Earnings Labs

Tandem Diabetes Care, Inc. (TNDM)

Q1 2021 Earnings Call· Wed, May 5, 2021

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Transcript

Operator

Operator

Good day and thank you for standing by, and welcome to the Q1 Tandem Diabetes Care 2021 Earnings call. At this time all participants are in a listen-only mode. After the speaker’s presentation there will be a question-and-answer session. [Operator Instructions] I would now like to introduce your host for this conference call, Susan Morrison

Susan Morrison

Analyst

Thank you. Good afternoon, everyone, and thanks for joining Tandem's first quarter earnings call for 2021. Today's discussion will include forward-looking statements. These statements reflect management's expectations about future events, product development timelines, and financial performance and operating plans, and speak only as of today's date. There are risks and uncertainties that could cause actual results to differ materially from those anticipated, or projected in our forward-looking statements. A list of factors that could cause actual results to be materially different from those expressed or implied by any of these forward-looking statements is highlighted in our press release issued earlier today, and under the Risk Factors portion and elsewhere in our most recent annual report on Form 10-K, quarterly report on Form 10-Q and in our other SEC filings. We assume no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or other factors. In addition, today's discussion will include references to adjusted EBITDA, which is a non-GAAP financial measure. Adjusted EBITDA is a key measure used by us to evaluate operating performance, generate operating plans, and make strategic decisions for the allocation of capital. Please refer to our press release issued earlier today for further information. Our call today will be hosted by John Sheridan, our President and Chief Executive Officer; and Leigh Vosseller, Executive Vice President and Chief Financial Officer. Following our prepared remarks, we'll open up the call for questions. Thank you in advance for only asking one question and one follow-up before getting back into the queue. I'll now turn the call over to John.

John Sheridan

Analyst

Thanks, Susan, and welcome everyone to today's call. 2021 is off to an incredible start with record first quarter sales and meaningful operational progress throughout our business. I am proud of our performance and Tandem's ability to continue delivering record-breaking results while improving the lives of people with diabetes. Credit for these accomplishments goes to our more than 1,500 employees, as well as our valued partners and suppliers. Thank you everyone for continuing to provide our customers with a positively different experience with Tandem, even while operating under constraints of the COVID-19 pandemic. Looking back, we are in the strongest position in our company's history. With world-class products and services, operational excellence, a differentiated product pipeline and robust balance sheet. The number of people using the t:slim X2 has nearly quadrupled over the past three years and we are now in more than 20 countries around the world. Tandem has moved from being a comeback story to being a leader in diabetes technology. We have a line of sight to achieving our longer-term goals. And as we demonstrated once again in the first quarter, we are – executing. In today's prepared remarks, we are going to concentrate on the highlights and updates from the quarter so there is ample Q&A time to expand on the topics that are most important to you. Starting with our top drivers of pump adoption in Q1, we were particularly happy to see the increasing international demand for our t:slim X2 pump and continued high interest in our Control-IQ technology. The strength of our performance outside the United States is a reflection of our offering a best-in-class product in a large and underpenetrated market. As a reminder, there are approximately four million people living with Type 1 diabetes, in the countries that we are in…

Leigh Vosseller

Analyst

Thank you John and good afternoon everyone. Overall, our financial performance in the first quarter was strong, with progress made across the key fundamental areas of our business. Highlights include our sales growth both domestically and internationally, the increasing contribution of reoccurring pump renewal purchases and supply sales, gross margin improvement even with continued investments, a 12-point improvement in operating loss and ending the quarter with the strongest balance sheet in our company's history. To add some color on each of these areas, starting with sales, the first quarter was record-setting for us once again. We achieved $141 million in worldwide sales, which is a 44% increase compared to last year. As a reminder, we provide details of our sales results by both geography and product in the Investors section of our website under events and presentation. Overall, our worldwide pump shipments exceeded 25,000 in the quarter with a record number of pumps to international markets. This is our second highest sales quarter ever only second to our most recent fourth quarter, which benefited from the traditional end of year seasonality. While we continue to feel pressure on our sales from the pandemic, it has been largely offset by high demand for the t:slim X2 momentum which is just beginning in the international market. The breakout of where our sales come from is beginning to look very different compared to historical years. In the first quarter nearly half of our worldwide sales were from reoccurring sources of revenue, which includes our scaling renewal pump sales to repeat customers as well as the ongoing sale of supplies to our installed base of nearly 240,000 customers. In addition, international sales now contribute meaningfully to the business and we anticipate that international will represent approximately 20% of our total sales this year. Turning…

