How digital twin tech could boost type 2 diabetes outcomes

How digital twin tech works in diabetes care

In the healthcare context, digital twins are digital representations of an individual patient. They "combine diverse health data streams and disease modelling to produce a dynamic copy of a patient that guides the clinical team towards personalized treatment while alleviating workload," one Stanford-led study stated.

Twin Health develops this technology for chronic disease management. The company's AI digital twin technology can be used to treat chronic metabolic diseases, including type 2 diabetes, prediabetes and obesity.

Lisa Shah, M.D., chief medical officer of Twin Health, explained that the digital twin technology creates a replica of an individual's metabolic function. This enables care teams to predict outcomes for each individual as well as the medications and lifestyle changes that would most benefit them.

"It's really the new standard in metabolic care because it's real-time, it's personalized and it's continuous," she said.

The company's Twin Precision Treatment Program combines the AI digital twin with a team of clinicians and health coaches. Program participants receive wearable sensors that gather 3,000 data points daily, Shah said. These data points are used to track health metrics, such as blood glucose levels, weight, blood pressure, stress, physical activity and sleep. These metrics offer the care team insights into the individual's behavior.

According to Shah, the AI digital twin technology leverages the data and insights to provide information on the factors that impact a particular individual's metabolism.

"When we know that, we can then use the digital twin to tell the member in real time throughout the day, the little, tiny changes in their actions or lifestyle choices that they can make that will have the biggest impact on their metabolic health in that moment," Shah said.

Program participants can access the personalized nutrition and exercise guidance via a smartphone app.

For instance, a type 2 diabetes patient could take a photo of their food and upload it to the app. The digital twin-powered app will inform the patient whether their choice is healthy or not.

"When you take a photo of that Chipotle bowl, it'll say:For you, this bowl of Chipotle, it's orange  -- so, really not the healthiest choice you could have made," Shah said. "It's not green, it's not red, but it's orange. And it says: If you eat it, this is what's going to happen to your blood sugar. And it shows you a curve."

The app also provides options for patients, such as adjusting the portion size and walking after eating or fasting for a certain amount of time after meals.

Twin Health's care team also tracks data and patients' behavior and works with the patient's primary care provider to make overarching changes to the patient's treatment plan if needed.

Understanding the study findings

Though the evidence is clear that healthy lifestyle changes can significantly improve type 2 diabetes management, making those changes is challenging due to a lack of information and real-time guidance, Pantalone stated.

Thus, Cleveland Clinic researchers conducted a study to assess whether the Twin Precision Treatment Program could support lifestyle changes compared to usual care in primary care clinics. They published their findings in NEJM Catalyst.

The study included 150 adults with type 2 diabetes, randomly assigning 100 to the Twin Precision Treatment Program and 50 to the control group.

Most study participants assigned to the program (71%) achieved the primary endpoint of a hemoglobin A1c level (HbA1c) of less than 6.5% without glucose-lowering medications, except metformin, at 12 months. Only 2.4% of participants in the control group achieved the primary endpoint.

GLP-1 receptor agonist medication use decreased from 41% to 6% among intervention group participants, and insulin use dropped from 24% to 13%. Weight loss was twice as high within the intervention group compared to the usual care group.

Additionally, significantly more patients in the intervention group sustained the primary outcome for 90 days or more within a one-year period without glucose-lowering medications, except metformin.

The study further shows that overall use of glucose-lowering pharmacotherapy decreased while quality-of-life and treatment satisfaction scores improved from baseline in the intervention group compared to the usual care group.

What the study findings mean for diabetes care 

The implications of the study findings are vast, particularly the finding that the Twin Precision Treatment Program can achieve HbA1c reductions without the use of most type 2 diabetes therapies.

"It shows you the power of the program that you're able to, for lack of better words, replace the Cadillac type 2 diabetes medications and yet achieve these glycemic targets with less medication as well as more weight loss than what was observed in usual care," Pantalone said.

"That tells you that there are some lifestyle nutrition modifications that are taking place that are negating the need for those medicines, and patients are capable through those lifestyle engagements to help facilitate a meaningful weight loss of nearly 9% within a one-year period of time," he continued.

These findings are significant, given the widespread use of GLP-1 medications for the treatment of type 2 diabetes. Pantalone emphasized that he is not advocating against GLP-1s, especially in cases where patients are using the medications for other comorbidities as well, like chronic kidney disease. But given the known side effects of the medications as well as the adverse impact of shortages, having another option for type 2 diabetes patients could be a game-changer.

Beyond GLP-1s, being freed from other type 2 diabetes therapies could significantly enhance patients' quality of life. Pantalone shared an anecdote about one of the intervention group participants in the study who was able to reduce their dependency on type 2 diabetes medications, allowing them to take up hobbies they had previously been unable to enjoy, such as hiking. Reducing type 2 diabetes therapies, like insulin shots, meant that the patient could go on long hikes without taking his injection paraphernalia as well. 

"That story isn't something that you can easily translate through this research article, but that's how impactful these sorts of interventions can be," Pantalone said. "And so, it's very important for us not to just minimize it or to overlook just how empowering this could be for patients."

Not only that, but getting real-time, continuous support is invaluable for patients looking to make fundamental lifestyle changes. Pantalone emphasized that the frequency of personalized feedback for patients is crucial to sustaining behavior change.

Shah echoed this, adding that the granularity of the personalized recommendations -- such as whether walking 7,000 steps would be more beneficial for an individual versus running on a treadmill for 45 minutes -- alleviates the day-to-day stresses of managing type 2 diabetes. 

Digital twin technology holds immense promise in addressing complex chronic diseases like diabetes. Pantalone hopes that the study findings will highlight effective alternative strategies to managing chronic diseases.

"Perhaps we can, with the right tools, the right technology, and really leveraging what's available to us, make meaningful changes in [diabetes patients'] lifestyles to really help manage diabetes with less therapy," he said.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.