale up and engineering work to do on the first generation Verily product. If it got to approved tomorrow we certainly couldn't manufacture 10 million of them. But we do -- we have scale up work to go. So there's a whole time line here of things that have to fall into place when we go. I think we'll just give you more clarity and talk about more of the test and things we have going on. I think we can talk about clinical study schedules and everything like that. And we're hoping to be able to do that in the next earnings call, so we can let you know where we are.

我——我們正在尋找加速一切的方法，包含我們的 G6 產品、第一個 Verily 上市計畫，以及我們未來的產品。我們也在看國際市場，思考策略，看看如何把這些產品的組合推出去，真正滿足那邊一些尚未被滿足的病患需求。我想下個季度你們可以期待我們給出更清楚一些的指引。我們需要從主管機關那裡得到更多指導。我們需要跑完資料與關鍵性試驗，看看 Verily 產品的免校正（no-calibration）數據會長什麼樣，並與主管機關進行充分討論。而且——你看，他們在我們主動聯繫時一直都非常配合，但這將是一份非常好的資料集，讓我們據此展開對話。我們在 Verily 第一代產品上仍有擴產與工程工作要做。就算明天就核准了，我們當然也不可能生產 1,000 萬個。但我們確實——我們還有擴產工作要完成。所以這裡有一整條時間線，很多事情必須到位我們才能推進。我想我們會給你們更清楚的說明，並談更多我們正在進行的測試與相關事項。我想我們可以談臨床研究時程等等。我們希望能在下一次財報電話會議上做到這點，讓你們知道我們目前的進度。

Okay. And then you referenced the FDA's view on calibration, and you talked a little bit about dosing, but in your view and in your recent discussions, are alerts and alarms and that fingerstick-like accuracy the sticking point at this point in order to get that dosing plan? And then again, in terms of calibration, have you had discussions with them about factory-calibrated devices? And what do you think the FDA's view of that is today?

好的。你提到了 FDA 對校正的看法，也稍微談到用於給藥（dosing），但以你的觀點以及你們最近的討論來看，警示與警報，以及那種接近指尖採血的準確度，是否是目前要取得該給藥方案的卡關點？另外，再談校正方面，你們是否與他們討論過工廠校正（factory-calibrated）的裝置？你認為 FDA 目前對此的看法是什麼？

I'm not going to speak for them. I can talk to you about our view and my view, in particular. With respect to our intensively managed patients, we need to deliver safe experience. We were looking at -- and quite candidly we added user guide the other day and it talks about -- and there's a statement right in the user guide, it says when this thing says 60 or below, the chances are 40%. You're between 80 and 180, and you can't rely on this for accurate measurement in the lower range. With our G5 505 Software, if our device reach 60 or below, the chances of you being above 80 are 2% 3%, and above 120 are 0. I take 2% to 3% over 40% any day. And the FDA's already seen non-adjunctive sensors, where they've given a label with that level of accuracy. So we know we're going to have to perform. I don't know if they're waiting for a fingerstick accuracy, Margaret. It'd certainly be lovely if we could get it. We know, as we run our pre-pivotals with no calibration data, quite honestly, we actually get better performance in the first day because of the occasional outlier from a calibration at this point in time. I think the industry is going to mature. I think we need to have really robust technology and algorithms and systems with no-calibrations sensors to keep patients safe. We talked with the FDA. We talked with others about is there a different class of product for non-intensively managed type 2s. I think that type of product can develop over time as well. But we're at the very beginning on this. We're kind of at the same place we were many years ago when we first started. And we're looking forward to the challenge, and think -- I'm pretty confident we can deliver the technology to get us there. But it's going to be a process. And the FDA has been nothing but cooperative, but I think they're proceeding with caution, and that's okay. They should. It's important to these patients that they're safe.