Operator

Operator

[Operator Instructions] Our first question comes from Steven Lichtman with Oppenheimer.

Steven Lichtman

Analyst

Thank you. Hi, guys. So, just a first question on international, great to hear the progress there. I was wondering, if can you provide any color on how trends have changed and I assume accelerated as you've launched Control-IQ in various countries, particularly with a couple of other countries you mentioned expecting to come online with Control-IQ later this year?

Leigh Vosseller

Analyst

Hi, Steve. Thanks for the question. It's really interesting as you think about it we're just at the beginning of the Control-IQ rollout. In fact, we haven't even launched it yet in France and Germany, which are our two largest markets and we're seeing great strength already without it. I think what we're seeing in the US with Control-IQ and the momentum that's driving is an indicator of what we can expect to see in the OUS markets. For now, I don't think we have a great trend in terms of what's happening there. There's been a lot of variability in ordering patterns from the distributors just based on the dynamics that they're fighting with the changing COVID environment. But it is encouraging to think about how this might translate into the long-term growth for us.

Steven Lichtman

Analyst

Great. Thanks. And then John, you talked about Type 2 and you're increasingly talking about Type 2. I was wondering, if you could frame for us sort of where you guys are at overall? You talked about seeking an approval for Control-IQ. You made the investment during the quarter in CeQur. Can you sort of just update us your thoughts overall on where Tandem is on approaching the Type 2 market?

John Sheridan

Analyst

Absolutely. Well, first of all we're very excited about the data that was in DTT. The 400 users that saw substantial improvement in time and range over the last year. So that was great data and great to see. But we are still working on sort of a longer-term plan and strategy that involves clinical study design, the user interface, and channel access. So those are sort of the lead things that we've been working on, but as we said before our first step is to take advantage of our existing products. Control-IQ is currently not indicated for Type 2 and so we really want to work with the FDA to get approval for that. It may require a clinical study, but we're still – we need to begin the conversations actually to get approval for that. And then obviously, we believe that t:sport with the smaller form factor and discretion is also going to be very appealing to the type two community. So with those two products almost in the bag, we plan to move forward with those aggressively here in the near future. And then we'll be working on longer-term issues that we've been looking at a discrete form factor specifically for this community and just take advantage of the newer products potentially simplifying the user interface. And also in the mean time studying, just the channel and market access dynamics so that when we actually get to that point, where we have these newer products we can be successful.

Steven Lichtman

Analyst

Great. Thanks, John.

John Sheridan

Analyst

Sure. Good talking to you, Steve.

Operator

Operator

Our next question comes from Larry Biegelsen with Wells Fargo.

Larry Biegelsen

Analyst · Wells Fargo.

Hey, guys. Thanks for taking the question. Congrats on the strong quarter. And just one question on international and one on CeQur. Leigh, how do we think about the cadence this quarter for international sales? If we look at seasonality last year using Q1, you would come in well above the guidance -- and I'll ask the CeQur question here as well. John that your quote in the release they put out obviously caught people's attention. What attracted you to that pump? How do you think it compares to the incumbent? And any color on the timeline? Thanks for getting the questions guys.

Leigh Vosseller

Analyst · Wells Fargo.

