Thank you, Robbie, and thank you, everyone, for being here today. Our mission at Dexcom is very personal. Battling diabetes is personal. I would guarantee, even though we have overflow crowd here, every one of you has been affected somewhere, somehow, by somebody with diabetes. A child, a friend of a child, a parent, a grandparent, or even yourselves. I recently spoke at our town hall meeting, and I talked to a woman who I used in my speech. She's 43 years old. She's had diabetes since she was three. And she told me the incredible impact Dexcom's had in her life. But then she finished with, "But I'm legally blind, and I would be so much better if I'd had this technology forever." And we think this only applies, this personal touch only applies to people who are on insulin, but it doesn't.
When we had our Stelo launch celebration, and I spoke with everybody, every one of our spokespeople, I spoke with one individual, a pretty large guy. I said, "So tell me," and I asked all the spokespeople this, "Tell me about your experience." He said, "I've learned more on two weeks with Stelo than all the years I've seen my doctor with Type 2 diabetes. I would be so much better if I'd had this." Diabetes is a problem that's not going away. As you can see by the numbers on this slide, over the years depicted, the incidence of diabetes is going to increase by 30%. We know it costs two and a half times more to take care of somebody with diabetes than somebody without it.
In an environment where we talk continually about the increasing costs of health care, $1 and $4 is actually spent on taking care of people with diabetes. Led by several Dexcom advances in technology, in adoption, and access, we believe CGM can play a critical role in these cost savings going forward. You know, nearly every advance in the CGM industry over the past 15 years has been led by Dexcom. First of all, accuracy and performance. We gave people a number they could rely on to make decisions and improve their health. We then realized to make this be bigger, we had to connect it and move it to different platforms and give people more choices to what they were going to do. And over time, with the tools that are being developed in AI, you can see us moving in that direction as well.
But our innovation hasn't been limited just to technology. While these have been the foundation of our growth, we've had an incredible clinical vision as well. Take a look at these three key studies. When I started at Dexcom, if you asked a physician, "Who would you give CGM to?" I'd get one of two answers. One of them was, "I won't give it to anybody because it's not paid for." The second answer was, "I'll only give it to somebody on an insulin pump because they're the only ones who care." The GOLD and DIAMOND studies opened the door for people on multiple daily injections to have access to CGM. These groundbreaking studies showed people had A1C reduction, increased time in range, and overall felt incredibly much better about their health care. That led to expansion. Then go to the MOBILE study. This was our study in basal insulin.
Put these patients on CGM. You saw a 1.1 point reduction in A1C for these people over the course of the study. And the A1C reduction was sustainable by keeping these people on CGM after the study. With outcomes like this, it's no wonder that CGM has become the standard of care for people who are using insulin. So let's take a look at what happens in a day of somebody with diabetes who's on basal insulin. These glucose tracings at the top of the screen show what this person's life is like. As you can see, their average glucose is really high. In fact, that would extrapolate to an A1C probably above 12. The person spent very little time in the healthy range and much, much time in an extremely high hyperglycemic range. This person's going to experience the horrible complications of diabetes. There's no question about it.
Heart attack, kidney failure, amputations. You can pick which ones they're going to experience. Let's see what happens with this patient, again, a basal insulin patient on several medications. Let's see what happens after a year on CGM. Look at that Time in Range. That's an average of 109. That A1C would extrapolate to something around 6. If we were a pharmaceutical and could lower A1Cs from 12- 6, you guys would be running out of here buying the stock now. This is what CGM does. It gives people the ability to make decisions in their health regarding lifestyle choices, nutrition choices, activity choices, and most importantly, the ability to determine how effective those medications are. We are committed to creating a standard of care for Type 2 diabetes. I'll get to more of that in the presentation.
We have offered customized solutions for our customers to build on this standard of care, to give them solutions that match their individual needs. For a long time, connectivity has been our platform. The best way to improve health care for health care providers and for people is to give people a solution which leads to personalized engagement in health care decisions, and our connectivity has done that. Take a look at our insulin management platforms. We offer people several different opportunities for insulin delivery solutions. We also give them several platforms where they can view that data, and we've offered solutions to their caregivers and their providers, so the entire team is empowered. This platform and this data we've built isn't limited just to insulin management. We firmly believe that with our real-time data, we can connect behavior and lifestyle decisions to glucose changes.
