Medworks – Managing Gestational Diabetes

Research shows that undiagnosed diabetes and gestational diabetes approximately affects 10%-25% of pregnancies globally. The problem is more pronounced in developing countries, resulting in increased risk of premature birth, immoderate birth weight and hypoglycemia for the infant, as well as increased blood pressure, pre-eclampsia and development of Type 2 diabetes for the mother or child in the future.

Leveraging self-monitoring of blood glucose technology, Medworks provides access to management of GDM via telemedicine. With real-time monitoring of blood glucose, diet, weight, exercise and blood pressure our cost-effective solution aims to nudge pregnant women diagnosed with GDM to adapt a healthier lifestyle with medical nutritional therapy and physical activity recommended by the HCP. At an institutional level, reducing the likelihood of pregnancy complications will reduce referrals to specialists and the need for using insulin for treatment. Subsequently, removing the burden on a health institution’s resources.

According to the International Diabetes Federation, 20 million births were affected by GDM in 2019 globally. With limited data available on GDM in Pakistan, there is little consensus on the national prevalence rate as studies have observed varying results in different parts of the country. However, research conducted with a sample of 11,430 participants in 2019 shows 11.8% individuals were diagnosed with GDM. Risk factors include being overweight, excessive weight gain during pregnancy and family history of diabetes. Meanwhile, hospital expenditure and outpatient care are major contributing factors to a high economic burden for diabetes management. The COVID-19 pandemic adds an additional barrier for seeking consistent healthcare as pregnant women with diabetes are at a higher risk for developing complications and are advised to practice social distancing. This interferes with attending regular appointments with physicians, leaving women with GDM vulnerable to complications. 

Our solution aims to improve the health outcomes of pregnant women diagnosed with gestational diabetes and their newborns. We are collaborating with hospitals and diabetes clinics to better understand the needs of women with gestational diabetes to offer a service that can effectively avert complications during pregnancy and upon delivery. 

The solution consists of mobile and web applications, as well glucose monitoring equipment that that interfaces with the smartphone. Through the application, we enable real-time data sharing, communication and goal setting for women with GDM. 

Our solution aims to improve the health outcomes of pregnant women diagnosed with gestational diabetes and their newborns. We are collaborating with hospitals and diabetes clinics to better understand the needs of women with gestational diabetes to offer a service that can effectively avert complications during pregnancy and upon delivery. With the help of diet and exercise to maintain glycemic control, we aim to reduce pregnancy complications, ts, maternal and child mortality rate as well as the possibility of developing type 2 diabetes in the future. Subsequently, improving the likelihood of safer deliveries.

A meta-analysis of 32 RCTs on GDM management found telemedicine can favorably impact glycemic control as well as reduce risk of maternal and fetal complications, in comparison to clinical care practices. Additionally, a web intervention offering remote monitoring has found evidence for the feasibility of telemedicine to supplement clinical care among women with GDM. Such solutions ensure consistency in treatment and prevent complications from escalating further, resulting in fewer referrals and cost savings from seeking specialized care. 

Problem - Gestational diabetes mellitus (GDM) affects maternal, fetal and newborn health that can hinder the quality of life if managed poorly. GDM contributes significantly pregnancy complications such as pre-term birth, stillbirth, excessive birth weight, and breathing difficulties for the newborn. It also results in more C-section births. Furthermore, it increases the risk of a chronic disease among future generations.

Solution - By digitizing diabetes management, we expand access to high quality care by improving service delivery through real-time reporting, virtual communication, and dashboard views that help identify at-risk women. Through our phone-compatible glucometer, we also contribute to improving diagnostics. 

We incorporate smartphone-enabled devices to record glucose data from the comfort of a patient’s home. However, our true innovation lies in interfacing this device with mobile and web apps that are connected using a secure cloud-based solution, and enabling real-time data sharing. For diabetes management, context to data matters when prescribing treatments. Through enabling patients to add comments, track their food consumption, record exercise, and log their medicines, we provide rich context to the glucose readings so that an HCP can know exactly what is going on before they make any modifications. The HCPs can then consult with their patients through the in-app video or text chat to make any adjustments necessary.   

