My name is Jayson Bedford. I cover the Medical Device sector here at Ray J. It's really our pleasure to have a longtime participant, Dexcom, present today. We have the company's CFO, Jereme Sylvain. We also have Matt Carey somewhere in the audience, who's a Manager of Investor Relations. So, with that, I'll pass it over to Jereme.
Thanks, Jayson, and thanks, everybody, for being here today. Let me start off with the exciting Safe Harbor statement. You guys can read this. I'll wait 10 minutes. I'm kidding. Let me start with just really about what this company is and what we do, and many of you follow the story, some of you that don't. This is an incredibly personal mission, really, to everybody in our organization. But it also becomes an incredibly personal mission to really a lot of those folks looking at our company. When you think about diabetes and continuous glucose monitoring, you can see the faces up there, the names, the faces of folks who ultimately are impacted, and there isn't somebody in this room that doesn't know somebody, isn't related to a friend, a coworker that's impacted by this disease.
And so all of us have our stories in the company, and it becomes really, really important for us to help address this issue. The issue here is around diabetes as an escalating health and economic crisis. And this isn't necessarily new news to anybody. There's obviously lots of therapies and things that have been made available over the years to help address it. But you can see over time that the prevalence of diabetes continues to grow across the world. There's many different reasons for it: diet, exercise, et cetera. But the reality is there's been a lot of therapies introduced. And while those therapies have helped curb the impact, the impact still continues to grow. And it's not just an economic and a health crisis that impacts individuals and quality of life. It certainly does that. But it also is breaking our system.
When you look at diabetes, there's 2.6 x, or 2.5x , the amount of expenses for those without. When you think about the system we have today, especially here in the U.S. with CMS, that's a massive burden. The demographics are shifting such that it's going to continue to grow. You can also look at more than one in four U.S. health care dollars are spent on folks with diabetes. When you think about that, there's about 25 million people, or about 10% of the population, covering about 26% of our dollars. It's got to change. The curve has to change over time. We believe we can be a product to do it. Let me just talk a little bit about some of the things we've done before we get into the details.
So this is a company that, while there's been these massive challenges, we've created and really pioneered the biosensing industry. There's a list of firsts that Dexcom has really taken on over the course of the years, with the first person to have hypo alerts, to go to the phone, to share, follow, single-digit MARD. And then some of the more recent ones, with the first CGM to go to an Apple Watch, the first CGM cleared in the U.S. without a prescription, our Stelo product, or the first CGM to integrate Gen AI into our sensing technology. And the list goes on. And we're going to talk about some more firsts we're doing over the course of time.
But I think that's one thing that's really important is we continue to pave the way technology-wise in this industry and expect to continue to do that for years and years to come. But we don't just do it on the technology space. We also do it in the key clinical research space. When you think about the coverage that's been attained over the course of time, we've run studies and studies and studies that have ultimately been the basis for reimbursement. It starts with DIAMOND and GOLD, two studies we ran years ago that paved the way for Type 1 and Type 2 intensive coverage. We also ran a MOBILE study. These are all RCTs that ultimately paved the way for coverage with basal coverage in the U.S. And why this is really important is we continue to make these investments.
W e're going to talk about more investments we've continued to make in this space later in the presentation, where not only from a technological, from a reimbursement perspective, we continue to pave and lead the way. And here's a little bit of the reason why. Many of you have seen these charts before. Our goal is to drive CGM to be the standard of care for all stages of insulin use and, quite frankly, beyond that. But let's just start with a case here. These are glucose traces. And so if anybody's worn our product, this might look a little bit familiar. You have target glucose ranges, areas that are healthy to be in long term. And the goal, of course, is to stay in the gray. If you stay in the gray, that's called time in range.
Time in range: the more time in range, the lower the issues of complications you have associated with diabetes. This is a real glucose graph of somebody that, prior to being put on a CGM, was on basal insulin, and this is what you see over the course of a 24-hour period. You can tell when the daily basal insulin shot was taken. You can see the glucose levels coming down, going into other various meals and lunch. This person spent a majority of their day out of range. Over the course of time, this person is going to have a significant increase in diabetes-related complications, whether it's issues, retinal issues, whether it's heart issues, whether it's amputation issues. There are a lot of things that staying at this level of glucose will cause.