On top of that, we believe we can make that very easy for people to understand with our software platforms. While we've achieved a number of wonderful accomplishments with glucose management and A1C reduction, we truly believe that this data can have an effect on all metabolic markers that are affected by blood sugars. Take a look at this study called CINEMA. This was done by a cardiovascular group, not by a bunch of endocrinologists like we usually have our studies done with. They saw outcomes in Type 2 diabetes patients who were on CGM that certainly reduced A1Cs and increased time in range, but also saw a reduction in BMI, a reduction in risk of cardiovascular disease, cholesterol, triglycerides, blood pressure. Everything across the board improved because of CGM. CGM unlocks better health care. We can do more.
We can do more across this healthcare spectrum to make people more healthy and achieve better outcomes and reduce costs in the system. And while we're very excited about our opportunity, it's very important we take a bit of a look at the current state of our business and how things are going today. As we announced today for 2024, our revenues came in, growing about 12% for the year organically, just over $4 billion for the year. US organic growth is 10%. OUS growth was 17%. Our user base has increased by 25% over the course of the year to between 2.8 and 2.9 million users. We accomplished a lot of things operationally as well. We went through the largest commercial expansion in the U.S. in our history. Our Malaysia plant is now up and running full scale. We've had a lot go on.
We've had two product launches. We had multiple updates of our software app. And just to give you an example, in the past with G6, we might update it once or twice a year. We had over 20 software upgrades in 2024, and plus our new product launches, our Dexcom ONE+ and the Stelo launch. Many good things happened in 2024 for us. At the same time, when you're our size and you attempt that many things, sometimes things can get a little choppy. And they did. But as we see, as our quarter ended in 2024, as we've seen our progress over the last six months, we're very excited for our 2025 opportunity. Our guidance for 2025 is $4.6 billion, total revenue growth of 14% for the year. In the U.S., we plan to grow in all of our core markets.
As we get near the end of the year in the U.S. markets, we see our volume and our revenue number growth converging to whereby that's a little more predictable for everybody. We'll have Stelo for the entire year, and we're also planning on a 15-day product launch over the second half of the year that could be a slight growth catalyst for us going forward. With respect to the OUS business, we'll see continued expansion of our G-series product, Dexcom ONE+ launched in some new countries, but also growing into the tenders of the countries where it's already been accepted. That will enable us to continue to take market share in all the core U.S. markets where we perform.
Our margin performance for the year, 64%- 65%, will be driven by continued maturation of our operating facilities and also to a large extent by volumes and the fact that we will not have the shift in distribution channels in the U.S. that we experienced in 2024. Add all that together, we expect to have increased operating margins with a lot of the gross margins going down to the bottom line, even though our investments in 2024 are going to go through the entire year of 2025. So we expect a very good year. That growth is still going to be driven by the U.S. You know, many people believe that everybody who's on intensive insulin therapy automatically has a CGM, or anybody on insulin has a CGM.
But the fact is, as you look at intensive insulin management between Type 2 intensive insulin and Type 1 patients, only 55% of that population is using CGM right now. And we add the basal opportunity to that. There are 4.5 million people in the U.S. who are not on CGM, who are on insulin therapy. That's more than who use CGM today. This is a huge market opportunity for us. Our core business remains strong and remains a strong market for future growth. But we have other big markets to go after as well. Take a look at the Type 2 non-insulin users, pre-diabetes, gestational diabetes, health and wellness, and metabolic health. These markets are an incredibly large opportunity for us, and we believe that we can make a big effect in these markets going forward. You know, we position Dexcom very well for our next wave of growth.
As you take a look at what we've done in 2023 and what we've experienced in 2023 and 2024, it puts us in a very good place. 2023 coverage for Dexcom CGM in the insulin world expanded more than any other time in our history. It was a massive expansion. Then in 2023, we launched our G7 product, which is a much better user experience than what we had before with G6. And we knew that that opportunity was going to scale as we got things up and running in 2024 as well. On top of that, we knew the Stelo launch was coming and was going to be an opportunity for type 2 diabetes, pre-diabetes, and metabolic health.