The Medworks application saves blood glucose readings on a smartphone using a mobile compatible glucose meter. Additionally, information regarding caloric and carbohydrate consumption, weight, blood pressure and physical activity can also be logged to track essential lifestyle parameters for GDM management. Saved on a cloud server, to offer data privacy and data protection, HCPs can monitor progress on the data dashboard on the web application. This includes ensuring glycemic levels are within target as identified in the individualized patient plan, through automated flagging and viewing interactive charts for observing trends pertaining to various metrics. Doctor-patient connectivity supports remote counseling in real time through a built-in chat module to facilitate better decision making and improve healthcare compliance.  

Women in Pakistan may forego treatment if they are unable to visit a clinic for routine care due to proximity issues and cultural norms. Using telemedicine, we want to increase coverage of healthcare services by connecting women with gestational diabetes to their HCPs through digital appointments. In doing so, we aim to reduce the need for physical visits to the doctor to prevent the spread of COVID-19 and reduce exposure among patients and HCPs, while offering continuous care to women with GDM.

There is evidence in favor of telemedicine for remote management and counseling on patients with chronic illnesses. Telemedicine is a means to increasing access to quality healthcare services and is cost-effective. Its benefits can be enjoyed by vulnerable groups as well those living in remote areas. It can be a valuable tool for strengthening healthcare systems to increase universal coverage. A survey conducted by WHO Global Observatory for eHealth shows there is growing interest in this space globally. 

Precision medicine identifies a patient-centric treatment plan for treatment success. Behaviorally designed interventions that leverage healthcare data to nudge patients to adapt healthier behaviors can achieve better outcomes. Providing a feedback loop between patient and the doctor can increase self-efficacy and provide support for managing chronic illnesses.

Benefits from telemedicine range from increasing compliance, health knowledge and improving self-care efforts. Simultaneously, research on self-monitoring blood glucose technology supports evidence for achieving better glycemic control.  

Researchers have also found that the usage of mobile technology in self-monitoring blood glucose resulted in a higher frequency of testing to achieve glycemic control. A study in Vietnam observed a decline of glucose level in the first two weeks and a clinically significant HbA1c reduction by self-monitoring blood glucose with the use of mobile technology. There is also research in favor of managing other non-communicable diseases through telemedicine as well.

Using self-monitoring blood glucose technology to record readings on the Medworks mobile application, HCPs can remotely monitor glycemic levels among pregnant women diagnosed with GDM. Patients can seamlessly record data points on diet, exercise, weight and blood pressure to share crucial information with their HCPs for effective management. 

Meanwhile, setting reminders for blood glucose readings and medication can improve adherence for achieving better health outcomes. Real-time data sharing with HCPs prevents dissemination of erroneous information due to poor memory or peer pressure, allowing HCPs to make informed decisions to help women manage GDM effectively. They can intervene through the chat module to nudge individuals to adapt a healthy lifestyle by providing medical nutritional therapy and suggesting ways to incorporate physical activity in their daily routine.

In receiving individualized care, women with GDM are more likely to consume the required amounts of carbs, fats and proteins. Following personalized guidelines will allow women to sustain a BMI according to their pre-pregnancy weight to maintain adequate maternal weight gain and fetal growth. Successful GDM management can reduce the risk of complications during pregnancy and at the time of delivery. Hence, reducing maternal mortality rate and child mortality rate. Meanwhile, along with reducing the likelihood of developing type 2 diabetes for the mother, the transgenerational effects can also be minimized by controlling glucose levels during pregnancy. This includes the occurrence of diabetes, kidney disease, obesity and hypertension among children.

Currently, we are serving 2000 individuals. However, these are not specifically gestational diabetes patients, but all are patients. In one year, we aim to reach 25,000 people and in 5 years 300,000. This, again, is not just GDM patients, but the overall population.  

In the next 12 months, we want to build a UI/UX that caters specifically for women having GDM. We want to facilitate 10,000 remote consultations, and equip 500 women with smartphone compatible glucometers. We want to incorporate personalized notifications that are triggered in response to certain clinical parameters.

