29 November 2016

Smart coach for diabetics aims to raise quality of life in the long term

Source: GlycoLeap website. Couple discussing content on a device.
Source: GlycoLeap website. Couple discussing content on a device.

A 'smart coach' service has been introduced to help people living with type 2 diabetes* to adopt healthier habits that can lead to a better quality of life in the long term. Diabetes, especially if it is not well controlled, can lead to problems such as blindness, kidney complications and nerve damage. It has also been implicated in Alzheimer's disease, which is sometimes called 'type 3 diabetes'.

Healthcare costs associated with diabetes continue to be a major concern worldwide. Diabetes affects more than 415 million people worldwide - a number that grows every year, said Holmusk, a digital health and data analytics company, noting that diabetes-related complications are a major cause of hospitalisation.

According to a 2016 article in the BMC Public Health journal, Singapore's healthcare spending for diabetes rose above S$1 billion in 2010, and is expected to soar beyond S$2.5 billion by 2050. A 2015 study by the International Diabetes Federation (IDF) found that Singapore has the second-highest proportion of people with diabetes among all developed nations - more than 10% of people aged 20 to 79. Three out of every 10 patients with diabetes develop the condition before age 40.

Holmusk points out that the high costs of diabetes - both for the individual and the healthcare system - and the personal nature of diabetes management, presents an opportunity for technologies that can provide scalable and engaging solutions for better diabetes management. The company has an advisory board where two members are medical doctors, and thought leaders in their fields.

"People are most familiar with the traditional model of making clinic appointments, travelling down to the clinic, and seeing the doctor for 15 to 20 minutes every few months. This model, which focuses on the clinic/hospital/doctor, will no longer be sustainable as the burden of chronic diseases rises - we need to move patient care forward, focusing on prevention, and into the patient's homes and community," explained Dr Yau Teng Yan, Chief Medical Officer, Holmusk. Dr Yau practised in primary care for over seven years, managing many patients with chronic diseases in the clinic.

The solution from Holmusk combines human expertise and mobile technology to nudge patients towards healthier habits. Called GlycoLeap, the subscription-based service tracks the user's behaviour with various tools and then delivers coaching advice from human dietitians via a mobile app. Just as a personal coach at a gym can give a person more incentive to stick with a gym programme and reach personal goals, GlycoLeap acts as a lifestyle coach to provide that added push to start and maintain a healthier lifestyle.

"GlycoLeap is transformative for people with diabetes, especially in the way it brings diabetes care out of the clinics and hospitals and into people's everyday lives," said Nawal Roy, CEO and Founder of Holmusk. "We want to contribute towards revolutionising the healthcare experience for people living with chronic disease."

GlycoLeap uses concepts from behavioural science to drive positive health outcomes for people with diabetes. Through small and sustainable lifestyle changes, users can achieve moderate weight loss and improve glucose control (as measured by HbA1c levels in the blood) within six-months of the GlycoLeap programme.

As part of the programme, users take photographs of their meals with the GlycoLeap app for rating by the GlycoLeap team of dietitians. Users are also provided smart devices, including a wireless scale, glucometer and fitness band to track weight, blood glucose and physical activity. This gives the coaching team a 360-degree view of each user's behaviour, allowing them to provide the right feedback and support at the right time on a daily basis.

Dr Yau commented that the GlycoLeap model is based on an outstanding user interface, ease of use and our natural need for human interaction. "Good design is vital. In developing a health intervention for the consumer, it has to look good and more importantly, be intuitive and easy to use. Consumers have high expectations of their apps and they take reference from well-designed apps like Facebook, WhatsApp, and Uber. So if your app doesn’t meet a minimum threshold of good design, no matter how many functions it has, people aren’t going to use it. Our earliest version of the app had a very minimalistic, modern-looking interface, but based on user feedback, we changed it to something a lot more personable and friendly," he said.

The devices in the GlycoLeap system are also designed to be as easy as possible to use. "For example, our wireless weighing scale is synced with your personal account out-of-the-box. Just step on it and your data flows into your account. There is zero setup needed. For those who are not ready or already have their own devices, we also offer them a purely app-based version of the product with the devices, at a lower price," Dr Yau said.

The human connection is also critical in health-related behavioural changes, he added. "We are social creatures at heart, and yearn to interact with other human beings - and not the computer! For us, our users stuck around for a much longer time only after we built in a two-way messaging interface which connected them with a real-life dietitian.