As we looked at that situation in late 2023 and early 2024, we came to the conclusion we didn't have the resources in the field to address these new markets that we were going to go after. Quite simply, Dexcom can't win in physician offices where we don't have a presence. It's pretty tough. So we made the decision to expand the commercialization organization by 40% so we could go after these opportunities. It was a little choppy in the beginning, but that organization is now performing the way that we envisioned that it would when we started back in the day. We added 50,000 new prescribers in 2024. It's a lot of new prescribers. We've asked the team now not to go chase a whole bunch of new prescribers, but let's go deeper within that base.
What we're seeing is the prescriptions per doctor has now bounced back up from where they were in the second quarter. We also saw a significant increase in our new patient growth. After we got through the second quarter, both Q3 and Q4 were record new patients numbers for us in the U.S. with this new sales organization. We also paid a little more attention to our distribution channels, stabilizing our DME relationships at the corporate level, but also after we got all the sales territories ironed out, we were able to get those relationships rep to rep reestablished or at least going in the right direction. We needed a commercial infrastructure this size to be able to go after the Type 2 opportunity that we see coming in the future.
We are fully committed, fully committed to getting insurance for those with type 2 diabetes who are not on insulin, the 25 million people in the U.S. who are afflicted with this condition. You know, I talked earlier about Dexcom's clinical vision and how we've been instrumental in driving coverage in the insulin-using world. There are four key pillars to getting coverage for these devices in these markets. The first one are clinical standards. When the medical community gets on board, people start to listen. The second is real-world evidence. You have to have a cachet of real-world evidence that shows that these products provide a better outcome than what people are using now. Third, we have to prove that this does not cost the system more money than what we're doing today.
Finally, a real-time real-world clinical study, randomized clinical trial, like I showed earlier in these Diamond, Gold, and Mobile studies, really kind of seals the deal when you can demonstrate all these things scientifically. Evidence is building rapidly in this case for broader Type 2 coverage. Recently, the ADA expanded their guidance for people with Type 2 diabetes not on insulin who are using other drugs to manage and lower glucose, saying CGM therapy should be considered for these people. Big upgrade from where evidence was before. We've been talking about real-world evidence for Type 2 for a long time. The study I'm referring to here is one that was presented at ADA last year. It was so well done, it was in their big press coverage. This is one of the excellent studies that we have.
These patients experienced a four-hour reduction in Time in Range using CGM. On the economic side, again, we've talked about studies with UnitedHealthcare and Intermountain Health, our own studies over the years. This study I'm referring to here is one that was put together by several of the thought leaders in the diabetes world. 75,000 patients out of the Optum database, all sorts of Type 2 diabetes, and guess what? Lower cost for every one of them who's using CGM, reducing the cost of medications, physician visits, lab tests, everything across the board, and it's also important to note that the outcomes in both these studies for the Type 2 non-intensive patients were actually better than those using basal insulin, had better Time in Range increases, better A1C reductions. As far as the randomized clinical study, I'm pleased to announce we started one. We started in 2024.
Last patients will be enrolled in 2025. We're very optimistic that we'll have data that will pull all these facts together and position us to get where we need to be in Type 2 non-intensive insulin therapy. But you know what? The world has started to notice. In recognition of the outcomes we've been talking about for years and people are seeing, we're happy to announce today that two of the three largest PBMs cover CGM. They cover it and they'll pay for it. This is going to give us access to 5 million more people over the course of the year, 5 million more people with Type 2 diabetes. We're very excited to go after that. Coverage means a lot in our world. What it truly means is utilization and retention increase.
When people get a product that is reimbursed and paid for, they stay on it and they use it. And that's what we've experienced across all the diabetes states up to this point in time when we don't expect it to become any different over time. I'd like to point out our retention rates are much higher than anybody else in this industry. Once patients go on Dexcom technology, which they love, they continue to use it. We also know with this new coverage, we're going to have to migrate some of our Stelo features over to G7 and vice versa because if G7 is covered, our Type 2 patients are going to use that. We need to incorporate those Stelo features into that product. Which brings me to Stelo. What a big accomplishment for our company this year.