If you look at the studies, folks that stay in these types of levels end up having much significant shorter lives than those that are able to maintain it. This is the exact same person, same medication regimen on a Dexcom CGM. You can see by just being aware of what was going on in the body, both what I ate, where my glucose levels were, my exercise, you can say this person stayed in range, really, for an entire day. What you find is these situations are littered throughout folks that use our products. We can see what happens when someone first jumps on a CGM and where they are over time. It's amazing to see the changes you can make in someone's life by just awareness. Many of these folks haven't even understood what these things will do.
By having access to this technology, you can see, you can work with your medications, you can work with your physicians. And so what we try to do is to take this inherent capability filled with firsts and align it with solutions that really address all of the pathologies associated with diabetes. And so you can see we have multiple different products here, all designed to address different areas, either economic or use case between G6s and G7s, Dexcom ONE and Stelo. But we're really addressing the entire swath of the customer base. So obviously, our predominant focus is those with diabetes. But as we move into more preventative care, you can see us addressing prediabetes and then obviously what we call preventative health or health and wellness. We can also use these technologies to optimize medication. We are connected to AID, or Automated Insulin Delivery systems.
Many of you will know the names Tandem, Pod, Beta Bionics, as well as some others. We're connected to which ultimately drives insulin delivery based on the CGM readings. But we're also connected to Pens. And as we ultimately get to smart dosing of insulin longer term, we're connected there. And we're also connected with glucose-lowering medications. When I say connected, we can track those and track the impact of glucose-lowering medications like GLP-1s and SGLT-2s to see when folks have taken that medication, how it impacted glucose levels and whether it's effective or not, and how to titrate up or down. We also have for safety and lifestyle. You can see hypoglycemia protection. That was our core that somebody who's taking insulin, we want to make sure we protect folks. But what's really important also is making sure we address hyperglycemia management.
This is your Type 2 individual that's impacted, that runs high for a significant period of time. Diet, activity, and lifestyle. It's really important to manage glucose levels. It helps add to longevity, weight loss. You'll see that over time. There are multiple studies coming out which show these types of effects. Where that always is interesting is we can unlock even more through managing this. We've talked a lot about all of the complications associated with diabetes. If you run high for a significant period of time, we'll look no further than this CINEMA. It was presented at ACC in 2024. What you can find is this was not a study for diabetes. This was actually a cardiovascular study. What they did is they tested CGM and the impacts on cardiovascular outcomes.
And what you saw was a loss in body mass index, obviously weight loss, reduction of cardiovascular disease, reduced cholesterol and triglycerides, and lowered blood pressure, all of this by putting on a CGM. The awareness of the impact on the body can be felt throughout, and as our journey to empower people to take control of our health, we know that where we sit today and where we're going, we can do more, and so it's a very exciting time for Dexcom. It's an area where we believe we're positioned rightly with the technology and the portfolio to address more than what you know us as today, which is a company who obviously is taking care of folks using insulin over the years. Now, to tell you where we're going, let's tell you where we've been.
To recap some of our 2024 performance, over the course of 2024, we delivered $4.033 billion. It was organic growth of 12% over the course of the year. Installed base grew 25%. We were serving 2.8 million-2.9 million customers globally. We expanded our commercial reach, and we'll talk a little bit about that further, where we made the investments in our commercial teams, both in the U.S. and internationally. We expanded our sales force to make sure we were positioned for future levers of growth. We'll talk about some exciting coverage wins that we were able to secure coming into 2025, which we were expecting to come over time. Some of those investments in the commercial foundation laid that, the capability to take advantage of it. It was a year of scale, an investment in scale.
So we submitted our G7 15-day CGM system to the FDA for review. For those not familiar with it, our current system is 10 days. And so obviously, having a 15-day system is less sensors needed to cover a population over the course of a month. We expanded our global manufacturing capacity. So we made investments in Malaysia in the past. Malaysia is now up and running, making millions and millions of sensors. And we also broke ground in Ireland, which will be our third or, as I say, fourth manufacturing facility over time. And we also delivered 100 basis points of operating leverage. And over the course of the past six years, we've delivered about 2,500 basis points of operating expense expansion. And that's building into the scale that we've built over the course of those years. And we launched some products.