I'll start Larry with the international question. So, when you think about the cadence, it is a little bit difficult to predict just based on this variability in the ordering patterns that we've seen. Starting with Q4 was a little bit unique because so much of that opportunity came from one particular distributor, at least half of the business in the fourth quarter. This quarter we saw everyone ordering, but I can't say yet that I see a particular trend that can help us develop confidence and exactly how it will play out. I think the thing to think about the most is generally speaking we expect pressure in the third quarter just due to typical seasonality outside the US because of European holiday season. And otherwise we expect continued growth as we gain traction across the new markets and Control-IQ continues to roll out there.

John Sheridan

Analyst · Wells Fargo.

All right. And then with regards to CeQur, we're excited about the investment. As you know diabetes is not a one size fits all condition. There are many market segments and there's different use preferences in each of these segments. And so this investment just aligns with our strategy to support solutions that meet the needs of these different segments particularly in Type 2. When you look at the CeQur Simplicity, it's a simple low profile alternative to injections and it's a valuable tool and it will appeal to customers who really are in a very different segment that we're operating in today. And so the intent here really is to learn about this particular segment as we formulate our Type 2 strategy. Specifically about the segments working closely with CeQur to understand that. But then there's broader Type 2 issues I think we can learn from working with CeQur about as I mentioned market access about working with PCPs versus Endos. So, I think there's a great deal of education that Tandem can gain from this relationship. And I think that we can help CeQur as well in many ways and so we're excited about the opportunity. And I think this is just kind of one element in our strategy to get into the Type 2 market effectively.

Larry Biegelsen

Analyst · Wells Fargo.

Thanks John.

John Sheridan

Analyst · Wells Fargo.

Yes.

Operator

Operator

Our next question comes from Matthew O'Brien with Piper Sandler.

Matthew O'Brien

Analyst

Afternoon. Thanks for taking the questions. Just looking at the guidance and there's not a lot to pick on here but I just want to make sure I'm asking this question just so we're clear on it all. But looking at the guidance you beat by $23 million versus what we were modeling. You're pushed in the midpoint of the guidance range up about $25 million almost all of that is international. So, is there anything given the competitive dynamic or anything else to really call out domestically as to why maybe didn't bump up things a little bit more in that piece of the business which is still 80% of the overall business?

Leigh Vosseller

Analyst

Sure. I'll just start by saying our philosophy and approach hasn't changed at all just a few months ago when we talked about guidance for the year. We talked about the positives and also a few of the things that we were more cautious about. And when I think about the positive it's really the momentum we've seen from Control-IQ in the US. It's been building now for quite some time and we're just starting to see it build outside the US. And then when we think about some of the -- I should add that we have UnitedHealthcare as a tailwind also at the beginning half of this year since we didn't have access until July of last year. The items that we're cautious about would still be that COVID dynamic I would say more so outside the US than in the US. It's not that we're not seeing it here but we think that the Control-IQ momentum is largely offsetting it. And then the other area is the potential for some noise in the market in the back half of the year as it relates to the competitive dynamics. And so I still think all those factors are in play. We -- to your point, we were still very pleased with our domestic results still outpaced our own internal plan and we look forward to seeing further growth across the year.

Matthew O'Brien

Analyst

Okay. Leigh, but just to be clear you're not incrementally more nervous about the competitive noise in the marketplace in the back half. Is that fair to say?

Leigh Vosseller

Analyst

Not at all.

John Sheridan

Analyst

Yes. I mean I think we feel very confident with our position and I think that's why we raised guidance both OUS and domestically.

Matthew O'Brien

Analyst

Got it. And then as a follow up that's really helpful. I appreciate that. Leigh, I didn't hear any comments as far as what the contribution was from United or on the replacement side in terms of quantitative figures, would you mind providing those?