It's available over the counter and there's so many different things with Stelo than what we've done in the past. It's a completely different distribution strategy than we've had before. It appeals to a new patient group, the Type 2 non-insulin group, pre-diabetes, health and wellness, the group across the board. It has a new software app. It's our first 15-day product. As I said from the beginning with this launch, our key objective here was to learn more than anything else. We wanted to learn what we needed to do in this market. And we learned a whole bunch. The first thing we learned is we got 140,000 new users. The majority of the customers signed up for subscriptions. They came from all three segments we targeted: health and wellness, Type 2 non-insulin, pre-diabetes.
It started very quickly in health and wellness, but then has migrated to the other two over the course of the year. There's a fourth group I'd call out and thank you all. That would be the investor group. I've seen many of you with Stelos and you've done very well. We've had solid reorder rates from our subscription model so far, and we achieved $22 million in revenue with Stelo from its launch through the end of the year. It provides us a great base going forward into 2025 and we have a lot of great advancements planned for Stelo. The first one is increasing distribution. We've talked about this before, but these things have come into place. We now have an infrastructure whereby we can sell direct business to business to clinics and physicians.
We also have signed contracts with several of our key DME distributors for them to offer Stelo to their Type 2 patient bases. We are now the official biosensor of Life Time. We'll co-market with them and eventually have that as a distribution channel. And I'm also very happy to announce that we're about to expand our Amazon relationship and Stelo will be available directly in the Amazon marketplace. Stelo.com, your physician, Amazon.com. We are expanding this distribution channel rapidly. Those aren't the only advancements we have planned. We heard loud and clear from people that we need more activity data and more glucose data. We need nutrition data added to this app. We have many advances planned for 2025.
We also are the first product ever to include AI in a software package for diabetes management, and we are going to have a whole bunch of AI additions added to this in the future. One of the things we've learned from our diabetes business in the past that we will apply to Stelo is the simple fact that we can't do it all alone. We'll make our Stelo data available to platforms where we can put more biomarkers together, taking data from others and putting in ours, providing Stelo data to them. We're absolutely thrilled with our recent announcement of our Oura Ring relationship, whereby we'll be putting Stelo data into the Oura Ring app and eventually take Oura data over to Stelo as a partnership opportunity. And we look forward to that going forward.
So with our increased access, our expanded salesforce, our new products coming, our Stelo launch, you can see why we're excited about our U.S. opportunity for 2025 and going forward. But the same applies to international opportunities. We grew 17% internationally last year, faster than our U.S. rate. We'll enter new geographies, and we've had a very calculated plan going direct into one or two key geographies every year. Some geographies, it doesn't make any sense to go direct because our distributors can do that better than we can. And we have good relationships with those distributors, and we do very well. We've addressed these international markets in particular with a different product strategy than we have in the United States, and that's our product portfolio because reimbursement and access is simply different in these countries.
In countries where reimbursement is broad and well-known and taken care of, we distribute only our G-series product. In many countries, it's a two-tiered strategy where you have to have a lower-priced product and a higher-priced product for automated insulin delivery. Hence, we have our Dexcom ONE product and our G-series product that we market and sell in those countries. And finally, in areas where CGM isn't reimbursed, we sell the product online for cash pay. And what we've seen with this expansion strategy we have on our multiple product offerings, that once countries and reimbursement authorities understand how good the Dexcom product and experience is, reimbursement follows not very long after that. It happens very quickly. One of the things that we're very proud of over the past several years is the international access expansion that we've experienced.
We've added more than 4 million new lives covered by Dexcom CGM over the last three years. 4 million lives. And again, as I've said earlier, when access starts and reimbursement starts, growth and revenue follows. There are still many areas where the G-series isn't covered. There are many areas where Type 2 coverage is lagging way behind, and there's only two countries in the world that cover all basal use. Our access efforts lead to a wonderful growth opportunity for us in the future with respect to these international markets, and we expect to execute on that. Well, if you're going to grow that much, you've got to be able to scale. And we did a lot to enhance our cash flow in 2025.
