Sugarpod Wins Alexa Diabetes Challenge

Alexander M Castellino, PhD

October 16, 2017

NEW YORK — The Alexa Diabetes Challenge has a winner. Drumroll please! Luminary Labs has announced that the winner of the $125,000 grand prize is Sugarpod by Wellpepper, chosen from among five finalists who presented their prototypes on demo-day in New York.

The challenge called on innovators to create Alexa voice-enabled solutions to improve the lives of patients with type 2 diabetes.

"Technology advances are creating digital health opportunities to improve support for people managing life with a chronic disease,"  said Tony Alvarez, president, primary care business line and customer strategy at Merck, which sponsored the challenge.

"A purpose of the Alexa Diabetes Challenge was to identify new ways to use the technology already present in a patient's daily routine. The winner of the Challenge [Sugarpod] did just that," Mr Alvarez said.

Sugarpod is an interactive diabetes care plan solution that provides tailored tasks based on patient preferences. The solution is a "comprehensive end-to-end plan. The team is very excited about this win," Anne Weiler, cofounder and chief executive officer (CEO) of Wellpepper, told Medscape Medical News.

Remarking on the other four finalists, Ms Weiler noted that they were also of a very high quality and highlighted the benefits of going deeper into specific aspects of care.

Alexa is Amazon's voice-activated digital assistant that provides real-time information through devices including Amazon Echo and Echo Dot. Alexa is one of several new digital assistants, such as Apple's Siri and Microsoft's Cortana.

The challenge pitted five teams against each other to showcase the potential of voice technology in diabetes care.

The prototypes developed by the innovators provide five unique ways for patients to use the Alexa platform for diabetes management: an interactive diabetes care plan that includes a smart foot scanner (Sugarpod), an intelligent agent that uses NASA-licensed artificial-intelligence technology integrated with Internet of Things device data (Personal Intelligence Agent [PIA]), a virtual nutritional assistant (Taming Type 2 Diabetes Together [T2D2]), a holistic management solution (GluCoach), and a virtual diabetes educator that is sensitive to a patient's mood based on acoustics (DiaBetty). 

The $125,000 Winner: Sugarpod

Ms Weiler, who, as well as being CEO of Wellpepper is coinventor of Sugarpod, said the solution's voice and mobile interactive treatment plans help people newly diagnosed with type 2 diabetes integrate new information and routines into the fabric of their daily lives to self-manage, connect to care, and avoid complications.

Wellpepper already delivers interactive patient experiences via SMS, email, web, and mobile application, she explained.

The team recognized that integrating voice was the natural next step to make the platform more convenient to use at home — where diabetes management mainly occurs.

Sugarpod weight and foot scanner.

Sugarpod includes a voice-powered scale and foot scanner that monitors for diabetic foot ulcers. It also takes pictures of the feet, which are classified for the provider, care team, and patient.

"Foot complications associated with diabetic peripheral neuropathy can lead to foot ulcers, amputations, increased hospital visits, and increased deaths, and account for up to $9 billion in healthcare costs," said Ms Weiler during the presentation in New York. 

"By continuously monitoring for foot ulcers, Sugarpod can save time and money and increase quality of life," she noted.

For patients with neuropathy at diagnosis, early scanning is important and is conducted at the same time as patients weigh themselves. Clinicians do not interpret the image, rather Sugarpod flags foot ulcers and looks for hot spots.

"The prototype developed for the competition was trained on 370 images of feet and wounds, and 100 people have tried it," Ms Weiler told Medscape Medical News.

Sugarpod uses Echo with the user care plan. A mobile application has several capabilities, such as tracking meals and recording mental-health surveys.

Paper-based information is often overwhelming for patients, Ms Weiler explained. "Sugarpod is comprehensive, but not overwhelming. It breaks down the activities associated with managing type 2 diabetes into manageable, interactive tasks — all personalized for the user and delivered via voice, mobile, or device."

Sugarpod was conceived as a home device to be used by consumers, but during prototype testing it was determined that the solution could also be used in the clinic for early diagnosis, she noted, adding that her team intends to further develop the device and integrate voice as part of a patient care plan.

A patent has been filed for Sugarpod, and the solution will be further tested in partnership with a large health maintenance organization before coming to market.

But there is still a lot of work to be done before it can be submitted to the US Food and Drug Administration. "By developing the clinical prototype first, we hope to get the costs down," Ms Weiler explained. She noted that the cost may need to be subsidized for the consumer/patient.

Finalist PIA

PIA by Ejenta, a finalist in the challenge, gleans and automates information from a patient’s connected devices, including blood glucose, blood pressure, and weight on an ongoing basis. The user can log in by voice; mobile and web-based interfaces will also be available.

Initially, the healthcare provider and patient create a care plan that is incorporated into the software to monitor blood glucose, nutritional goals, medication plan, weight target, activity, and sleep, for example, which "can be personalized for each patient," explained Rachna Dhamija, CEO of Ejenta, San Francisco, California. The care plan and data collected from patients can be integrated into electronic medical records, she added.

PIA uses Amazon Echo and also works with chatbots and devices by other manufacturers. The prototype is an Amazon Echo Show, a multimodal interface with voice and graphic display.

The solution provides a to-do list and reminders, predictions based on past patterns and behaviors, in-context education, and personalized feedback, as well as promotes social support.