Really important to know, we launched Dexcom ONE+. It's a product that's predominantly international at this point. It was really addressed to fit the needs of tenders. And Stelo, our over-the-counter product. Many of you may have trialed it at this point. Certainly, I would have suggested it's a wonderful product to help better understand how glucose impacts your day-to-day. And we completed 23 software updates over the course of the year. Years ago, we might have done one or two. And this just goes to support the expansion we've made in our software group. We're over half of our R&D is now spent on software. We're quickly moving to a software company to allow us to iterate. Now, all of this did not come with various challenges. I would love to say that all of this went incredibly smoothly last year and there were no challenges.
But we did have a few hiccups, part of this expansion. It was the right move to make. We did have some expansion. Part of our expansion, the sales force, we did have a few challenges. But we did so with this in mind, which is really thinking about 2025 and beyond. And so our guidance was really is $4.6 billion. We launched this about a month ago, which represents 14% growth. And you can see across the bottom there the margin impacts, both gross operating and EBITDA margin. And I think the really interesting thing here is you're starting to talk about a company that's spinning off a significant amount of cash as well as growth on the top line. At that adjusted EBITDA margin, you can see that's well over a billion dollars in EBITDA per year, which is an exciting time for us.
Obviously, that provides us a lot of opportunity and flexibility to both invest in the business and obviously to provide that to investors. As you think about the 2025 outlook, there's a few things we've thought about it. It's continued strong category momentum. I think that's the one thing you'll see is CGM is here to stay. It is replacing fingersticks. It already has replaced fingersticks in many ways, but the use cases as it goes well into beyond the classic fingerstick replacement is well known and continues to be better known and better covered. We do expect to see revenue and volume growth converging as the year progresses. This is important. We had a bit of a, I'd say, a mixed challenge last year, and I think those will start to get closer over the course of this year.
Our international business, we haven't spent a ton of time talking about it. We'll get into it in a little bit. This is a business that has basically reached $1 billion in revenue last year. So this is a very exciting business that continues to grow and do very well internationally. And it's something we'll continue to expand via access. We will advance Stelo. And we'll talk a little bit about that here in the future. Stelo is going to be a really interesting product as we go and address areas beyond our typical insulin management. And then we do expect to launch our 15-day product in the second half of 2025. So as soon as we have both the FDA coverage as well as the appropriate amount of insurance coverage, I'd expect to see us launching that and getting folks access to it.
So let's just talk about the market and where we are today and what the opportunities are. So this is the U.S. market. You can see the penetration rates down the right-hand side. There is a lot of opportunity in the core insulin-intensive market. We expect Type 1 and Type 2 insulin-intensive, the top two on here to get to 80% penetration. So still a good amount of room to go despite all the success in the industry. Type 2 basal, we expect to get to 60% penetration. So you can see we're in our infancy here and we have coverage really across this population. And Type 2 hypo risk, t his is the folks that have a hypoglycemic event that have Type 2 are covered in many cases and ultimately very, very low penetration there.
So these are the worlds that are covered today, over 4.5 million in the U.S. today who are covered and a long way to go in terms of category penetration there. But there's also a huge opportunity in future markets. We talked a little bit about Type 2 non-insulin, only 5% penetration in that market. And that's a 25-million-person market. Talk a little bit about prediabetes and focusing on Stelo and prediabetes, less than 1%, gestational, less than 1%. In hospital, we have 14 million issues per year in which very, very few folks are using it. Currently today, the measurement in the hospital is a fingerstick. Currently today in gestational, the answer is an oral glucose tolerance test after the second trimester. We can get ahead of these things and the technology today that can help address it in a meaningful way.