In five years, we want to scale to impact 100,000 individuals in Pakistan and the SAARC region. We will facilitate at least 2 million remote consultations through video link, and continue enhancing our platform. We would like to deploy content aimed at women with GDM, and maternal health more broadly.  

The political economy of health service delivery is one of the challenges we expect to encounter. HCP incentives are often misaligned with the objective of good service delivery due to the influence of large pharmaceutical industries and rent-seeking behavior. Organizations and individuals are averse to partnerships due to a low trust factor, and we feel striking partnerships with institutions and public health programs may be a challenge. Furthermore, although broadband usage is growing, it is still relatively low in our target populations, which may impede interventions such as video-based consultations.  

To address broadband accessibility, we would like to develop partnerships with telecom companies who can offer subsidized or free broadband packages of a certain number of megabytes for our target populations. We also feel that through alliances with programs such as MIT Solve, we would gain credibility that can help us forge strong partnerships. We would also like to leverage similar alliances through other entities to help us pass the gatekeepers of institutions treating GDM, and enable us to develop partnerships whereby we can deploy our solution. Addressing corrupt practices in the healthcare sector is a larger challenge that we believe we cannot directly address, but we would try our best to find the right partners to help us bypass individuals engaging in these practices.  

Our team consists of 4 full-time employees, a technical advisor and a contractor for mobile development.

A dynamic group of individuals makes up our team at Medworks. Our founder, has done his Master’s in Public Administration from the London School of Economics, and has experience working in digital health in a resource-constrained setting in Pakistan previously. He has worked as a Business Analyst, gaining experience in finance and financial modeling. Meanwhile, our technical advisor has 20 years of experience working with several programming languages. He is an Enterprise Software architect and is Director of Engineering at 10Pearls – a leading software house working on many health applications. His expertise in data security and data privacy, along with his prior work in telemedicine proves valuable in the development of our mobile and web applications. His understanding of the pain points experienced by doctors and HCPs allows us to create a solution that is robust. Meanwhile, our software engineer handles the entire web development and ensures clinical workflows are incorporated for effective remote-monitoring. Furthermore, the Business Manager has worked in public health research, implementing several programs in low-income communities. This allows her to develop valuable partnerships with primary care clinics, tertiary care hospitals and diagnostic centers.

We work with Interactive Research and Development as a referral partner for their COVID-19 mental health response, whereby counseling services are provided to individuals who have reported for COVID-19 testing.

We work with Genetics Pharmaceuticals – a large pharma company in Pakistan – and have deployed a solution for them whereby their mass glucose screenings are digitized and they get a dashboard view of all test results from across the country. We also supply them with the device and the consumables.  

For our commercial operations, we have collaborated with several pharmacies and pharmacy chains, including some of the biggest ones in Pakistan, giving us access to over 50 pharmacies in our home city, Karachi. We supply them with the hardware to sell through their pharmacies, ensuring a steady proliferation of digital diabetes management in Pakistan.    

Medworks is currently a for-profit organization. However, we wish to integrate the GDM program to deliver a social impact. We will provide our target populations with the ability to remotely consult with a healthcare provider. Our key activities will be the provision of our mobile and web apps, as well as the provision of glucose tracking hardware.

Our target populations will benefit from these resources as up to 25% of all pregnancies, depending on the specific country, encounter gestational diabetes. Women who develop GDM encounter higher chances of C-section births, premature birth, stillbirth.

To understand the impact of our intervention, we would like to track the overall blood glucose averages for various meal times, percentage of readings within range, highest and lowest BG values.

Key Resources:

-Strong financial and business modeling skills in the team, as well experience in healthcare delivery

-Strong linkages in the health sector in Pakistan, including access to mentors in public health organizations.

Key Activities: 

-Providing real-time counseling to women diagnosed with GDM. Delivering information on lifestyle interventions.