我不會代他們發言。我可以跟你談談我們的看法，尤其是我個人的看法。就我們密集管理的病患而言，我們必須提供安全的使用體驗。我們一直在看——而且坦白說，我們前幾天新增了使用者指南，裡面提到——而且使用者指南裡有一段話寫得很清楚：當這個數值顯示 60 或以下時，機率是 40%。當你介於 80 到 180 之間時，而在較低區間你不能依賴它做精準量測。使用我們的 G5 505 軟體，如果我們的裝置達到 60 或以下，你實際上高於 80 的機率是 2% 到 3%，而高於 120 的機率是 0。我任何一天都會選 2% 到 3% 而不是 40%。而 FDA 已經看過非輔助（non-adjunctive）感測器，他們也曾在那樣的準確度水準下核發標示。所以我們知道我們必須拿出表現。我不知道他們是否在等同於指尖採血（fingerstick）的準確度，Margaret。如果我們能做到那當然很好。我們知道，當我們在跑沒有校正資料的前期關鍵試驗（pre-pivotal）時，老實說，我們在第一天的表現其實更好，因為目前偶爾會出現來自校正的離群值。我認為這個產業會逐漸成熟。我認為我們需要非常強健的技術、演算法與系統，搭配無需校正的感測器，才能確保病患安全。我們已經和 FDA 討論過。我們也和其他人討論過：對於非密集管理的第二型糖尿病患者，是否存在不同的產品類別。我認為那類產品也能隨時間發展。但我們現在才剛開始。我們有點像回到很多年前剛起步時的狀態。我們期待這個挑戰，而且我相當有信心我們能提供所需的技術來達成目標。但這會是一個過程。而 FDA 一直都非常合作，但我認為他們是謹慎推進，這也沒問題。他們應該這樣做。對這些病患而言，安全非常重要。

And if I can squeeze one more in. In terms of patient demand trends outside of Medicare, I think, you mentioned earlier that MDIs were 2/3 of your new patient adds maybe in the first half. I assume that's true in the quarter as well. What kind of indicators are you guys looking at that can continue to drive that double-digit growth, let's say, over the next few years in the MDIs?

如果我可以再塞一個問題。就 Medicare 以外的病患需求趨勢而言，我想你先前提到 MDI 在上半年新增病患中占了 2/3。我假設這一季也是如此。你們在觀察哪些指標，能在未來幾年持續推動 MDI 維持雙位數成長？

I think one thing that will drive that double-digit growth is we'll have systems for MDI patients where there will be Bluetooth apps on phones where we combine -- we can combine MDI data with CGM data and really give a patient a good view of their overall diabetes picture, similar to what they get on the face of their insulin pump today when they have a glucose sensor. I think those will be helpful. I think, from a cost perspective, in all honesty, as you look at payers and what they're spending on the cost of diabetes, an integrated pen solution is going to be very -- it's going to be a less expensive alternative than going on the insulin delivery systems that we have today and a CGM. So I think there's a number of ways we can drive this. I think there will be new technology and devices that will make it much more accessible and much better for the patients.

我認為能推動雙位數成長的一件事是：我們會為 MDI 病患提供系統，在手機上有藍牙 App，把——我們可以把 MDI 資料與 CGM 資料結合，真正讓病患對其整體糖尿病狀況有很好的視圖，類似於他們今天在使用胰島素幫浦且搭配葡萄糖感測器時，在幫浦螢幕上看到的資訊。我認為這些會很有幫助。我認為，從成本角度坦白說，當你看付款方在糖尿病成本上的支出時，整合式智慧筆解決方案將會是——相較於使用我們今天的胰島素輸注系統再加上 CGM，成本更低的替代方案。所以我認為我們有很多方式可以推動這件事。我認為會有新的技術與裝置，讓病患更容易取得、使用體驗也更好。

And our next question comes from Chris Cooley from Stephens.