Leigh Vosseller

Analyst

I'm sure I'll talk to you a little bit about the -- how those turned out. So from a renewals perspective first, we did see -- just like we've been seeing across the recent quarters about four to eight quarters, we saw an increase in the volume compared to last year as well as an improvement in our cumulative rate. And I think those are key factors. Right now, the renewals are really about strong, steady, just that solid progress. And what you've been seeing in the baseline is easy to predict off of. What's really exciting about renewals more so is what's going to come next year. When you think about the comparison of 2017, which are new opportunities this year and the 2018 shipments, which are new opportunities for next year those doubled in terms of size. And so this year just think about a continuation of what we've been seeing and think about next year as being the loud year I guess if you will. And then from a United perspective, it's just tracking along in the line with our expectations. It's clearly up year-over-year because we didn't have access in Q1 of last year, but it started in the baseline in Q3 and we're just trending as we would expect. We likely won't comment to the particular size of it going forward because we don't typically comment to quarter-to-quarter variations on different payers. But now it is a good part of the baseline and so we are happy with where that's tracking.

Matthew O'Brien

Analyst

Great. Thank you.

John Sheridan

Analyst

Yeah. Thank you.

Operator

Operator

Our next question comes from Brooks O'Neil with Lake Street Capital.

Brooks O'Neil

Analyst

Thank you. Good afternoon. Congratulations on the great start to the year. I'm curious obviously, there's been what I would call widespread expectations about the new pumps from the competitors. Do you guys think you lost business in the first quarter as people waited to see what those new products look like? Or how do you think the market is responding to you in light of the expectation that these new pumps are catching up to where you've been for a long time?

John Sheridan

Analyst

Yes. I mean Brooks, I don't think so. I'm pretty certain we haven't. I mean we obviously had a great quarter. Right now, the -- one of our competitors' pumps is available OUS and it's particularly available in the German market. And you saw that in the last few quarters, we've done extremely well in Germany. And we did that with Basal-IQ, Control-IQ was not even there yet. So we're excited that we're going to compete effectively against that product. And you can't market these products in the US until they've been approved by the FDA and neither have in the US yet. So I think it's unlikely at this point that we've seen any impact. We'll just have to see what happens as they do gain approval, there'll probably be more noise and we'll probably won't see that until the second half of the year.

Brooks O'Neil

Analyst

Yes. Okay. And then I'm curious I understand the competitive issue. But I'm curious about your comments on the mobile bolus and then subsequently t:sport. Is your sense that the FDA believes that your mobile capability works and is safe, but they just want a little bit more information? Do they want more data help us to understand kind of how you read the FDA's response and feelings about that product?

John Sheridan

Analyst

Sure. I mean I think that the -- this is just part of the normal interaction with the FDA when you have a submission like this. And I think that I don't want to comment specifically about things in our interaction with the FDA, but I will say we're very pleased with their response to us on cybersecurity. And I think that might have been one of the areas of greatest risk. And, I think, we've alleviated any concerns that they've got there with our response and our design. So we feel very positive about that. I'll also say that the FDA remains very supportive of using mobile technology in medical devices particularly in insulin pumps. And so I think that's also a positive. And I think that we still remain very confident that we're going to get approval for this product. It's just -- this is just a normal back and forth interaction. And I think that clearly we're going to have to now respond and there's inherent uncertainty in dealing with the FDA in the review process. But those product is coming to market and we'll keep you informed as we know more about it from our interactions with the FDA.

Brooks O'Neil

Analyst

Okay. Thank you, John.

John Sheridan

Analyst

Yes. Thank you.

Operator

Operator

Our next question comes from Matt Taylor with UBS.

Matt Taylor

Analyst · UBS.

Hi. Thanks for taking the question. So I just wanted to follow-up on a question there about the cadence in the environment. I know there's still some uncertainty. Could you offer any color on recent trends did things improve through the quarter? Is there any trend to extrapolate through April? Anything that you could provide on that would be really helpful.

John Sheridan

Analyst · UBS.

