DexCom (NASDAQ:DXCM) reported fourth-quarter 2025 revenue of $1.26 billion, up 13% from $1.11 billion in the prior-year period, as management pointed to strengthening sell-through trends late in the year and early interest in its G7 15-day continuous glucose monitoring (CGM) system. The company said full-year 2025 revenue finished above the high end of its most recent guidance, and it entered 2026 with what newly appointed CEO Jake Leach described as “momentum” following improvements across manufacturing, logistics, and product performance.
CEO outlines strategic priorities and product updates
Leach, who said this was his first earnings call since officially stepping into the CEO role last month, highlighted three strategic priorities: maintaining Dexcom’s position as the “premier glucose sensing solution for all,” setting the standard for customer experience, and expanding international market share.
Leach also discussed several customer-experience initiatives, including:
- My Dexcom Account, a recently launched digital support system intended to streamline customer support.
- Early access launch of Dexcom Smart Basal beginning this month, aimed at people with type 2 diabetes using basal insulin.
- Dexcom Direct EHR integration, which management said is live or onboarding at more than 160 health systems.
- Upcoming enhancements for Stelo, including a comprehensive nutrition database for smart food logging and a redesigned app experience later in 2026.
- Regulatory clearance for a new patch technology that the company said improved G7 sensor survival in clinical trials, including for G7 15-day.
Q4 financial performance and operational improvements
CFO Jereme Sylvain said U.S. revenue totaled $892 million in Q4, up 11% year over year, while international revenue rose 18% to $368 million (15% organic growth internationally). Management cited strength in Germany, the U.K., and France, with France described as one of the fastest-growing markets following “significant Type 2 access expansion” late in 2025.
Gross margin improved meaningfully. Sylvain reported Q4 non-GAAP gross profit of $799.8 million, or 63.5% of revenue, compared with 59.4% in Q4 2024. He attributed sequential improvement to lower freight expense as Dexcom reestablished ocean shipping routes, along with improved scrap rates and supply chain performance.
Operating income was $331.5 million (26.3% of revenue) versus $209.5 million (18.8%) a year ago, and adjusted EBITDA rose to $422.2 million (33.5%) from $300.1 million (27.0%). Net income for the quarter was $265.1 million, or $0.68 per share.
Dexcom ended the quarter with approximately $2 billion in cash and cash equivalents. Sylvain said the company settled $1.2 billion of expiring convertible notes in cash during Q4 and repurchased $300 million of stock in the open market. He also said Dexcom surpassed $1 billion in free cash flow for the first time in 2025.
2026 guidance and investment priorities
Dexcom reiterated its 2026 revenue outlook of $5.16 billion to $5.25 billion, representing 11% to 13% growth. Management said the range assumes continued category growth, incremental contribution from Stelo, and new product advancements, while also assuming the coverage landscape remains “predominantly the same” as today.
For profitability, the company guided to:
- Non-GAAP gross margin: 63%–64%
- Non-GAAP operating margin: ~22%–23%
- Adjusted EBITDA margin: ~30%–31%
Sylvain said gross margin is expected to improve 200–300 basis points in 2026 from lower freight expense, manufacturing efficiencies, and growing contribution from G7 15-day. He also said the company expects margin expansion to flow through to operating margin even with incremental hiring and spending to support sales, innovation, and preparation for the launch of its Ireland manufacturing facility late in 2026.
In Q&A, Sylvain explained that Ireland-related costs are expected to run through operating expenses during 2026, then shift into cost of goods sold when the facility turns on, which he said could create a gross margin decline in the fourth quarter due to fixed overhead and initially lower production levels.
Coverage expansion, utilization trends, and international opportunity
Management repeatedly pointed to the potential expansion of CGM access, particularly for type 2 diabetes patients not using insulin. Leach said Dexcom has already seen commercial coverage unlock for type 2 non-insulin users and that Medicare expansion would represent “almost 12 million people” gaining access. He also noted updated American Diabetes Association guidelines recommending CGM choice for type 2 non-insulin users.
Leach said Dexcom expects to report out results around the middle of 2026 from a randomized controlled trial of about 300 type 2 non-insulin participants, comparing CGM use with standard care. Separately, he described a registry of type 2 non-insulin users with coverage today, which he said is showing sustained health improvement and high sensor utilization.
On utilization by cohort, management said automated insulin delivery users are “well north of 90%,” with type 2 intensive insulin therapy and non-AID type 1 users in the 85%–90% range, and type 2 basal insulin users around 80%–85%. Leach said registry data for reimbursed type 2 non-insulin users is showing utilization “very similar” to basal users.
Internationally, Leach said Dexcom believes the opportunity outside the U.S. could become larger than the U.S. business over time, though CFO Sylvain cautioned the timeframe is “more than 5 years,” given continued U.S. runway. The company emphasized its tiered product portfolio outside the U.S. and said it plans to add Stelo and a new CGM system internationally in 2026 to expand access to additional segments.
Additional notes: Stelo, seasonality, and rollout dynamics
Sylvain said Stelo generated $130 million in revenue in 2025. For 2026, management said it expects Stelo to contribute “about a point” to growth. Leach added that Dexcom is seeing a range of Stelo users, including type 2 non-insulin patients without coverage, and described an opportunity to transition those users to G7 as reimbursement expands.
On seasonality, Sylvain said the company expects Q1 2026 revenue to decline sequentially about 6%–7% from Q4, reflecting a gradual shift toward pharmacy channels and reduced fourth-quarter stocking dynamics that are more common in durable medical equipment channels.
Dexcom also said it is planning an Investor Day for May 2026, where it expects to provide additional details on its outlook.
About DexCom (NASDAQ:DXCM)
DexCom, Inc is a medical device company that develops, manufactures and distributes continuous glucose monitoring (CGM) systems for people with diabetes. Its products are designed to provide near real-time glucose readings, trend information and alerts to help patients and clinicians manage insulin dosing and reduce hypoglycemia and hyperglycemia. The company’s offerings combine wearable glucose sensors, wireless transmitters and software applications that deliver data to smartphones, dedicated receivers and cloud-based platforms for remote monitoring.
Founded in 1999 and headquartered in San Diego, California, DexCom has focused its business on advancing CGM technology and expanding clinical use beyond traditional insulin-dependent populations.