下一個問題來自 Stephens 的 Chris Cooley。

Just two quick ones for me. One maybe either Kevin or Steve. Could you just remind us, I realize that as we see the growth in the Medicare opportunity that this is a script model. But are there any variances to the cadence or the order patterns that we should expect in the early penetration of that opportunity that you want to make sure that we're all mindful of? And I realize we're still, I guess, pre-first inning in that regard. And then secondly, I just wanted to clarify, I think, Kevin, your prior response in the cost to serve, or the cost to acquire those patients, saying it was essentially or just a little bit above the commercial pay patient today. I just want to make sure I fully understand the puts and takes there with the incremental product you have to ship as well as the -- well, I'd assume the added handholding their time from an administrative level?

我這邊兩個很快的問題。第一個可能給 Kevin 或 Steve。能否提醒我們一下，我知道隨著 Medicare 機會的成長，這是一個處方（script）模式。但在該機會早期滲透時，節奏或訂購模式上是否會有任何差異，是你們希望我們在預期上特別留意的？我也知道在這方面我們大概還在第一局之前。第二個，我想釐清一下，Kevin，我理解你先前對服務成本（cost to serve）或取得這些病患的成本（cost to acquire）的回覆是：基本上與目前的商業保險自付（commercial pay）病患相當，或略高一些。我想確認我完全理解其中的增減因素，包括你們必須額外出貨的產品，以及——我猜還有在行政層面需要更多手把手協助所花的時間？

Yes, so I'll take the first part. I think it's a great question because there are 2 critically important points to keep in mind about the Medicare patient. Kevin spoke to one, in one of his responses, which is, the initial contribution from a Medicare patient will be substantially lower than a commercial, private payer patient because -- best case, we're going to get close to $500 out of the gate from a new Medicare patient based on the receiver and a first month's bundled. Whereas we might get $1,000 or $1,500 dollars or more from a private payer patient depending on how many boxes of sensors their insurance company would let us ship on an initial sale. So that's -- when you're modeling it's really important not to get ahead of yourself on the initial contribution. But the follow-up to that is we love that the model that Medicare has set forth, where it's effectively a subscription model. So this 200 -- around $250 a month, once we have the systems in place, it's great. We can pick up the phone and reach out to that patient every month and figure out exactly what supplies we need and we ship them. And so once the initial paperwork is done, once we've got it up and running, over the course of 12-month period, the Medicare patient becomes a great patient in terms of our ability to fulfill them on a more consistent basis. So I think that's an important point.

好的，我先回答第一部分。我認為這是個很好的問題，因為關於 Medicare 病患有兩個極其重要的重點需要記住。Kevin 在先前某個回答中提到其中一點：Medicare 病患的初始貢獻（initial contribution）會顯著低於商業、私人付款方病患，因為——在最佳情況下，基於接收器（receiver）與第一個月的套裝（bundled），我們從一位新的 Medicare 病患一開始大概只能拿到接近 500 美元。相較之下，私人付款方病患我們可能拿到 1,000 或 1,500 美元甚至更多，取決於他們的保險公司在首次銷售時允許我們出貨多少盒感測器。所以——在你做模型時，非常重要的是不要對初始貢獻過度樂觀。但接著我們很喜歡 Medicare 所設定的模式，因為它本質上是一種訂閱模式。因此每月約 250 美元，一旦我們把系統建置好，這就很棒。我們可以每個月打電話聯絡該病患，確認到底需要哪些耗材，然後出貨給他們。所以一旦初始文件完成、系統上線運作，在 12 個月期間內，Medicare 病患會成為很好的病患，因為我們能更一致地履約供應。所以我認為這是一個重要重點。

Yes. And as far as time, Chris, we know and we've done logistic studies. We know, for example, a call from a Medicare patient takes us longer to respond to than a call from a non-Medicare patient. We -- in Arizona, where we set up our second call center in our new building, we have a Medicare call team set up ready and ready to go with the Medicare patients. Now they're answering other calls now and dealing with folks who haven't got their systems yet and want to know when they're coming. But ultimately, we're building a structure around this to try and figure it out. And as Steve said, with the monthly cost -- with the monthly opportunity to interact, we believe, over time, it will be a very good business model. We just have to get the systems in place and get our cadence down, to whereby, we understand how it works. And it is different than what we do today with our current patients. It really is.