I mean, I'll just say that there's been strong demand into the second quarter as well. So we're excited about 2021 and that we have confidence that we're going to achieve the goals this year that we set out for ourselves as well as the next couple of years based on what we're seeing now and the positive reaction to Control-IQ from the physicians who are prescribing it as well as the people who are using it. It's just outstanding. And as we talked about we have 150,000 people who are now using it and we have momentum. We have incredible momentum that physicians are prescribing more and more systems. We have their confidence and trust. And the people who are using it I mean, I can't tell you how many positive anecdotes I get daily from people using it that are so motivational to our whole organization, but I think we're in a great spot.

Matt Taylor

Analyst · UBS.

Got you. Got you. And then just a follow-up on international. There was definitely some outperformance there it sounds like relative to what you expected that was broad-based. Is that what you think is going to continue, I guess, broad-based ordering or just wanted some more specificity on if there were any kind of pockets of strength that you would call out?

Leigh Vosseller

Analyst · UBS.

It was really strength across the board from all of the regions that order and we were happy to see everyone was ordering, including Germany who just placed such a substantial order in the fourth quarter already reordering in the first quarter. It's hard to say if their orders today are a new trend within each country they're still wrestling a lot with the COVID dynamic. So how is it impacting their local markets? How do they get their inventory right set as they think about the demand that's in front of them. And so it's just -- it's a bit of a challenge for the distributors throughout this to try to figure it out. But what I think is we're hearing loud and clear is there's enthusiasm and there's a lot of awareness about what we're bringing. And I think again it will be something that we will continue to see in the long-term.

Matt Taylor

Analyst · UBS.

Great. Well, thanks for the color and congrats on a good quarter.

John Sheridan

Analyst · UBS.

Thanks, Matt.

Leigh Vosseller

Analyst · UBS.

Thanks, Matt.

Operator

Operator

Our next question comes from Ravi Misra with Berenberg Capital Markets.

Ravi Misra

Analyst · Berenberg Capital Markets.

Hi. Good evening, everyone.

John Sheridan

Analyst · Berenberg Capital Markets.

Hi, Ravi.

Ravi Misra

Analyst · Berenberg Capital Markets.

So just a couple my question. So on the 20 million days Control-IQ that's a rather large number. And can you just help us think about, kind of, longer-term some of the innovation that you think you can extract from that data whether it comes to algorithm refinements or kind of, any value-add capabilities you can add for the patient? And then maybe my second one I'll just ask it upfront. For Leigh, just on the guidance and the leverage metrics. You -- it looked like international leverage was a lot better than you thought it was given the sales outperformance this quarter and you brought that number up, but it seems like you're kind of holding fast to the profitability metrics that you had laid out in the prior call. So just kind of wondering what's the offset there given kind of the revenue outperformance? Thank you.

John Sheridan

Analyst · Berenberg Capital Markets.

Yeah. That's a great question, Ravi about the how we use the data. And as you can see, we have a tremendous amount of data and we have invested greatly in our data science team and our algorithm teams. And they're looking carefully at this data to do just what you're saying. We're mining the data we're looking for exactly how the system performs. And we're looking for opportunities to make improvement in the overall performance of the system and its interactions as the algorithm works. And I think this is -- it's really the data is what's driving the formulation of the next steps for our Control-IQ advancements in time. And so I think that there's the algorithm itself that's on the pump. There's also data that we collect that I think we can probably help physicians optimize settings over time for the people who are using the pump. So there's algorithms that could potentially exist in the cloud that could support and make the physicians who we consider a customer as well more efficient, as they interact and provide better therapy and more effectively for their patients. And then there's also just the product itself. We see how the product performs. It helps us understand where the opportunities are for improvement. And clearly, we've taken a lot of that information and we've applied it to t:sport. And we're going to continue to apply it to the next-generation process over in time. So it's a treasure trove. It's hugely important to us. We're fully taking advantage of it and we're building teams out who know how to do just that. And I would finally say that when we work with payers, payers really value this data as well. And we see ourselves establishing dashboards with this type of information that we can make available to payers to help them see the benefits of our technology and potentially go back to them and look for additional reimbursement for our products in time.