I bring that all up because we positioned our company in 2024 to take advantage of it. So we'll kind of harken back to 2023 and 2024 just to let you know we were planning for these types of expansions over the course of the year. So in 2023, you can see we had a large expansion in coverage. So 2023 is when basal coverage kicked in. So that's a massive opportunity for us. That's about 3 million people in the U.S. now covered with basal. We also launched G7 in 2023. And we can talk a little bit about that later. G7 really positions us across both Type 1 and Type 2. And we prepared for 2024's Stelo launch. And Stelo ultimately ended up launching here in August of 2024. So what did we do in 2024? We expanded our sales force by 40%.
And we positioned ourselves really to be a jump-off point to reach more general practitioners, primary care physicians to make sure that we were able to take advantage of this opportunity. And so in doing so, we changed sales territories. We certainly made the investment there. It was a little rocky. I think we'll admit that. We've talked about it in pretty good depth over the course of 2024. We are getting our feet underneath us. And as we can see here, the productivity is growing. I think that's the one thing that was really exciting to see. I was just at our national sales meeting. It's wonderful to see the sales force starting to hit their stride as they move into the year. We added over 50,000 new prescribers.
It's a massive expansion of reach when you think about, there's only about 250,000 primary care physicians in the United States. We were able to call on those and we were able to stabilize share in DME, and one of the great things as you think about productivity in this space is when you look at the amount of, and this is something we pay a lot of attention to, the amount of scripts written per physician. It started to stabilize and then grow despite adding all of these new prescribers, which means we're going deeper and deeper into accounts. We're basically showing folks that CGM can change their practice and you're starting to see that play out, so it's very exciting as we think about 2025. It indicates it was the right investment to make, and as we get to 2025, we're excited about it.
So why would we prep it? Well, certainly we were going to launch Stelo. So we knew we needed to get ahead of that. We knew we were going to launch. We knew we had coverage in basal. But we also knew that we're trying to get broader Type 2 coverage. Obviously, this is 25 million people. It's a big opportunity. And there's really four areas to really focus on evidence-wise in terms of preparing ourselves. We have to set clinical standards. We have to develop the real-world evidence to educate payers around what actually happens with CGM. We have to make sure there's economic outcomes and that those economic outcomes ultimately show we can take costs out of the systems. And then a randomized controlled trial. Certainly where there's a clinical requirement, we want to make sure that we have the appropriate clinical data to support it.
Let's talk about some progress made. In 2025, the ADA changed their standard for people with Type 2 users where they should use it. That is a big change. This is the type of evidence. It's B evidence around using CGM. That is a wonderful opportunity now that ADA has changed those standards. They're seeing the change in the market. Real-world evidence. We have multiple different studies out there. We use databases with various different parties to make sure we can take a look at what's taking place at the payer level, and what we see is a four-hour increase in time in range for folks that are using our product. You showed the graph before of somebody using basal who was out of range most of the day. Four-hour increase means you're in range 17% more time over the course of the day.
That's a meaningful reduction in long-term complications with diabetes. With economic outcomes, we've proven that we can reduce the cost of taking care of somebody through reduced hospitalizations and healthcare usage by about $500 a month. That's a big number of reductions. Certainly, it dwarfs the cost of our product and provides massive opportunities for healthcare savings. And lastly, we have launched an RCT for Type 2 non-insulin. We started it back in early 2024. We're completing enrollment right around now. And the six-month readout should be by the end of this year into early next year. So very exciting. This level of body of evidence should help us get that coverage for Type 2 over time. But there's good news associated with that. As of January 2025, two of the three largest PBMs actually already cover Dexcom CGM for remote diabetes.
This is a massive expansion opportunity for us in an area where we start to get to a point where we believe it's not an if, but a when Type 2 is covered across the entire population. And you can see here by the end of the year, we'll have commercial coverage for greater than five million people with Type 2 diabetes. And we'll be working on doing more than that. We'll be working on the third PBM. We'll be working on going deeper in non-formulary coverage within those two PBMs. And we'll certainly be working on CMS, which CMS covers about half of the 25 million folks. So a real opportunity. Coverage is building. And that's one of the other reasons we expanded the sales force. And the one thing we do know is Dexcom CGM has a very, very high utilization.
