Insulet, Abbott, and Dexcom all showed up to the same conference with the same plan: chase the massive, untapped Type 2 diabetes market. The land grab is on, and the stakes couldn't be higher.
For decades, companies like Insulet, Abbott, and Dexcom have been locked in a fierce battle over Type 1 diabetes patients. These are the roughly 2 million people in the U.S. who need insulin to survive, no exceptions. The devices built for them (continuous glucose monitors, insulin pumps, automated delivery systems) are brilliant, life-saving, and increasingly commoditized.
So what do you do when your core market starts getting crowded? You look next door.
At the ATTD conference in Amsterdam this week, all three companies showed up with the same playbook: go after Type 2 diabetes. Not the insulin-dependent kind they've already been serving, but the massive, undertreated population of people managing their blood sugar with pills, lifestyle changes, or sheer willpower. It's like three rival pizza chains simultaneously deciding to start selling tacos. Something big is clearly happening.
The Numbers That Explain Everything
About 38 million Americans have diabetes. The vast majority, around 90-95%, have Type 2. Many of them don't use insulin at all. Historically, that meant they weren't customers for glucose monitors or insulin pumps. They'd prick their finger once a day, maybe, and hope for the best.
But the market for continuous glucose monitors (CGMs) alone tells you where things are headed. The U.S. CGM market was valued at roughly $2 billion to $3.7 billion in 2024, depending on which estimate you trust. That kind of growth doesn't come from selling more devices to the same Type 1 patients. It comes from opening up an entirely new customer base.
And that customer base is enormous. Type 2 patients who don't use insulin represent the single biggest untapped opportunity in diabetes devices. Every one of these companies knows it. Now they're racing to get there first.
Abbott: The Volume Play
Abbott has been positioning for this moment longer than anyone. Its FreeStyle Libre system already holds about 56% of the global CGM market by revenue, largely because it's cheaper and easier to use than the competition. Think of Abbott as the Toyota of glucose monitors: reliable, affordable, everywhere.
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Last year, the FDA approved Abbott's over-the-counter devices, Lingo and Libre Rio, which target non-insulin users and even non-diabetic wellness consumers. That's a significant shift. You no longer need a prescription to strap on a glucose monitor and start tracking your blood sugar like you'd track your steps on a Fitbit.
Abbott's strategy is pure scale. Price it low, make it accessible, get it on as many arms as possible. The company also locked in an OEM deal with Medtronic and is developing a dual-analyte sensor that could further distance it from competitors. At ATTD, Abbott held two separate industry sessions, including one in the main auditorium on Friday. They're not being subtle about their ambitions.
Dexcom: Premium, but for How Long?
Dexcom takes the opposite approach. Its G7 system is widely considered the most accurate CGM on the market, and it integrates beautifully with insulin pumps for automated delivery. In the U.S., Dexcom commands about 74% of CGM revenue share, even as Abbott leads in unit volume. Think of it as the iPhone of glucose monitors: fewer units, higher price, fiercely loyal users.
The problem? Abbott is coming for Dexcom's lunch money. Barclays recently downgraded Dexcom to Underweight, citing accelerating share gains by Abbott, especially in the Type 2 market where price sensitivity is higher. When your competitor is selling a perfectly decent monitor for less, your premium positioning becomes a vulnerability.
Dexcom's answer is Stelo, its own OTC glucose monitor launched in the U.S. to reach Type 2 patients and the health-curious crowd. But Stelo is competing directly against Abbott's more established OTC offerings, and Abbott's volume advantage is real. Dexcom presented a breakfast session at ATTD on Friday morning (yes, they provided breakfast; smart move when you're asking clinicians to show up at 8:30 a.m.).
The bigger question for Dexcom is whether its "premium moat" holds as the market shifts toward less intensive users who don't need the absolute best accuracy. They need "good enough" at a price that doesn't make them wince.
Insulet: The Wildcard That Could Change the Game
Insulet is the most interesting story of the three, and the one getting the least attention. While Abbott and Dexcom fight over who gets to monitor your glucose, Insulet is asking a different question: what if Type 2 patients could use an insulin pump, too?