是的。至於時間方面，Chris，我們知道而且我們做過物流研究。例如我們知道，回覆一通 Medicare 病患的來電，所花的時間比回覆非 Medicare 病患的來電更久。我們——在亞利桑那州，我們在新大樓設立了第二個客服中心，並成立了一個 Medicare 來電團隊，已經就位並準備好服務 Medicare 病患。現在他們也在接其他來電，處理那些系統還沒到位、想知道何時會到的人。但最終，我們正在圍繞這件事建立一套架構，試著把它摸清楚。而如 Steve 所說，透過每月費用——透過每月互動的機會，我們相信長期來看這會是一個非常好的商業模式。我們只是必須把系統建置好，並把節奏調整到位，讓我們理解它如何運作。而且它確實不同於我們今天對現有病患所做的方式。確實如此。

Our next question comes from Tao Levy from Wedbush.

我們的下一個問題來自 Wedbush 的 Tao Levy。

So maybe first off, in terms of the new patient trends that you're seeing in the U.S., any general comments you can provide? I know you, obviously, had a good quarter here in the second quarter, but versus your Q4 first quarter, how are things shaping up in the field as new patients start coming on board?

那麼也許先從您在美國看到的新病患趨勢談起，您能提供任何一般性的評論嗎？我知道你們顯然在第二季有個不錯的季度表現，但相較於你們的 Q4、第一季，隨著新病患開始加入，第一線的情況目前發展得如何？

New patients are hitting us, that's certainly a big portion of our numbers. I would tell you on an overall basis, the amount new patients contribute, now that we have this much bigger installed base, isn't as big in the overall revenue picture as servicing the ones that we have. Our opportunities for new patients continue to grow rapidly. We get a lot of leads. I would tell you the only thing we've seen, and it is just what it is, as more of our leads come from social media. And our DTC campaigns, it takes a little longer to close those than it does to close some of the ones we've gotten from physicians directly, where your physicians says, "You're a candidate for CGM, you need this. You need to wear it," versus somebody who goes online and we have to go through conversations and then call their doctor and say, "Your patient wants the system and wants to use the system," and go through that versus a patient, who gets a script directly from their doctor and reaches out to us. So I'd say close time on some of those leads is a little longer, and they may not be as committed as the others. So we have more opportunities than we've ever had. Our close rate is probably not as high as it used to be, but that's expected as you expand your market and do what we're doing. But new patients are good, I think the limiting factor on new patients, I said it earlier, has been the ability of field team to focus on new patients as they've dealt with the Medicare issues and the physicians saying I want my Medicare patients taken care of. We need to get those folks taken care of. But our team is doing well.

新病患確實在增加，這當然占了我們數字中很大的一部分。但我會告訴你，整體而言，現在我們的既有裝機基礎更大，新病患對整體營收的貢獻，相較於服務既有病患，並沒有那麼大。我們獲取新病患的機會仍在快速成長。我們得到很多潛在客戶線索。我會說我們唯一看到的情況——也就是如此——是我們越來越多的線索來自社群媒體。而我們的 DTC（直接面向消費者）行銷活動，成交所需時間會比一些直接由醫師轉介而來的線索更長；因為醫師會說：「你適合使用 CGM，你需要這個。你需要配戴它。」相較之下，若是有人上網，我們必須先進行溝通，然後再打電話給他的醫師說：「你的病患想要這套系統並想使用這套系統」，並走完這些流程；而不是病患直接從醫師那裡拿到處方，然後主動聯絡我們。所以我會說，部分線索的成交時間會稍微更長，而且他們可能不像其他人那麼投入。因此我們的機會比以往任何時候都多。我們的成交率可能不如過去那麼高，但當你擴大市場、做我們正在做的事情時，這是可以預期的。但新病患的狀況是好的；我認為新病患的限制因素——我之前也提過——在於第一線團隊在處理 Medicare 議題時，能否把重心放在新病患上，以及醫師會說我希望我的 Medicare 病患能被妥善照顧。我們需要把那些人照顧好。但我們的團隊做得很好。