If you look across the board in utilization for folks that are on AID, it's greater than 90% utilization. It makes sense. It powers your pump. But what sometimes surprises folks is the amount of adherence as you move down through the acuity curve. For folks that are using mealtime insulin, 85%-90%, it makes total sense. You're using mealtime insulin. You have to monitor it. But basal insulin, we see people using 80%-85% of the time, almost the same. And I think the one that most folks probably didn't know is for those that Type 2 non-insulin, when there is coverage, we see utilization at 75%-80% of the time, almost full-time wear in that population.
So as we go further and further into this population, it's a real opportunity because CGM provides the value, provides value as you go through your day and understanding what happens. It provides value in educating you on medications and activities and sleep, and as time moves on, we'll be adding more value to the app, and I think we're excited about some of those software features we'll unveil over the coming weeks and months, which should be very exciting here. One thing we've added this year, which I think is also quite exciting, is Stelo, so Stelo is our first over-the-counter product in the U.S. And it's quick and easy e-commerce access. Today, it's on stelo.com. We'll talk about where you'll be able to find it here shortly in other areas. It's personalized software.
It's a really interesting technology where we're looking at personalizing your experience, helping you with your glucose levels. And it's 15-day wear already. We talked about a G7 product being 15-day. Stelo is already a 15-day product. And the label indication for this one is anyone not on insulin, not anyone with diabetes, anyone not on insulin. So this will go beyond diabetes. This will go to prediabetes. This will go to health and wellness. This will go to anybody above the age of 18 who's not on insulin. So it's a very exciting time for us as we launch Stelo. It was a big win for us. We were the first one to do it. And just a few updates. We launched, and this was as of the last time we spoke publicly, there were 140,000 + users since launch.
This is really scaled at the end of January. That's a lot over the course of a five, six-month period of adoption over that period. Really exciting. There was a lot of pent-up demand for this product. I think there continues to be a lot of demand as we bring it to more and more folks and the awareness that there is a product that is for them out there that doesn't require a script. We also know that a majority of customers have signed up for a subscription. I think one of the questions is always, how often are you going to use it? A majority of customers are signing up for subscriptions. The reorder rates and the utilization has been very solid. We've been very excited about that. There's been broad demand across all swaths of Type 2, prediabetes, and health and wellness.
I think that's really important. This product was really designed out of the gate to address Type 2, but we know there's interest as you move beyond. Because why wait till you're diagnosed? Why not take advantage of it much earlier? And so you're seeing these things, and I would expect to see these continue as we get into the course of the year because all of this was just on stelo.com. As you start to think about over time, we are selling now physician B2B. So if you think of your health and wellness centers, physicians are now able to put Stelo on the counter there and sell it in conjunction with other health and wellness remedies.
DME cross-selling, if you think of all of our durable medical equipment providers, they also offer other things like CPAPs and other types of products that generally have high levels of comorbidity rates associated with diabetes. And so those are now being rolled out over the course of the first quarter. And Life Time Fitness just announced they are going to have us as their official partner as we move forward in those gyms, as well as sold via their storefront. And Amazon is coming here in the very near future. And so it'll open up the aperture in which we can ultimately get ahead of folks in markets. So it's a real good opportunity for us to continue to push Stelo forward.
I think as you move forward, one of the questions is, well, what are we going to do once we have this data, once you have these glucose traces? I might not be on insulin. I don't need to measure daily because I'm not injecting a drug here. What could I do to help it? We've launched Gen AI into our product already, which is providing personalized weekly insights. And we're going to launch even more Gen AI into the product over time to help give you the so what. So what do I do with this data? How do I modify my life? And we also will unite multiple biomarkers on the platform. If you think about all of the areas with glucose, we've integrated Apple Health, Google Health Kits into the app itself.
We announced earlier this year, I should say late last year, our partnership with Oura Ring, where we can take things like sleep, nutrition will be embedded into our app over time, glucose levels, activity levels, stress levels, and integrate those all together to provide even more tailored insights, so it's a very exciting time. The more data markers we have, the more exciting opportunities we have to deliver customized outputs, so more and more of that to come over time, and I'd be remiss not to talk about our international opportunity. Certainly a large opportunity for us, one that I think makes a ton of sense to focus on. We will be entering into new geographies, going direct in markets per year, one to two markets per year and leveraging distributors. Again, I told you this business was a business that years ago was relatively small.