Traditionally, insulin pumps were exclusively for Type 1 patients. Insulet's Omnipod 5, a tubeless, wearable pump that automatically adjusts insulin delivery, has been a hit in that market. But its SECURE-T2D trial showed that automated insulin delivery can produce meaningful HbA1c reductions (a measure of long-term blood sugar control) in Type 2 adults as well.
At ATTD on Wednesday, Insulet presented results from a fully closed-loop system for Type 2 diabetes. A fully closed-loop system is exactly what it sounds like: the device reads your glucose, calculates the dose, and delivers insulin without you having to think about it. It's autopilot for your pancreas.
The company's roadmap targets a fully closed-loop Omnipod for Type 2 by 2028, and it's also developing Omnipod GO, a simpler basal-only device designed for the millions of Type 2 patients who need some insulin but not the full automated system. That's a smart segmentation play: give the complicated patients the full Omnipod 5, and give everyone else something simpler and cheaper.
Barclays, however, isn't entirely convinced. They downgraded Insulet alongside Dexcom, pointing to emerging competition from the tubeless variant of Tandem's Mobi pump (expected 2026) and Medtronic's Fit pump (2027). Insulet's tubeless monopoly is about to end, and that matters.
The Elephant in the Room Wears a Semaglutide Patch
You can't talk about Type 2 diabetes devices without talking about GLP-1 drugs. Ozempic, Wegovy, Zepbound: these medications are transforming how Type 2 diabetes (and obesity) gets treated. The GLP-1 market is projected to hit nearly $63 billion by 2025, growing at up to 17.5% annually.
So here's the tension. If a patient takes Ozempic, loses 20% of their body weight, and gets their blood sugar under control, do they still need a glucose monitor? Do they still need an insulin pump?
For CGMs, the answer appears to be yes, maybe even more so. GLP-1 patients still benefit from real-time glucose tracking, especially during combination therapy. Rising diabetes diagnoses mean more total patients even as individual outcomes improve. There's no evidence that GLP-1 adoption is reducing CGM demand; if anything, the expanding patient population lifts all boats.
For insulin pumps, the picture is murkier. If GLP-1 drugs reduce insulin requirements for some Type 2 patients, that's a headwind for Insulet. But the company is hedging by designing its pump platform to deliver non-insulin drugs eventually, not just insulin. That's a forward-thinking bet.
What This Actually Means
Three companies, one conference, one message: Type 2 is the future. The competitive dynamics break down neatly:
Abbott is the price leader, betting that affordability wins in a mass market. Its OTC approvals give it a head start with non-insulin users, and its global scale is hard to match.
Dexcom is defending its premium position while trying to play the volume game with Stelo. It still owns the best technology, but "best" matters less when you're selling to patients who just want basic glucose trends.
Insulet is the only one bringing drug delivery to the Type 2 party, which gives it a differentiated angle. But it's also the most exposed to both GLP-1 headwinds and new pump competitors.
Together, Abbott and Dexcom control more than 80% of the CGM market. The digital diabetes market is expected to grow to $21 billion by 2026. And the Type 2 insulin pump segment is projected to grow 40% over the forecast period, the fastest growth rate in the pump market.
The Scoreboard to Watch
This race won't be decided in Amsterdam. It'll be decided over the next two to three years as OTC adoption data comes in, GLP-1 prescribing patterns stabilize, and new pump competitors launch. The companies that win will be the ones that solve a simple but hard problem: making diabetes management so easy and affordable that 38 million Americans actually do it.
Right now, CGM penetration in non-insulin Type 2 is still low. The upside is massive, but so is the execution challenge. These aren't Type 1 patients who will wear a device because their life depends on it. These are people who need to be convinced that a sensor on their arm is worth the hassle and the cost.
The ATTD presentations this week weren't just science updates. They were opening salvos in what could become the biggest market expansion in diabetes history. Insulet, Abbott, and Dexcom all see the same prize. The question is which one grabs the biggest piece of it.
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