CEO of Quin: Cyndi Williams | Terra Podcasts

Key takeaways

Quin focuses on the 24/7 self-management needs of diabetes patients, emphasizing personalized education and support.
20% of Quin's users engage with the app for 15 days or more each month, a high rate for health apps.
Quin has achieved 5% to 10% improvements in users' time-in-range, a critical diabetes health metric.
Cyndi Williams co-founded Quin after realizing the relentless nature of diabetes self-management from her co-founder, who lived with diabetes for over 20 years.
Quin's approach includes addressing diabetes distress, a significant factor in improving health outcomes.

In this podcast with Kyriakos the CEO of Terra, Cyndi Williams shares insights on Quin's journey to support diabetes patients. Quin's app, live in the UK and US, boasts a 20% user engagement rate for 15 days or more each month. Cyndi discusses how Quin's personalized approach and focus on diabetes distress have led to 5% to 10% improvements in critical health metrics.

Kyriakos: Cindy, great to see you again. Why don't we start with an introduction on what you are working on? Cyndi: Yeah, good. So I am the co-founder and CEO of Quin, which is a digital therapeutic focused on self-management of diabetes. We're 100% focused on the 24/7 needs of an individual, starting with the fact that 99% of diabetes care is self-care done by the individual when they're away from their doctor. It's a lifelong learning journey. People are making hundreds of decisions a day about things that most of us just take for granted. So can I eat this now? Can I get in the car and drive? Can I go into this meeting without passing out? There's just layer on layer of uncertainty about everything from activity to sleep to stress. Lots of things going wrong, lots of ups and downs just in day-to-day life. We take data from diabetes devices and phones and build complex models of personal behavior and physiology. We use that to curate hyper-personalized education, support, and guidance based on each individual's personal past experiences. We've been live in the UK for over a year and in the US since November of last year. We're seeing extraordinarily high engagement rates and improvements in critical healthcare metrics. Kyriakos: I think something very interesting you touched upon was that each individual is different. So you would need different data sources and maybe different outcomes for each person. Having said that, can you walk us through how you started? Cyndi: Yeah. I started seven years ago now, a little over that, along with a co-founder. She's now gone on to do her PhD, but she'd been living with diabetes for 20-plus years at the time that we started. She clued me into the relentless nature of self-management of the condition. We set the company up around that, thinking about how we can use phones and wearable devices to alleviate some of the cognitive and psychological loads. We spent the first year working out of the British Library in London, interviewing people with diabetes. We quickly realized we needed to create a medical device, so we worked out the regulatory strategy and raised some money to develop an MVP. It was wrong, and we had to iterate. I always say Quin is really three companies. The first two failed, and the third one is now working. Kyriakos: So it sounds like the problem was always the same, but then the execution took three different products to come to the right moment. What was the first MVP you created? Cyndi: The first MVP was focused on insulin dosing. How much insulin should I take and when? It's a lot of guesswork and trial and error. We wanted to make that easier by helping people recall past experiences. But we realized there's something bigger: the mental health aspects of managing diabetes. The world of diabetes management is set up around getting good blood glucose results, but 80% of people don't achieve that target. This leads to diabetes distress. We saw that we needed to treat diabetes distress to improve health outcomes. Our app became more education-oriented, focusing on personalized, relevant information to help people manage their condition. Kyriakos: Can you give me the foundations of diabetes? What does it mean? What should the levels of your glucose be? And then what about your insulin? Cyndi: Diabetes is an umbrella term for chronic high blood glucose. There are two main types: type 1, where your body isn't making enough insulin, and type 2, where your body isn't using insulin properly. Insulin allows cells to take glucose from the blood. If you're not making or using insulin effectively, your blood glucose is high. The endocrine system, which diabetes affects, is very complex. There are two major metrics: time in range and HbA1c. Time in range measures how often your glucose is in a safe range, and HbA1c is the average glucose over a period. Managing diabetes involves measuring glucose and adjusting insulin based on various factors like activity, stress, and diet. Kyriakos: It sounds pretty difficult because let's just assume that you don't have a glucose monitor that is measuring all the time, right? How would you know what's the dosage and what are the right things to do? Cyndi: You're going to measure your blood glucose before eating and make a guess about insulin dosing. If you have access to testing strips, you'll check your glucose two hours after eating to see if you need more insulin. It's a guessing game, even with continuous monitoring, because you can't predict everything that will affect your glucose. The individual has to be involved in the decision because they know their plans and how those will impact their glucose. Kyriakos: You mentioned something I've never heard before. If someone gets angry, is there a chance for the glucose to go higher? Cyndi: It can be, depending on the person. It's hormonal, involving cortisol and adrenaline. When we rebuilt the product, we focused on understanding diabetes distress and providing education. People often aren't taught about how insulin behaves, so we provide small, relevant pieces of education. We acknowledge that managing diabetes isn't an exact science and offer support to deal with uncertainty. Kyriakos: And basically once I sign up for Quin, then what do I get as a user? Cyndi: You download the app, and we start learning about you. We give value for every piece of information you provide. We say three minutes a day for three weeks helps us understand you enough to give guidance. Insights around insulin and dosing are key. As a business decision, we initially focused on type 1 diabetics because of the deep subject matter expertise and unmet needs. We're now expanding to type 2, focusing on understanding where people are in their diabetes life and helping them break the cycle of distress. Kyriakos: Once you launched, how did you go about finding the first few customers? Cyndi: We had a research program with hundreds of people co-creating with us. We recruited on social media and built a social presence. Our marketing strategy included content creation, influencer programs, and multi-channel marketing. We've had over 40,000 downloads. Our initial funding was friends and family, which allowed us to release a product and complete regulatory requirements. We've raised over five million U.S. dollars in smaller tranches, with the same angels supporting us across rounds. Kyriakos: That's pretty interesting. So for someone that starts today, how do you approach these people? How do you find them? Cyndi: Our angels came from our networks. We have one angel group, E100, but the rest came from personal connections. Investing in your networks is crucial. It makes a big difference in getting support and resources down the line.