Great. And also just as a quick follow-up. Steve, you've made an interesting comment in your prepared remarks, where you kind of talked about patients in Europe who initially were on Libre now transitioning to your system. I mean, what type of insight is that, I guess, anecdotal information providing you? How does that make you feel? Or how do you think about how that might impact things here in the U.S. or even internationally over time?

很好。另外再快速追問一下。Steve，你在事先準備的談話中提到一個很有意思的評論，你談到歐洲有些病患一開始使用 Libre，現在正轉換到你們的系統。我的意思是，這類洞見——我想——這些軼事資訊對你們提供了什麼？這讓你有什麼感受？或者你如何看待這可能隨時間對美國、甚至國際市場帶來的影響？

I don't really want to comment on the U.S. because we still don't know if Abbott gets approved, what their labeling is going to look like, et cetera. But what it's -- frankly, what our field folks is, is we've gone direct in a number of these markets and even with the distributors, who we're closer to, they say once reimbursement is put in place, patients, clinicians, everybody involved, absolutely prefers real-time alerts and alarms. And they absolutely prefer the improved accuracy of our system over what Libre is able to provide them, particularly, when you look at performance accuracy, performance in the hypoglycemic range. So when Libre was competing purely on a cash basis and offering it on a per day basis, a slightly less expensive product, it was tougher. But when patients are able to get it paid for, they're becoming DexCom user.

我不太想評論美國，因為我們仍不知道 Abbott 是否會獲得核准、他們的標示（labeling）會長什麼樣等等。但坦白說，我們第一線同仁的回饋是：我們在其中一些市場採取直營，即使透過我們更貼近的經銷商，他們也表示一旦建立起給付（reimbursement），病患、臨床醫師以及所有相關人士，都絕對更偏好即時警示與警報。而且相較於 Libre 能提供的，他們也絕對更偏好我們系統更好的準確度，特別是當你看表現準確度、以及在低血糖區間的表現時。所以當 Libre 純粹以自費方式競爭、並以按天計價提供一個稍微便宜的產品時，競爭會更困難。但當病患能夠獲得給付時，他們就會成為 DexCom 的使用者。

And our next question comes from Joanne Wuensch from BMO Capital Markets.

我們的下一個問題來自 BMO Capital Markets 的 Joanne Wuensch。

Last quarter, you had quantified, I think, it was $2.5 million of sort of a Medicare patient loss associated with the implementation of the program. Should we think a similar number happened to this quarter?

上一季你們量化過，我想大約是 250 萬美元，屬於與該計畫導入相關的 Medicare 病患流失。我們是否應該認為本季也發生了類似的數字？

Sure. Yes. Well, and what we said, just to clarify for everybody, is we have several cash-paying Medicare patients that was between $2 million to $3 million in Q1, and we have the same thing again in Q2. We're not billing any of these people and not collecting any money.

當然。是的。而且我們之前說過——為了讓大家更清楚——我們有一些以現金自費的 Medicare 病患，第一季大約在 200 萬到 300 萬美元之間，第二季也同樣如此。我們沒有向這些人開立帳單，也沒有收取任何款項。

And should we anticipate that the headwind for the remainder of the year? Or just sort of ease off as you get more paperwork and processed in place?

那我們是否應該預期這會在今年剩餘時間持續形成逆風？還是隨著你們取得更多文件、流程逐步到位後就會緩解？

Our goal is to get our existing patients up and running quickly, and then take on the new ones as well. So -- we'd love to say it's going to -- we're going to get a lot more than $2.5 million in Medicare revenues in Q3, but I really can't quantify a number today. And I think we would be wildly unsuccessful if we didn't get more than $2.5 million in Q4. So I think, over time, it will reverse itself and the trend will be positive.

