It's driven off the cam with a helical cut gear, so regearing it is major undertaking. Cam gear is critical, so it can't be altered.
Strange thing about Duramaxes is they are built more race engines than industrial devices. Gear driven cam, fully counterweighted forged nitrated crank, piston crown oil cooling jets (internally), solid roller cam, 4v per cyl, aluminum heads, intercooled variable nozzle turbocharger with watercooling, 6 head bolts per cylinder, etc. Just changing the factory tune will double the engine output. But the cooling system isn't very good even at stock power levels for some reason.