Leigh Vosseller

Analyst · Berenberg Capital Markets.

And Ravi to your question on the margins, I think I would just start by saying that this just gives us even more confidence in achieving those margin targets we've set for this year. And one way to think about it is this is when we set our operating plan is based on the revenue assumption and there are many things that people in the organization would like to spend money on that we can't necessarily afford within the construct that we put together. And so by having an overachievement in sales, it allows us the opportunity to maybe advance some of those initiatives or investments, or go ahead and put them on the table for something that we could do this year as opposed to maybe putting off to next year. So we still feel very confident in handling those margin targets and it will allow us to keep moving forward towards meeting our long-term objectives as well.

Operator

Operator

Thank you. Our next question comes from Jayson Bedford with Raymond James.

Jayson Bedford

Analyst · Raymond James.

Good afternoon. Just a couple of quick ones I guess. On the pipeline John, I just want to paraphrase your commentary a bit here to make sure I understand the message. On t:sport I think you said, pushed out a few weeks, so is that still fourth quarter? Or could it slip into early 2022? And then just a follow-up on that. Do you believe you've solved kind of the user interface and human factors dynamics that you talked about last call?

John Sheridan

Analyst · Raymond James.

Yeah. Good question. So I think that the -- we're still on track with this program. We're very excited about it. We believe that the interface refinements that we elected to make last year are definitely resulting in a much more positive experience and so we're pleased with those results. I would say that when we developed the strategy to submit the mobile bolus at first, we did that intentionally because we need there to be lessons learned that we could apply to t:sport and other products that use a mobile app. And so there's -- now there's these new requirements that we -- I guess we should have anticipated and did anticipate they're going to -- we're going to have to go back and do additional work and it's going to be measured in weeks as we said. I think it's -- the way we look at it is that by incorporating these improvements now we're likely to gain during the review process itself. So that the commercialization should hopefully end up at the same point in time that we expected it to in 2022 anyway. It's possible we might slip into 2021 -- excuse me 2022 with the filing. But we anticipate that the commercial availability of the device will be roughly the same as it was to start.

Jayson Bedford

Analyst · Raymond James.

And John maybe you could just remind us, if you haven't disclosed it before what is the expected commercial availability time line?

John Sheridan

Analyst · Raymond James.

I mean, we haven't said specifically, but I would say it's probably sometime in the summer of 2022.

Jayson Bedford

Analyst · Raymond James.

Okay. And then Leigh if I can sneak in another one. Just on the international if I annualize first quarter sales, the guidance implies that the average over the next few quarters is lower than in the first quarter. You're launching Control-IQ in a few key countries. So I'm just wondering is the hesitation about that going higher on international just largely a function of the uncertainty tied to COVID and the distributor ordering patterns?

Leigh Vosseller

Analyst · Raymond James.

Yeah. And just a reminder too that third quarter pressure we tend to see because of the European holiday season. I would add that to it. But yes it's just -- it's caution around the fact that we really haven't been able to discern it. A specific cadence or trend with the distributors they're all really getting back on their feet. And I hope it's the beginning of the new trend, but just want to be thoughtful about some of the variability we've been seeing in the last few quarters.

Jayson Bedford

Analyst · Raymond James.

Fair enough. Thanks.

Operator

Operator

Our next question comes from Joanne Wuensch with Citibank.

Joanne Wuensch

Analyst · Citibank.

Good afternoon, and thanks for taking the question. The other diabetes companies are starting to sell their products into the pharmacy channel. And I recognize that traditional pumps are into the DME channel. But is there no way that Control-IQ and those that come after it can move into the pharmacy?