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Exploring ketogenic diets

Kyriakos

If we touch a bit on nutrition and maybe training as well, when it comes to nutrition, what's something that works in this context? I hear a lot about ketogenic diets, for example, where basically you reduce the carbohydrates level to zero and technically the glucose levels. Does something like this work or not?

Cyndi

It works for some people. I mean, that's the thing, we have to remember it's an incredibly complex condition. Everyone's biochemistry is unique to them. Whatever is broken in your endocrine system could be different than what's broken in mine, broken in someone else's. So it could work. And also some people could just be not in cultures where carbs get eaten that much. It's not hard for me to cut carbs and I have the kind of diabetes that this thing actually works for.

Cyndi

I think Virta is probably the best example. They've had recent studies released that show a lot of success really on their platform. A lot of it is about a keto diet basically. Keto can work for a lot of people. I think there's not enough research into the long-term effects and complications related to keto. So that needs to be looked into. But yeah, it can work. But I think that's the problem in diabetes.

There's no one size fits all. There's no one solution that says, if we all do this, then we're gonna get this result. We've got to remember, people are people. They're not just diabetes patients. That's not feasible, viable, or desirable to do keto for a lot of people.

Cyndi

We just have to look at solutions that work and try to be as personalized as we can in the approaches. You still need to stratify at some level just to get started with technology and solutions. So you've got to find ways to say, okay, these kinds of people could respond well to this kind of a solution. Let's put that together. There's a ton of research around that, basically stratifying and saying, what's gonna work with whom?

That needs to continue. But I think the more and more personalized that we can get with the therapies, and that's something that digital and data and algorithms allow us to do really.

Personalized health solutions

Cyndi

If you think about what we've done in gaming and social media to really get to know a person and place an ad in front of them, that's exactly what, I mean, those companies know a lot about us. Those technologies have been, whether we like it or not, very smart in personalizing things for us. I think we've not even begun to do that really in the health space, certainly not in diabetes and chronic conditions more generally, but in health across the board.

There's so much more we can do with technology to really understand who is this person, not patient, but person. What do they need? How can we support them where they are in their life, in the life that the condition that they're living in and put the right kinds of solutions in front of them. It's gonna be different for everybody. And that's so hard.

Kyriakos

I guess it's an engineering question as well. The more data you have and the more hardware devices you get, the more understanding you're going to have of the problem. Then you would need to create many feedback loops in order to test, iterate, and learn how each individual's body reacts, which is different in each person, and then give them a very personalized recommendation, which is so much different from what we've used for the last 20 years, isn't it?

Cyndi

Yeah, totally. I mean, that is what you're seeing, like all these different metabolic companies and platforms, like understanding for you personally, how does this food affect you? How does that affect you? How does this exercise affect you? That kind of thing. We can definitely go a lot further in that, but I think we can also do it at the psychological level. What is this person's personality? Are they somebody who's super achievement-oriented or someone who's a bit more relaxed?

Cyndi

One of the big things we look at, particularly in diabetes, is how can we personalize and do patient-led engagement with your healthcare team, basically. So helping the individual understand who are all these people in my healthcare team? What could I use them for? What do I want out of them? What are my goals in working with this team of people? How do I want to be approached and handled and treated in a conversation?

Am I somebody who needs much more emotional support versus like, let's sit down and look at numbers for eight minutes and pick on specific things and really personalizing it to that level, kind of help, like so dealing more with the kind of emotional, mental side of things, in addition to, okay, how does your body react to this particular food?

Patient-led diabetes management

Kyriakos

Fantastic. And then, just last question from me. Where is Quin in five years?

Quin's five-year vision

Cyndi

We are definitely, as I mentioned already, we're expanding now beyond type one into type two. Our approach is all about self-management of a condition as a lifelong learning journey. It requires skills and education and knowledge and personal understanding and motivation and support through that journey. How can we use data and algorithms and really good user experience, like really thoughtful user research and understanding and experience to provide solutions for people who are self-managing chronic conditions, basically, so to help them through that lifelong learning journey?

Cyndi

We see doing that type one, more segments of type one. We've not even begun to cover all the people there. Type two and several segments of type two. I don't know if we'll be able to do everything well. Then moving into other chronic conditions down the line. I think in five years, we will certainly have done a very good pass at type one and type two, and we'll be in a few others as well. Again, all about really self-management.

We're not talking, I mean, I think what we see in the industry right now is taking the existing care models around diabetes, around MSK, around, I mean, name your chronic condition. People are looking to digitize that. We've basically taken the care models, which may or may not be working for individuals, and put digital stuff around that. We've not acknowledged the self-management load here. So much of chronic condition management is self-management.

Cyndi

Really just going deep into that and empowering people to better manage on their own when they're away from their doctors, living their day-to-day life, which is where most of the care happens, and really going after that. So not virtual care solutions backed by doctors looking to digitize the healthcare system, but rather deep in the weeds, in the wild with that individual 24 by seven as they're going through life. And actual life, not just patient life, but their life.

Empowering self-management

Kyriakos

Fantastic. Cyndi, thank you so much for this podcast. And we will speak soon.

Cyndi

Yeah, thanks for having me.

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