We were able to get 100 basis points in operating leverage, even with all the growth and all the things that we got done over the course of the year. We now have very, very high throughput automated manufacturing facilities in Malaysia and Mesa that can do all the capacity we need to for this expanded access and the Stelo launch that we have planned. These lines are fully automated. We also shut down our San Diego manufacturing facility for manufacturing, but we turned it to an R&D center of excellence. That's going to enable new product development to go much faster because these scientists will have dedicated manufacturing facilities where they can go build all the stuff that I wear that none of you guys get access to.
We expect to be able to generate $1.4 billion of Adjusted EBITDA in 2025, even with all these scaling activities and all this expansion going on. We're very optimistic about our financial profile for next year. So what's next? What should you be looking for in 2025? Let's start with the 15-day rollout. That product's been filed with the FDA. It's under review. We expect to launch it in the second half of the year. This is a key milestone for us. Over the next one and a half to two and a half years, we expect all our platforms to move over to 15 days. That's an incredible margin and expansion opportunity and something that our patients want. We're seeing very good 15-day results with Stelo so far. We have many software enhancements planned for the year.
One of the key ones is going to be an update of our Follow, which we really haven't updated for a long time. But you can see by the Stelo app and the other things we've done, we're in good shape on the software side. There are going to be numerous clinical publications that advance these new areas for us over the course of 2025. Watch for Type 2 non-insulin publications, gestational diabetes publications, health and wellness, and related comorbidities with diabetes publication, which will drive coverage. And our product pipeline has never been more robust than it is now. There are actually individuals wearing the G8 wearable right now. It has much more powerful electronics, can handle multi-analyte sensors.
We have several new sensor probes in the R&D pipeline too, all of which have extended lives, can lower costs, and some of which can measure two to three things at the same time. We've never had a better product portfolio than we have now and never had better capabilities to bring it forward. I say every year, I'm wildly excited about Dexcom's future opportunities, and that has not changed. We're in a great position. Thank you for being here.
Lots to talk about there. Maybe we could start with fourth quarter. You put up, I believe it was a $17 million beat versus the street, end of the year above the range you provided. Any color you could talk about in fourth quarter about maybe some of the important trends that happened through the year, whether it was DME or pharmacy and the relationships there?
Sure, yeah. So it was a record new patient quarter. So really important, ultimately, as we think about going forward, reestablishing the momentum. We would have expected that given the salesforce. And so I think what you're seeing is a few key things. One, the DME channel is stable. We had a bit of a hiccup there. It's stable. I think we're really trying to demonstrate and work with our DME partners, as we should, and making sure that leads are going to the right places and taking advantage of those opportunities. We continue to do well on the other channels as well. As you can see, even before type 2 coverage, which is obviously a big catalyst for next year across two of the three PBMs, we're doing really well around penetration.
And so as you think about all of the categories, including basal, you are seeing some good penetration across the board there. And then I think the other part you're seeing is the salesforce effectiveness. We talked about expanding all of those prescribers. What generally happens is the amount of scripts per prescriber go down as you expand. It's classic math. But what we've seen is as we've added prescribers, our prescriptions per prescriber have remained the same, which means we're going deeper into all of those categories as we've established those relationships. So we were about 90 days behind. What we did expect as part of that salesforce. It's played out as expected, and I think you're starting to see that play through the numbers.
You added about 300,000 patients in the second half of the year versus the update you gave in Q2. I just want to make sure that doesn't include the Stelo number, right?
Correct. No, it doesn't.
Yeah, that's a really impressive fourth quarter there. Maybe we could talk about that Type 2. There's a couple updates there. There's the commercial plan coverage, and there's also the announcement of a trial for the first time. So maybe talk about the conviction that these payers had and why you feel like they did it now and who that trial is really targeting, and then when we might see that data and potential updates.
The study finishes enrolling in 2025. Read-outs on that study wouldn't, at the earliest, would be in late 2025 for the first six months, more likely into 2026. We're targeting Type 2 patients across the board, including those on GLP-1s. We're not being bashful about this study. We know that we drive better outcomes when people have that information, and we're very cautiously optimistic that we'll get the data that we're looking for. In all fairness, when we started the Diamond study, when we started the Mobile study, there were a lot of doctors who looked at us and asked us, "What are you guys doing?" Well, the outcomes bore out. We think the outcomes for this study will demonstrate the same thing. We're targeting a very broad Type 2 audience.