Leigh Vosseller

Analyst · Citibank.

I would not put a no way on it Joanne. I think you're right. What we're seeing is a lot of moving into the pharmacy channel across the space, but those products aren't necessarily like our product. Our product being a little bit more specialized in nature those means being more I'll call it commodity like. And so today we're really focused on well what are the benefits we have in the DME channel that maybe that aren't in the pharmacy channel. And we really like the fact that we have clear line of visibility to our customers in terms of who's ordering where they're coming from, it helps us build that customer relationship right up front, which is key and important as we think about the long-term renewal prospects. So that's piece number one. And the other element that we like about the DME channel it's just the pricing stability that we've seen there. One of our initiatives really is to continue to enhance reimbursement by demonstrating the clinical value of the product to the insurance payers and we think we have a good path for that through the DME channel. So those are the things that we're focused on today. What you hear about the pharmacy channel many times is it seems -- it sounds like it's more streamlined upfront. So we're focused on then how can we streamline that ordering process that people don't have that perceived negativity around it. And so we're focused on digital solutions, automating just improving our processes in order to make the flow better. So that's where we're focused on today is on the DME side really and we can continue to evaluate the pharmacy channel for the long-term.

Joanne Wuensch

Analyst · Citibank.

I appreciate that. And my second question has to do with a replacement cycle. It sounds like it's significant in 2022. Is there any way to quantify that? Thanks.

Leigh Vosseller

Analyst · Citibank.

Sure. From a renewals perspective, if you think about it the people who purchased pumps in 2018 are going to be coming up for their first opportunity in 2022. And when you compare that to 2017, I should say we shipped 34,000 pumps in 2018. That's double what we shipped in 2017 and it really was just the beginning of the escalation of our business up through this year. So, where renewals have been strong and steady just very solid path and trajectory, I think it's going to get a lot more exciting in the coming years that those become a more meaningful part of the business opportunity for us. And renewals when you compare it to attracting new patients, I mean those are the people we've built a relationship with. So our goal is to continue to offer innovation is to enhance that customer experience so that they will want to stay with us when their warranties expire.

Joanne Wuensch

Analyst · Citibank.

Thank you.

John Sheridan

Analyst · Citibank.

Thanks, Joanne.

Operator

Operator

Our next question comes from Alex Nowak with Craig-Hallum.

Trenton McCarthy

Analyst · Craig-Hallum.

Great. Good afternoon everyone. This is Trent McCarthy jumping on for Alex. Just to dig a little deeper on the competitive question. What are you hearing from patients and providers in the EU and UK around Medtronic 780G? Are you finding it more or less competitive than you originally thought? And is the feedback there allowing you to tweak your plans to defend when Medtronic launches here in the states?

John Sheridan

Analyst · Craig-Hallum.

I would say that we are just now beginning to hear about it. And I think that we feel like we're doing quite well OUS with the products that we've got there today as I was just mentioning a moment ago. We're in Germany today with Basal-IQ. The 780G has been there for two or three quarters and we did exceptionally well last quarter and we did quite well again this quarter. So, I feel that when you look at the 780G is an incremental improvement to an algorithm is on a system and sensor that have been problematic. So I think that while Medtronic is a formidable competitor, I think we feel comfortable that we can compete effectively against them in the OUS countries as well as here in the states.

Trenton McCarthy

Analyst · Craig-Hallum.

Got it. And then just a follow-up. Dexcom ran a big consumer push and is taking prices lower than you to help pick up greater adoption. Are you seeing any benefit from their efforts translate into an increase in MDI conversions? And do you anticipate the EU push to help your conversion potentially in that geography?

Leigh Vosseller

Analyst · Craig-Hallum.

So from the DTC perspective and the campaigns, I don't have any evidence that can show a direct correlation to an add and what benefit we might get. But I think it's natural to assume we've always gotten benefit from the relationship that we have with that's come in the market. When their sales reps are in talking with physicians and patients it's a natural conversation to talk about the integration of our products. So I think it's fair to -- if they're seeing an uptick based on that that we might also be having that enable effect.