It's now up to $1 billion. It's a big chunk of our revenue going forward. And in doing so, we've got a tiered portfolio approach. G Series, we have Dexcom ONE, and we ultimately have tailored our go-to-market approach to match the reimbursement requirements in the various areas. And you can see examples here where there's one reimbursement, Germany, Japan, Canada, where you have tiered reimbursement, where you have tendered markets like the U.K., Italy, Spain, France. And then areas where there's limited reimbursement, Dexcom ONE's been a wonderful product out there. And the BELL countries are a good example where Bulgaria, Estonia, Latvia, Lithuania, where there was no coverage when we launched and shortly thereafter coverage ultimately came. The governments ultimately did so. And so you can see here where we're adding international access. We added four million people internationally over the past three years.
That's a huge market opportunity for us to go after. And that doesn't even include a lot of Type 2 intensive categories, which still continue to build. So we talked about the U.S. has coverage there in both basal. We're far behind that in international. We are starting to see some countries, though, catching up. Japan and France now cover basal. And so it's interesting. I think we'll expect to see Germany and others over the years. And we'll continue to build evidence and economic data to support broader coverage. So think about all the studies we're running. Think about how those will ultimately contribute to opening up access. That's a massive opportunity. And the more we can demonstrate the clinical outcomes and the economic outcomes, I think there's real opportunity here to continue to go deeper in these international markets. So it's a very exciting time outside the U.S.
We haven't even talked about the margin expansion. We talked about 2,500 basis points earlier. How are we doing it? You can see how our product platforms are all the same based on the G7 form factor. It provides a lot of opportunity for things around scale. Our systems, our machines, our capabilities ultimately can leverage systems that talk to each other, that use the same mold, that use the same subcontract manufacturers, and ultimately enable us to drive cost out of our product. We talked about getting to a $10 cost per sensor by the end of this year, and we're still on track to do so. You can see through that process, we're enhancing cash flow generation, leaning into Malaysia and Mesa. Some of you that followed the story, you know that we've actually exited San Diego.
San Diego is turning into a center of R&D excellence. It makes sense to have an R&D center of excellence near our headquarters. But the facility wasn't designed for high-throughput manufacturing. So we shut down manufacturing capabilities and moved to where it is. Again, we broke ground in Ireland. That'll be added to this one as well. These are fully automated platforms. And so you put it in, you set it, forget it, it runs through these machines. And so we're able to enhance and embrace scale. And obviously, getting to a 15-day sensor is paramount to our long-term capabilities here to drive additional cash flow and additional margin. We do expect in 2025 to generate $1.4 billion of adjusted EBITDA. So certainly, you can see these scale investments are really playing through in that cash flow generation.
It's a very exciting time for us in terms of margin expansion on the gross margin. We've been expanding on the operating margin now time for some years. Just briefly, what is next? You know, look, 15-day rollout in 2025. We're very excited about that. Look for software updates all of the time. You'll see that we'll update one, sometimes two a month across our various platforms, sometimes three. Keep an eye on them. These are going to be some significant opportunities. We are going to have key gestational and clinical gestational diabetes evidence coming out, which will help support addressing it. It's near and dear to my heart, given our family has some challenges associated with the testing process. I think having this in here will be wonderful. Then improved outcomes related to ketones and progression on diabetes users.
So we are working on dual analyte and making some progress on a continuous ketone device. So look for a lot more of that in 2025, in addition to the momentum as we enter the year. It's really exciting. There's a lot of runway for growth. We talked about coverage expansion. This is an opportunity where I think we've positioned ourselves incredibly well for 2025 and beyond, and we're looking forward to it. So that said, I think that's all for today. Any questions, Jayson? Be happy to answer.
Yeah, you know, you hit the 30-minute mark on the nose. So you're obviously scared of my softball questions. So I think we're going to take questions downstairs in the breakout. Thank you very much. Nice job, Jereme.
Thank you.