Yeah, and then in terms of the commercial payers and what they saw, I mean, I think what they're seeing is some of the economic data that's already been presented at many of these conferences, along with really a growing groundswell for those folks that are impacted with diabetes, with access to technology. And so when you sit in front of a payer and you can say, "Look, your employers that sign up for your insurance want it. The patients across the United States really want it as well. And by the way, we can lower your costs in year one." That resonates. And I think you're seeing that resonate across two of the three. We've got one more to go, but we'll keep working on those.
Maybe we could touch on the 15-day. You submitted that. I think the announcement was at some time before the third quarter earnings call. So typically a 90-day approval window. We should get that sometime in the beginning of 2025. What's the, I guess, the gap from approval to launch? And I remember with G6, it took a couple months to get a lot of the insurance plans on formulary. Is it more just you want to wait until you have critical mass until going out?
Yeah. And again, we can't comment when and if FDA is going to approve things. Our G7 approval took longer than we had planned. We think the 15-day date is very strong, and we're in discussions with the FDA right now. But we're confident we'll be in a position in the second half to launch this. We're committing to that date because we also have learned over time that rushing to launch isn't a good plan. We need to have a plan with insurance coverage, but also that access with our DME distributors as well. This is a wonderful opportunity to get a product to them also and enhance their businesses. So just let us see where the FDA is, get approval. We'll give you more details on that launch afterwards. But we got to remember when we launch, it's still not connected to all our pump partners.
So there's time before this goes through the entire system and becomes our main product offering. So that's why we said second half. And I said there can be a revenue boost and a growth catalyst, but it still won't be the primary product in our business until you get later into 2026.
It is really important, more in Jereme's world, as you move down the P&L since you're scaling a 15-day sensor over basically the same cost base of a 10-day sensor. So how should we think about how that flows through in gross margins and operating margins in 2025? And then I know it's a multi-year process to get integrated with your pump partners, get outside the U.S., etc. How do we think about how long it might be before we ultimately see it fully integrated in the P&L?
Sure. I think when you think about the 2025 numbers, it's relatively minimal because as you're launching this, remember, it's a recurring revenue business. And so as you bring folks on, you're still weaning them off of their existing products. So those 64%-65% margin guidance has a relatively small amount. If we can go faster, great. So you really start to see it more play out in 2026. The benefits you see in 2025 are actually all of the scale that we've built. We talked a little bit about it earlier, shutting down our San Diego factory, turning it into a center of excellence for R&D. Wonderful for R&D, but it also moves all of our lines to the high throughput lines that you're seeing both in Mesa and Malaysia. So the margins you're seeing now are purely on that.
You'll see it play out even more, I would say, in 2026 and beyond.
Great. There was a one-time issue with gross margin in fourth quarter. Is that now fully resolved as we move into 2025?
Yeah, majority of it was spoilage and shipment. So it sat on the docks too long. So those are one of those classic things that will be covered via reimbursement insurance. It'll take some time. So I think we'll work through that. There's a little piece of it related to new suppliers as we bring them on. We're still working through those. That's a smaller piece of it, though. So we'll navigate through those. We don't expect those to have a significant impact, but we will work through those this quarter. You saw a little bit of it in the 3Q as well. Pretty common for us as we bring on new suppliers. You just don't get the same throughput as you did for existing ones. So we're going to have to burn through that over the coming weeks.
But I would not expect that to be a material impact on the full year of 2025.
Great. Kevin, maybe I could circle back. I know you put a ton of personal time and effort and focus into DME relationships in 2024. How do you feel about that aspect of the business going into 2025?
I feel we're in a much better position. My calls with the DME and all of our efforts internally with the DME folks range from, "Thanks, you finally called," to, "We didn't know there was a problem." But there is, and we need to win in that channel. And what we have learned is we need to be channel neutral in the field more than anything else to offer physicians and our sales reps and the payers and the other customers within our chain multiple options to get the product. The perception is that we were not, and we will, and we can do that going forward. And we think we're in a much better spot than we were before.
What about Stelo? If I can envision a world in a couple of years from now where you have insurance coverage for your 15-day G series for non-intensive Type 2s, how does Stelo fit in the picture? And is this, in your view, maybe just a temporary product, or is this a long-term durable product?