我們的目標是讓既有病患快速上線運作，然後也同時承接新病患。所以——我們當然希望能說第三季的 Medicare 營收會遠高於 250 萬美元，但我今天真的無法量化一個數字。而我認為，如果第四季沒有高於 250 萬美元，那我們就會是非常、非常不成功。所以我認為，隨著時間推進，它會反轉，趨勢會轉為正向。

Excellent. Congratulations on hiring Quentin. Is there something that he will be tasked with that you can explain as we think about him coming on board?

太好了。恭喜你們聘用了 Quentin。在我們思考他加入後的角色時，你能否說明他將被交付哪些任務？

We're excited to get him. And I think if you look at what we've done over the past couple of years at our company, I believe and I firmly believe this, I'm taking away from my closing remarks, I'll take it now. I compare this to other diabetes companies for a long time and never seen a team as good as the one that we have here. And what we've done in the past couple of years as we've added, for example, a new HR person, a new Head of Quality, a new Head of IT, we just brought in a payer person from the pharma world, we have added really, really strong talent because we've learned, to go to the next level we need some new skills. We've been very good at diabetes and very good at what we've done, but there are just -- there are other skills that these new folks have brought to the table that are going to make us a better company, combined with the excellent team that we have now. And I think Quentin will fit into our team very nicely, and yes, I've got a list for him but I'm not going to go over it on the phone.

我們很期待他加入。我想如果你看看我們公司過去幾年所做的事情，我相信——而且我非常相信——我本來要在結語中提到，我現在就先說。我長期以來把我們和其他糖尿病公司做比較，從未見過像我們這裡這樣優秀的團隊。而在過去幾年裡，當我們新增了例如新的人資主管、新的品質主管、新的 IT 主管，我們也從藥廠領域引進了一位負責支付方（payer）的人才；我們加入了非常、非常強的人才，因為我們學到，要邁向下一個層級，我們需要一些新的技能。我們在糖尿病領域一直做得很好，也很擅長我們所做的事，但確實——這些新同仁帶來了其他技能，能讓我們在現有優秀團隊的基礎上，成為更好的公司。我認為 Quentin 會非常契合我們的團隊；是的，我有一份給他的清單，但我不會在電話上逐一說明。

And our last question comes from Jayson Bedford from Raymond James.

我們最後一個問題來自 Raymond James 的 Jayson Bedford。

Just a couple of quick ones. The incremental cost that is going direct for Medicare, is that absorbed into the expense guidance that you laid earlier this year?

我有幾個快速問題。針對 Medicare 改為直營所增加的額外成本，是否已經包含在你們今年稍早提出的費用指引之中？

Yes.

是。

Okay. And then second, on the type 2 market, is the DIaMonD data, or even CMS's willingness to cover intensive type 2 patients, had any influence with commercial payers, I think, potentially getting broader coverage for type 2s?

好的。第二，關於第 2 型市場，DIaMonD 的數據，或甚至 CMS 願意給予重度第 2 型患者給付，是否對商業保險支付方產生任何影響，我認為可能會讓第 2 型獲得更廣泛的給付？

We're just starting to write that story now but we hope that it does.

我們才剛開始撰寫這個故事，但我們希望確實會有幫助。

And we have no further questions, turning it back over to you, Kevin.

我們沒有其他問題了，把時間交還給你，Kevin。

Well, a lot of the things I was going to say in my close we've covered but I'll just hit the key points anyway. Three takeaways from this call that you should all remember. Our international growth has been really strong and it's really confirmed what we always knew. CGM is going to be a worldwide solution. It's not just going to be domestic. Example after example come in where we're doing very well. In Italy, we're growing nicely. In Israel, we're doing very well. As Steve talked about earlier, in Australia, reimbursement came out early this year. And in 4 months, we've already become the dominant player there with a wonderful distributor.

