By Teresa Murray, freelance writer & Giant Health Team writer

When you hear Cyndi Williams of Quin talk about diabetes, you are struck not only by the depth of her knowledge, but also by how much she cares about the people living with this disease.

That’s the reason she’s spent the last seven years of her life tackling some of the most challenging problems in diabetes care.

Cyndi is an engineer who relishes solving big problems and there is certainly no shortage of those in diabetes care! She was in top-level management in the tech industry when she started to learn about the challenges of managing diabetes from Quin co-founder Isabella Degen.

The more she learned, the more she realized how reframing some of the big problems in diabetes care could generate better solutions.

Both Cyndi and Isabella saw the value too in approaching a medical-care problem from a human-centered engineering approach and set out to improve the lives of millions of diabetes patients.

Practically 99% of diabetes care is self-management, interspersed with relatively infrequent visits to the doctor primarily focused on blood sugar levels and drug therapy effectiveness.

As Cyndi and her team talked to more diabetes patients, it became clear that there were significant self-management needs that had not only gone unmet, but also unnoticed.  

They saw that people living with diabetes are very much left to manage on their own, often poorly equipped with tools or challenges in accessing up to date knowledge about diabetes.

The challenge Cyndi and her team first targeted was insulin dose decision-making.

The current care model forces the patient to make dozens of complex decisions a day on how much insulin to take based on little more than carb counting and general formulae that need constant tweaking to match energy needs and how the person is feeling.

It’s a delicate juggling of insulin and blood sugar levels involving a lot of guesswork. Basically, inject and hope for the best, then repeat over a lifetime.

For Cyndi framing diabetes using these two parameters, glucose and insulin, is a gross oversimplification of the human endocrine and metabolic systems.

Anecdotal evidence gathered from patients clearly indicated that many other factors affected glucose levels, variables that don’t fit neatly into an equation:  sleep quality, mood, personality, stress, activity to mention but a few.

Cyndi sees these medical formulae as omitting the human from the loop.

Shockingly, this care model has a whopping 80% failure rate, which means that 80% of people with diabetes fail to achieve the recommended medical targets. This translates to negative health outcomes for that 80%.

This high failure rate Cyndi says would not be accepted in any other industry.

Cyndi and her team´s first iteration prototype was co-designed with users. The application’s goal was to assist diabetes patients with the complexity of insulin dose decision-making. It’s called Quin to stand for Quantified Intuition.

The driving concept was to improve the insulin dose calculations by tracking and surfacing past contextual information and activity data from multiple signals and combining that with similar past dosage decisions taken.  The person’s insulin decision-making when facing a plate of spaghetti Bolognese would thus be made easier and more accurate.

The app was a heuristic program designed to compensate the cognitive limitations of human recall. It put the human-being back into the loop and applied modern day technology to the problem. Cyndi says “not only are no two people with diabetes the same, no two days are the same.” 

The build mindset and approach was rooted in their homegrown Quality Management System and the device passed as a regulated medical device with a CE Mark.

Once they had a prototype, they raised enough capital to build out a larger research program.

However, whilst the technological side of things was challenging, design was even more of a challenge.

The dosing problem wasn’t perceived as big enough of a problem and the team couldn’t resolve it quickly enough for a strong enough consumer value proposition. 

When one door closes, another one opens!

Yet, as is often the case in innovation, when one door closes, another opens. Their larger research cohort produced a major insight that led them to focus on a much bigger challenge: diabetes distress.

Diabetes distress is a clinically recognized mental health issue resulting mainly from the relentless battle the diabetes patient wages to keep their blood sugar within range.

Staying regularly in range for the majority is basically an unattainable goal. Remember that 80%?

This high failure rate is not because the person is flawed in any way, but rather because the medical premise itself is flawed. The patient is set up to fail regularly which causes a mental health backlash.

It is no minor fact either that being regularly out of range can have serious health effects. Knowing this causes additional distress. 

The Pivot

Cyndi and her team pivoted to tackling diabetes distress.

The dosing decision-making component was preserved but app development forged ahead in a more human-centered holistic direction.

Key to the development strategy was leveraging game narrative theory and character evolution from gaming and edtech, the Quin team developed dynamic, rich, hyper-personalized solutions that put the individual human and their specific set of circumstances at the center.

Today, the Quin app gives diabetes patients a way to learn about their personal version of diabetes based on their own experiences. The more they learn, the more confident they feel in their ability to manage their condition on their own. The app provides support and insights.

The hyper-personalization delivered by algorithms and machine learning gleaned from the person’s data tailor to the individual’s life in a way that carb counting and formulae cannot.

Importantly, patients using the QUIN app learn up-to-date information about diabetes, understand the drugs they are taking and the mental health repercussions.

“This support is essential for people who have to  take hundreds of decisions a day to stay alive”.

As Cyndi puts it “people are trying to run their endocrine system with their brain alone and that is a hugely stressful load to put on people.”

Education is well known to improve outcomes in self-managed, chronic conditions. Gaming techniques and storytelling improve personalization and user engagement with content. As users progress and engage with the app, navigating different levels of challenges designed to put their learning into practice, they receive motivational rewards and personalized support.

Subsequently, their distress reduces and their mental health improves. Cyndi’s decision to stop chasing the problem of improved ranges in favor of targeted, tailored support for reducing diabetes distress actually ended up improving ranges.

Cyndi’s take on this is that “considering that so much of diabetes care happens away from the doctor, when people become experts in managing their own version of diabetes, and feel supported, it is no surprise health outcomes improve.”

This is good news for diabetes patients!