Trenton McCarthy

Analyst · Craig-Hallum.

Got it. Thanks for the questions.

Operator

Operator

Our next question comes from Matthew Blackman with Stifel.

Mathew Blackman

Analyst · Stifel.

Good afternoon everyone. Thanks for taking my questions. I'll just put the boat out there upfront. I guess the first one can you size or frame the incremental opportunity and expanded age indication would open up for you? And then the follow-up question sort of back to the DTC theme. Obviously, we've got more competition coming and those folks are spending more on developing new patient funnels. Are you considering any incremental investment in DTC or even outside the traditional Endo channel, something in the primary care channel? Just how you're thinking about sort of the investments from here to drive more patients to pump therapy? Thanks.

John Sheridan

Analyst · Stifel.

Thanks, Matt. I think the numbers that we've seen are there's approximately 1.1 million children under the age of 18 with Type one worldwide. So it's not necessarily a large number, but it's a very important population that does need control immediately. I know that a number of pediatric endocrinologists are suggesting that we should put children in this age group on pumps immediately, because of the benefits the technology is providing. So, I don't think it's going to be a meaningful increase in opportunity for us. It's just a very important age group that we want to work with and just provide the benefits of Control-IQ too. So, we want to be able to market to that group as well so that people are aware of it. We can't do that today until we get this indication. And so, we're going to continue to push forward with this, and we would anticipate that our study will be completed probably in the early 2022 time frame and that during that time of 2022, we could get the indication for that group. That's our hope.

Leigh Vosseller

Analyst · Stifel.

Then to your question Matt on DTC strategies, I'll just start by saying we have a very smart team of marketing folks who are constantly evaluating the best ROI and the way to attract customers and to reach them. Our focus is primarily today on social media engagement, streaming platforms, ways that we can really connect directly with the Type 1 community, and we know and see that they are highly engaged when it comes to online activities. And so that's where our focus is today, but we will continue to define and refine our strategies and determine, where is the best place versus spend our dollars.

Matthew Blackman

Analyst · Stifel.

Thank you.

John Sheridan

Analyst · Stifel.

Yes. Thank you.

Operator

Operator

Our next question comes from Danielle Antalffy with SVB Leerink.

Rebecca Wang

Analyst · SVB Leerink.

Hi. This is Rebecca Wang for Danielle. I have a higher-level question on the competitive landscape. So, we're saying the insulin pump market will be more competitive with all those new entrants. How much do you think the overall pump market growth could accelerate from current levels with more options for patients? And I mean do you think the market needs to accelerate for Tandem to sustain your current growth trajectory? Thank you.

John Sheridan

Analyst · SVB Leerink.

That's a good question. Thank you. We have stated publicly that we believe that we can increase the penetration in the Type 1 community from probably in the low-30s today to the mid-50s. Other endocrinologists and others, who work in manufacturing companies within diabetes, believe that can even go higher. And so, I think it does -- it just -- there's a lot of opportunity. We think that the new technology that's coming to market, whether it's CGM or whether it's pump technology with algorithms, is definitely going to reduce the threshold that people face when they make a decision to go from pens and needles to pumps and other technology. We think we are drafting behind the CGM companies as CGM companies get their products on to people who are MDI. They see the benefits of the technology. They see the benefits of working with a company that provides service and support. And I think that they're more likely to consider a pump at that point in time. So, we think that the market is going to continue to expand. And I think as it does we'll all benefit and we think technology and ease of use is driving that adoption.

Rebecca Wang

Analyst · SVB Leerink.

Thank you.

Operator

Operator

Ladies and gentlemen, I'm not showing any further questions at this time. And since there are no further questions, this also concludes today's presentation. You may now disconnect and have a wonderful day.