Source: Holmusk. In-app conversation.
Source: Holmusk. In-app conversation.
"Our dietitians actively reach out to the users and ask questions if they need to clarify something. We see each food photo as an opportunity for highly-personalised health education, and to deepen the relationship with the user. Our goal is not to tell the user exactly how many calories or how many grams of fat they just ate, but rather to reinforce key concepts through direct and timely feedback. This approach opens up a deeper, more honest discussion with our users."

Dr Yau recounted that one user had been eating irregularly and did not like vegetables when she first joined the GlycoLeap programme. "After a little prodding from our health coach through the app, she also shared that she had a poor relationship with her doctor and was fed up that everything she did was ‘wrong’. At the beginning, her meals were full of carbohydrates and low in fibre. But over time, the accountability and the relationship she established with her health coach through our app led her to have a lot more balanced meals and include more vegetables in her diet. She went to her doctor recently, and her HbA1c (a marker of diabetes control) improvement far exceeded even our expectations," he said.

The GlycoLeap model also makes much more effective use of a dietitian's time, Dr Yau said. "Because of the intuitive dietitian coaching system that we've developed, our dietitians can see the user's diet and activity history at one glance and focus on where they can add the most value. This makes the process much more efficient.

"In the clinics, dietitians usually see six to eight patients a day, and spend 20 to 30 minutes per patient just trying to take a proper food history, before going into the more important counselling aspects. By taking the manual, time-consuming parts out of the way, a dietitian on our system is able to handle up to 200 clients on a given day. We have three full-time dietitians, and will hire more according to need."

Dr Yau said the main target audience for GlycoLeap would be people who are at the early end of the diabetes spectrum - those with prediabetes*, newly-diagnosed type 2 diabetes, and early type 2 diabetes.

"We've gone live with GlycoLeap for two months now, and are looking for the right channels to reach out to people who can benefit from this. Because it is a novel model of care, we anticipate it will take some time to educate the market, to understand how digital health can be an important and effective component of medical care," he said.

"It's really about prevention," he added, citing the IDF study on people under 40 developing the condition. "From the public health perspective, it's of greatest cost-effectiveness and importance to manage your condition well as early as possible, before complications start to set in. Also, this group of people tend to be younger, and are more comfortable with smartphones and mobile apps."

Dr Yau added that people with diabetes who also have other conditions such as hypertension can also benefit from GlycoLeap. "Hypertension and high cholesterol are common in the population, and our dietitians have the expertise to counsel them accordingly. With complex conditions, for example late-stage kidney disease, we set expectations that you should always listen to your primary medical team who knows your condition best, while we provide a supporting role," he said.

Holmusk currently provides users with a monthly PDF summary that they can discuss with their doctors. "We are exploring ways to integrate more deeply with the patient's health providers," Dr Yau disclosed. Plans are also in the works to develop tailored programmes for people with prediabetes - as well as other chronic diseases, such as high blood pressure and high cholesterol - in the next six months.

Another milestone will be the introduction of an artificial intelligence (AI)-backed chatbot to provide the first line of support to users. "You can expect to see that live in a few months time - a hybrid human-AI system will enhance our scalability while maintaining efficacy," said Dr Yau.

"After using GlycoLeap for six months, my HbA1c was reduced from 8.7 to 6.2%," said Singapore user Wen Shi. "The feedback provided by the dietitians on food rating has helped me realise what types of food are good at controlling my glucose."


Watch the video introduction to GlycoLeap

GlycoLeap is currently available in Singapore, and expected to become available in Malaysia and Hong Kong by early 2017. The app is available for iOS and Android.

The service is available on a monthly subscription. Users begin with a six-month core programme that costs S$69 a month, and then move on to a maintenance programme at S$20 a month. There is no minimum period for the maintenance programme, and users may can cancel anytime.

*People with Type I (or type 1) diabetes are born with the inability to produce insulin, while people with type II (or type 2) diabetes typically develop the disease in later life and produce too little insulin, or cannot make use of the insulin they produce. Problems with insulin are reflected by consistently high levels of HbA1c in the blood. 

Prediabetes refers to elevated HbA1c levels which are high, but not high enough to be considered diabetes. The condition is considered to be an indicator of eventual diabetes if the person does not take steps to lower HbA1c, with lifestyle changes for instance. 

posted from Bloggeroid