Ms Dhamija said PIA would help cut down on paperwork, provide nurses with a dashboard showing risk-stratified information as to which patient needs the most attention. For physicians, it provides trends and patterns of patient behavior.

"It will not displace anyone, it will make their roles more efficient," she said.

Clinical trials are expected to start in 2018.

Wellpepper team, including cofounders Anne Weiler (standing, center) and Mike Van Snellenberg (standing, far left).

Finalist T2D2

The finalist T2D2 is a voice-first virtual nutritional assistant that is personalized, offering diabetes self-management support, including social support, via an Alexa Skill and chatbot. 

"Most people are unable to sustain drastic dietary changes. T2D2 helps people identify and achieve manageable but impactful changes to their diet," one of the innovators, Elliot Mitchell, a PhD student in the department of biomedical informatics at Columbia University, New York, told Medscape Medical News.

It provides personalized nutritional recommendations to each user based on preferences and past patterns.

"When a user asks for meal advice, T2D2 suggests healthy ingredients that can be added and ways that portion sizes can be changed to improve the glycemic impact of the meal . . . to better meet goals created by the user based on prompts from T2D2," Mr Mitchell said.

T2D2 runs on Amazon Echo and most devices that run Alexa at home, or for example, it can link with Facebook messenger and a typed conversation can drive its use.

In addition, the "together" component brings in a supportive network of family and friends and encourages conversation.

Finalist GluCoach

The finalist GluCoach is a voice-based solution that supports patients with newly diagnosed type 2 diabetes by taking on three distinct and interwoven roles to keep patients engaged and motivated: personal assistant, diabetes teacher, and lifestyle coach.

Built in partnership by HCL Technologies and Ayogo, GluCoach leverages the information collected through many sources, such as a patient’s profile, patient conversations, health profile/patterns, and emotional states at different times, calendar, contacts, and other wearable and medical devices. This intelligence hub enables GluCoach to have more a contextual, highly engaging, and personalized conversation with its user.

"Voice as a channel of communication is positioned to be a game changer in building patient-centric solutions," Aashima Pathak, regional director at HCL Technologies, New York, told Medscape Medical News.

Another innovator on the GluCoach team, Rohit Sethi, senior director, digital health, at HCL Technologies, explained that his team were already working on a voice-first patient engagement platform before this contest came up.

Extending that experience to diabetes management was logical and exciting, according to team GluCoach.

For their prototype, GluCoach demonstrated the experience through the persona of Mary, a 69-year-old retiree recently diagnosed with type 2 diabetes. Her nurse recommended GluCoach and, as Mary uses the platform, it gets to know her better, its responses become more personalized, and it anticipates her needs.

Finalist DiaBetty

The finalist DiaBetty is an Alexa-enabled tool that acts as a virtual diabetes educator and at-home coach developed by innovators from the University of Illinois at Chicago. It is unique in that it responds to acoustics of speech to interpret a patient's emotional state.

The user invokes the DiaBetty app and can ask questions related to diabetes. "As a diabetes coach, DiaBetty is sensitive and responsive to a patient’s mood," one of the inventors, Olusola Ajilore, MD, PhD, told Medscape Medical News.

"DiaBetty will become more adaptable and flexible the more she is invoked, as well as be able to incorporate connected health devices," Dr Ajilore said. 

The Journey

In May 2017, 96 entrants from research institutions, software companies, startups, and healthcare providers submitted proposals for consideration for the challenge. A panel of judges, independent from Merck, whittled the field down to five finalists, each of whom received $25,000 in cash and 10,000 Amazon Web Services credits.

The finalists advanced to the virtual accelerator phase, a 2-month period used to develop a working prototype. As part of this phase, finalists attended a boot camp on July 25 to 26, 2017 at Amazon's headquarters in Seattle, Washington, where they received expert mentorship to develop their concepts to solution. They had sessions led by experts in voice as a vehicle for transformation, behavior specialists, healthcare innovation, and diabetes education, and patients themselves.

The finalists then had 2 months to build a prototype and demonstrate how they saw their solution roll out. The prototypes were presented to a panel of judges on Demo Day, September 25, 2017, at the Amazon Web Services Pop-up Loft.

Each innovation was evaluated based on criteria that included feasibility and potential for true impact. The prototypes are currently not commercially available.

Judging the finalists were Ifeoma Ajunwa, JD, PhD, from the Berkman Klein Center at Harvard University, Cambridge, Massachusetts; John Brownstein, PhD, chief innovation officer from Boston Children's Hospital and professor at Harvard Medical School; Rob Coppedge, CEO at Echo Health Ventures, Seattle, Washington; Michele Tuck-Ponder, Esq, producer at Diabetes While Black, New York; and Matt Yanchyshyn, architecture lead at Amazon Web Services.

"The Alexa Diabetes Challenge has been a great experiment to rethink what a consumer, patient, and caregiver experience could be like and how voice can become a frictionless interface for these interactions. We can imagine a future where technological innovations, like those provided by Amazon and Amazon Web Services, are supporting those who need them most," said Oxana Pickeral, global segment leader in healthcare and life sciences at Amazon Web Services, in a statement.

The challenge was sponsored by Merck, powered by Luminary Labs, and supported by Amazon Web Services.

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