We are bombarded with stark warnings of the obesity epidemic facing our children and nation generally, the strain being placed on our health and bodies, the need to look after ourselves better, eat less sugar, take more exercise blah, blah blah and, as I tuck into another biscuit, I’ll tell myself that I’ll start my new healthy regime tomorrow. But what if I lived with a condition that made it almost impossible for me to eat what I want, when I want – what would that mean for me and my life? According to research carried out by Diabetes UK in 2015 and released in 2016, there are an estimated 4.5 million people living with a condition in the UK that prevents them being able to eat and drink whatever they want without worrying how their body will react. Frighteningly, their report states that since 1996, that figure has more than doubled from 1.4 million.
So, what is diabetes and what is the difference between Type 1 and Type 2 diabetes? In very simple terms, diabetes is the umbrella term to describe the body’s inability to regulate the blood glucose that enters your system. Failure to regulate glucose results with it building up in your blood which then causes all sorts of problems. If you have a diagnosis of Type 1, you basically can’t make sufficient insulin whereas with Type 2, the insulin your body produces doesn’t work effectively. This is an extremely simplified description of what is a very complicated condition and the fact that it is so complicated is why it is incredibly difficult to come up with a cure or a means of managing it effectively.
It was Sir Frederick G Banting, Charles H Best and JJR Macleod in 1921 at the University of Toronto who were the first to extract and purify insulin so that it was possible to inject into a human who could no longer produce it for themselves. Having then been further purified by James Collip, it was successfully used in January 1922 for the first time and, almost 100 years later, it remains the only “effective” treatment for people with Type 1 diabetes today. Although with a success rate of just 8%, it is debatable as to how sufficient it is.
Given the time that’s elapsed since its discovery and the rapid rates of progress in almost every facet of life today, particularly in technology, news of Quin’s revolutionary approach to research into this chronic condition is both exciting and awe-inspiring. What’s more, it’s being led by two fantastic female founders – Cyndi Williams and Isabella Degen – which is even more exciting. I spoke with Williams to find out more about the company and the marriage of tech and science that will help people make the best decisions to better manage their condition via an app running on Apple smart devices.
With the very medical nature of the condition the app is intended for, I was expecting that both co-founders would have a strong medical background. It was a surprise to discover that neither Williams nor Degen are medically trained but are both from an engineering background. Coincidentally, both Williams and Degen came from families with farming backgrounds but it was Isabella’s decision to leave her engineering position at ThoughtWorks determined to find a better solution to make living with diabetes easier for herself and everyone else that led her into business with Cyndi:
“I’ve been living with Type 1 diabetes for over 26 years and managing this condition means a lot of work. No doctor can tell me how much insulin I should take, and when I should take it. I use trial and error to figure this out on a daily basis and this is where Quin will make a difference.”
As an engineer herself with 24 years’ experience at Sun Microsystems and ThoughtWorks, Cyndi met Isabella at ThoughtWorks where she mentored Isabella as a graduate engineer building software and whom she describes as ‘an exceptionally talented individual’. When Isabella informed Cyndi of her plans, Cyndi was excited by the nature of the project and so decided to join Isabella and Quin was born.
The Quin App, whilst it is a Class 1 CE regulated app, does not yet instruct users when and what dose of insulin to take but rather shows them the decisions they have made in similar situations in the past and how their blood glucose outcomes turned out using data that the app has gathered. Initially the course of action to be taken will remain the decision of the user, but eventually the app will provide specific personalised guidance to each user about what to do, and also integrate with other diabetes devices to administer insulin automatically.
Information is gathered using a combination of data from a user’s CGM (continuous glucose monitor) and IPhone shared via Apple Health with the Quin App. As the majority of people are creatures of habit, a pattern can be established relatively easily. Crucially, the established pattern generates a profile which is 100% matched to the user since it is from their own behaviour and data. This means that any suggested course of action that will alter the level of glucose will be more likely to yield the best outcome rather than the current rather crude treatment method of trial and error based on very general medical formulas.
