Diabetes is a very common metabolic disorder that saw 31,726,680 prevalent diagnosed cases of both type 1 and type 2 diabetes in the US in 2019, with the number of diagnosed cases growing to over 41 million by 2026, according to GlobalData estimates.

For people with diabetes, measuring blood sugar (glucose) is a daily (or more than daily) task, typically done by an invasive finger prick to draw blood for glucose measurement. Among the many pitfalls to this method is the fact that blood glucose measurements taken this way only provide a snapshot in time, without any context; they don’t track rising and falling levels of blood glucose. Knowing whether their blood glucose is rising or falling, and being able to follow patterns over time, is valuable information for people with diabetes, and would inform better treatment decisions.

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Continuous glucose monitoring

To solve this issue, multiple companies have invested in the development of continuous glucose monitoring (CGM) systems. As their name suggests, these systems are designed to track blood glucose continuously, 24/7, so rising and falling patterns can be visualised and acted upon. A CGM system consists of a wearable sensor, a transmitter, and a display device. The sensor is placed just under the skin and kept in place with an adhesive patch; it measures glucose levels in the interstitial fluid. The transmitter sends information from the sensor to the display device, which showcases the results. Many CGM devices also offer additional features, such as smartphone connectivity, notifications when glucose levels are rising or falling too rapidly, long-distance sharing of data with family members, and even predictions of upcoming glucose levels powered by machine learning.

Dexcom, Abbott and Medtronic

DexCom, Inc. was the first company to have a CGM system approved by the FDA, and as a result, has remained a major player in the market ever since. The company reported revenues of $1.03bn for FY2018, an increase of 43.6% over FY2017. Dexcom has updated its system over time, with its current offering being the Dexcom G5 Mobile CGM system, which is sold in multiple countries worldwide.

Dexcom’s main competitors in this space are Abbott Laboratories’ FreeStyle Libre CGM device and Medtronic’s Guardian Connect CGM device. However, Dexcom’s device is superior in-app connectivity: the Guardian Connect cannot connect to smartwatches, and the FreeStyle LibreLink app is only available on Android phones in certain countries. Still, with Abbott Laboratories and Medtronic both having such a dominating presence in the MedTech space, GlobalData predicts that they will consume significant market share in the foreseeable future, leading to a market that is evenly divided between Dexcom, Abbott Laboratories, and Medtronic. One smaller company, Senseonics Inc., is also producing a CGM system: the Eversense system.

While GlobalData predicts that smaller companies will have difficulty breaking into this market, given that it is currently dominated by three large players, the Eversense system is one of the most long-lasting of the available CGM systems (the implant lasts 90 days), which may give it a competitive advantage.

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Overall, given their ease of use and diagnostic advantages, GlobalData predicts that the vast majority of people with diabetes worldwide will use a CGM system by 2026. The huge and still-expanding pool of patients represents enormous market potential. Smaller companies looking to break into this market should examine ways to introduce improved technology into this space, to give themselves a competitive advantage over the incumbent players.