嗯，我在結語中原本要說的很多內容我們都已經涵蓋了，但我還是把重點再提一下。這通電話有三個你們都應該記住的重點。我們的國際成長非常強勁，也再次印證了我們一直以來所知道的事。CGM 將會是全球性的解決方案。不會只侷限於國內。一個又一個例子顯示我們表現得非常好。在義大利，我們成長得不錯。在以色列，我們做得非常好。如同 Steve 先前提到的，在澳洲，今年年初就開始有給付。而在 4 個月內，我們已經成為當地的主導者，並且有一位很棒的經銷商。

Our International investments were well timed and are paying off. And in spite of our International success, the U.S. is still where more than 80% of our business remains, and it's still a great opportunity. And remember, while we talked about all these Medicare implementation difficulties, the fact is we've gained access to 30% more type 1 patients in the U.S. than we have before. And for the first time, with a very large market. We have access to type 2 intensive insulin users.

我們的國際投資時機掌握得很好，現在也正在開花結果。儘管我們在國際市場很成功，美國仍然是我們超過 80% 的業務所在，而且仍是一個很大的機會。也請記得，雖然我們談到這些 Medicare 落地執行的困難，但事實是，我們在美國可觸及的第 1 型患者比以前增加了 30%。而且第一次，面對一個非常大的市場。我們也能觸及第 2 型的重度胰島素使用者。

We will continue to drive awareness. I think our marketing teams have been very good there. And we're going to be making big investments in access as well. We need to get more patients covered and more lives covered as we look at our international successes and what we have here. That's important to us.

我們會持續推動認知度。我認為我們的行銷團隊在這方面做得非常好。我們也將在可近性方面進行重大投資。當我們看到國際上的成功以及我們在這裡所擁有的機會時，我們需要讓更多患者獲得給付、讓更多受保人群（lives）納入給付。這對我們很重要。

And finally, I just want to remind everybody. We're built for the long haul here at DexCom. Our R&D investments are going to pay tremendous dividends. Our product focus on our reduced cost, increased adherence, convenience and finally, continued world-leading performance, will get us where we need to be. Glucose monitoring is a product category in its infant stages, and we intend to grow far beyond the markets where we play today, and our strategies are taking shape.

最後，我只想提醒大家。在 DexCom，我們是為長期而打造的。我們的研發投資將帶來巨大的回報。我們的產品聚焦於降低成本、提高依從性、提升便利性，以及最後，持續保持世界領先的性能，將帶我們達到所需的目標。血糖監測仍處於產品類別的萌芽階段，我們打算成長到遠遠超過我們今天所參與的市場，而我們的策略也正在成形。

Think about what we're talking about: the new factory we put up in Arizona, 180,000 square feet; our relationship with Verily to bring, literally, telecom technology and microelectronics to diabetes; our thoughtful approach to our new markets and our type 2 efforts; our strengthened balance sheet, with our $400 million in cash we just raised and even more capacity for debt if we had a great opportunity; and finally, the strength of this management team that we continue to build, this opportunity to remains exceptional and has got a lot of legs. Thank you very much.

想想我們在談什麼：我們在亞利桑那州新建的工廠，18 萬平方英尺；我們與 Verily 的合作，將電信技術與微電子技術真正帶入糖尿病領域；我們對新市場與第 2 型業務的審慎布局；我們強化的資產負債表——我們剛募得 4 億美元現金，若遇到很好的機會也還有更大的舉債能力；最後，是我們持續打造的管理團隊實力，這個機會仍然非常卓越，而且還有很長的成長動能。非常感謝。

Thank you, ladies and gentlemen. This concludes today's conference. Thank you for participating. You may now disconnect.

謝謝各位女士、先生。今天的會議到此結束。感謝各位參與。您現在可以掛線。