It has taken Williams and Degen four years and two rounds of Angel funding along with Innovate UK grant funding to get the app to this stage. The decision to set up in the UK was a conscious one despite the fact that Cyndi is from America and Isabella is from Switzerland. With the current uncertainty over the future as Brexit draws potentially ever closer (or does it?!), Cyndi feels the decision remains the right one:
“We were both based here and we had a good network of engineers which was very important. The UK is also very much an early adopter when it comes to technology with people willing to try and experiment which is also important as we are very much co-creating and co-developing the product with our users.”
“The UK remains attractive for businesses such as ours with the Government’s Enterprise Investment Scheme providing tax relief for investors and courageous Innovate UK grant funding. We’re hopeful that the UK will continue to operate under the same medical regulation framework.” Williams admitted that the current situation is of concern and any major changes could have a negative impact for the business.
Funding is not easy to secure for any start up but Williams confirmed that being an all-female start-up in tech had been difficult, particularly in the early days. They experienced openly sexist attitudes; questions such as ‘who is writing the code?’ with the oblique inference that as women, they wouldn’t be able to do so, and, when seeking funding, ‘why doesn’t one of you just marry a billionaire’ being one of the more jaw-dropping instances. They remain undeterred and are fully committed to continuing to develop the app, harnessing the frequent positive user feedback to keep them going when it seems that the size of the problem they’re committed to resolving seems insurmountable. Williams is full of admiration and praise for the skill and determination of the team they have assembled. Until recently the team had been almost 80% female which is unusual for a tech company but one which Williams described as a ‘happy coincidence’ rather than any conscious plan on their part. Three new male hires means the team is now 65% female but for Williams it is the ability of the team and their commitment to the aims of the company that is more important than their gender.
I asked Williams for her thoughts on why there are so few females opting for the Stem (science, technology, engineering and maths) subjects at university, especially when results show that 73% of female graduates achieve a 2:1 compared to 69% of men in all subjects and less than 1/5th of females are studying for degrees with the highest pay prospects (technology and science). “I think perhaps the emphasis is wrong as education tends to focus on content rather than application”. Williams went on to explain that she sees a lot of incredibly intelligent graduates with an in-depth knowledge of content – text book type material – which might be very hands on, but that there seems less focus on the application of engineering learning to problem solving. She contests that women are perhaps more interested in the more human side of engineering in its application to solve and improve situations for people rather than what might be the traditional image of stereotypical classroom-based engineering learning. As this is the side that is rarely promoted, it may be that the subjects are indeed less appealing to young females.
Williams commented however that things are changing, albeit slowly. Having just taken part in the “Wired Health” conference for the science and tech industry, the three main keynote speakers were all female and they spoke in celebration of the way in which their respective organisations had been able to solve problems and improve the lives of others through the use of technology. It wasn’t so much about the technology itself but more the application of the solution that was the driver for change – the more human side, if you like.
In response to my question as to what the future would bring for Quin, it seems like the sheer volume of people with diabetes and the ongoing refinement to the app to provide a truly personalised useful aid to living with the condition will be keeping them fully occupied for the next decade at least. The trials are underway and as data is gathered, they will continue to develop the app to make it ever more accurate and tailored to individual users with more informed choices to manage their blood sugar levels. “Type 1 and Type 2 are simply broad descriptions of what is an incredibly complicated condition. That definition is oversimplified and misleading. It takes far more than your pancreas to regulate your blood glucose. You need your entire endocrine/metabolic system, in all its complexity”.
“As engineers, we know we need to zero in on smaller problems we can solve, create new “truths” from the solutions, and hold them loosely until we have evidence. That also means throwing out old “truths” that don’t stand up in the face of new evidence – this is going to take time to achieve”.
Decisions also need to be made as to future business models – will the app always be free to use or will it become a subscription-based product that is perhaps funded by medical insurers at an individual level? With the vast amount of data being collected, there is also an opportunity for perhaps a business to business model whereby anonymised data gathered over a period of time can be sold to pharmaceutical companies to assist in research into drug solutions with users able to participate in the economic upside since they are the data owner and providers in the first instance – the possibilities are many and not yet decided. Williams and Degen are still very much at the start of an exciting journey and it seems as if that excitement will remain with them for a long time to come.
*If you take insulin for diabetes and would be interested in either finding out more about their work and/or interested in signing up to take part in their trial, go to https://quintech.io/research/