No, I think it's a long-term durable product. I think what happens over time is Stelo becomes more of something that is for prediabetes and the metabolic health journey as we get coverage for Type 2 people that are not on insulin, and we can offer features and add things to that that, in essence, get into the healthcare journey earlier. Now, if we see outcomes data over time with Stelo use too, whereby we delay prediabetes from becoming diabetes for a number of years or things like that, but we're going to be very methodical here. We need reimbursement for the Type 2 non-intensive patient sooner rather than later. That's a big population with an unmet medical need that is growing dramatically, and it's a silent killer, so that's where we're going to go first.
We'll then take the Stelo feature, still include the type 2 features in it, because quite candidly, everybody's not going to have coverage to begin with. And our reps, as they've gone into offices by having Stelo with the primary care physicians, what has happened, it leads to conversations. And conversations where the doctor will say, "Well, wait a minute, I've got this person, and we'll find that person may have type 2 coverage." And now we've got a reimbursed patient who that doctor wouldn't have spoken with us about before because we didn't have a product offering that that healthcare provider thought the individual could get or could afford. So Stelo's become a big part of the overall general sales cycle and our call patterns and our educational patterns.
The other thing it'll do will give us the opportunity to incorporate, again, I talked about nutrition information, more activity information, bringing other biomarkers in. We can do that in a health and wellness environment, and as we learn, we can migrate that stuff over to the insulin management system and vice versa. I think it's something that's going to be here forever. The question is, what markets are we going to address and who's going to use it, but it's not going to go away.
I appreciate the great charts in terms of the different addressable markets and the penetration rates. It's really helpful. I would imagine if you put up the biggest unpenetrated population, though, it's outside the U.S. patients. So it's an area where generally U.S.-centric here, but it's the largest addressable market that isn't using CGM right now. What are some of the near-term opportunities, whether it's better reimbursement or new markets you're entering that we can look forward to for CGM outside the U.S.?
Yeah, so certainly in, I'll call it what we call the enormous nine, the biggest nine markets, it's going deeper into those markets, and so in a lot of cases, while type 1 penetration outside the U.S. is growing quite nice, the type 2 intensive is still quite low, and then as you move into basal, it's almost nonexistent. You have two countries that really cover it en masse, France and Japan, opportunities to go all the way down there, and so in those markets, we're going to go deeper in terms of where those coverage items exist. As it comes to new countries and expansion, I think Kevin alluded to it a little bit earlier. While these don't move the needle as much, there's a lot of countries that don't even have type 1 coverage and certainly don't have type 2 intensive coverage.
And as we go in with products like Dexcom ONE, we found that coverage has come there as well. So I think there's a lot of markets we're not in. You can think of, if you saw that grid up there, you'll see there's some countries with large populations, heavy exposure to diabetes. We are not in. We will be targeting those for expansion. But make no mistake, in the existing markets, going deeper, still a ton of room. You're 100% right.
Yeah. Just about out of time, but I wanted to ask one question here. In the U.S. and pretty much outside the U.S., it's been a two-player market. You have huge barriers to entry, manufacturing being just one of them. How do you feel about Dexcom's position over the long run as it relates to competition?
You know, several years ago, I would have told you the only major barrier was technology because really nobody else could do what we were doing. I think now with the scale of this industry, our manufacturing and the scale of things we've invested in over the past several years create a huge barrier. If you can't make these things at scale at a low cost and make them consistently, it's difficult, and I think that really puts us in a very good position. There will be more products over time. I'm not sure where they'll come from. I mean, there's certainly more in Europe from Asian manufacturers than there are in the U.S., but in the U.S., the other barrier, and it's an important one, these things have to work. iCGM standards are hard. They're very difficult.
Even Stelo had to meet iCGM standards because the agency's view on this is somebody with insulin is going to buy it and use it anyway. I think the scale and the performance barriers are really important. I think those are the places where we'll focus. We'll continue to scale, continue to cut costs out of the product, at the same time improving performance. If we do that, we'll be fine.
Great. Well, we're out of time. Thank you very much for joining. Thanks, everybody, for attending.
Thanks for having us.
Thank you.
Thank you.