Partners:

National Incubation Center

Clinic 5

Sindh Public Private Partnership Initiative

Interactive Research & Development

Intervention Type:

Software and IoT medical devices

Channels:

Access patients through partners

Value:

Decrease maternal and childhood morbidity and mortality, reduce risk of complications

Revenue:

Grant-based

Support from telcos

If pilot proves successful, we would charge future users for the hardware, and charge healthcare institutions a minor fee from platform usage.

Cost Structure:

Program Implementer and HCP salaries

Software Developers

Content development cost

Medworks is currently a for-profit organization. However, we aim to integrate the GDM program within our offering. Our partners currently include the National Incubation Center, which provides space and other forms of support, such as access to their mentor network. Microsoft offers us cloud-support, providing us with startup credits to ensure that our cloud-based solution stays securely deployed. SAMI Pharmaceuticals – a large pharma company in Pakistan – helps us through improving our distribution reach. Our current revenue source is through the sales of hardware and software, as well as through software development services for certain pharma clients.

To pilot the GDM program, we will solicit grants. Once a proof of concept is established, we would like to make it financially sustainable through charging patients for the hardware. Furthermore, we would like to charge healthcare institutions for the use of our platform.  

Solve offers exposure to a a broader audience, which can be extremely helpful in us getting exposure and recognition. Furthermore, it offers a strong support network, with an extremely qualified peer group, experts and funders who can help us with the challenge of scaling.  

While Solve can also help us tap into funding sources, equally, if not more important, is the personalized support our team will get over the course of nine months. The partnerships this would help us build can help not just in Pakistan, but even beyond, would prove extremely valuable. The multiplier effect from associating with Solve and its partners will enable us to greatly augment our impact, and help improve many more lives.   

Business Model - We would like to provide the platform to institutions and charge them a fee. However, given the low-resource settings we operate in, institutions may hesitate in providing any fee. We would like mentorship on the right product mix pricing strategies to help us integrate our product.   

Product Service/Distribution - A challenge for us thus far has been access to patient populations, and incorporation of our innovation into existing service delivery programs. Through Product & Service Distribution partnerships, we would find it easier to reach populations who can benefit from the solution.

MIT offers a plethora of resources to technology companies pursuing innovative technologies. Some of the organizations affiliated with MIT that we have identified for partnerships include the following - 

MIT D-Lab Mobile Technology Group - The group focuses on mobile technologies that have a social impact, and with its emphasis on UI design, we feel we can adopt many good practices and learn from the group's members.

Martin Trust Center for MIT Entrepreneurship - The center has many faculty members affiliated with it who provide exceptional mentorship opportunities. One such individual is Professor Elaine Chen - her extensive experience working with healthcare companies, as well her expertise in fostering public-private partnerships, would be helpful for us as we try to forge some of these partnerships ourselves.

UNFPA - The UNFPA lays strong emphasis on maternal & child health, highlighting the role of strong health systems to ensure good service delivery. A partnership with UNFPA can help us reach target populations by helping us 

Gestational diabetes mellitus (GDM) affects maternal, fetal and newborn health that can hinder the quality of life for women if managed poorly. GDM contributes significantly pregnancy complications such as pre-term birth, stillbirth, excessive birth weight, and breathing difficulties for the newborn. It also results in more C-section births. Furthermore, it increases the risk of a chronic disease among future generations. 

Our solution digitizes diabetes management. In doing so, we expand access to high quality care by improving service delivery through real-time reporting, virtual communication, and dashboard views that help identify at-risk women. Through our phone-compatible glucometer, we also contribute to improving diagnostics.  

Pakistan accounts for 7% of neonatal deaths globally, estimating to a mortality rate of 49 per 1000 live births. Curtailing adverse pregnancy outcomes through effective management of gestational diabetes can reduce complications. These complications can result in pre-term birth, comprising of 28% of neonatal deaths worldwide. Our solution aims to strengthen healthcare infrastructures by making management of GDM ubiquitous in both, urban and peri-urban communities where logistical challenges may hinder access to quality healthcare.

By digitizing hospitals and clinics with our secure cloud-connect diabetes solution, we aspire to equip HCPs with the tools needed to acquire accurate information about patient health in real-time. So trained diabetes professionals can remain connected with women with GDM to administer compliance to an individualized patient plan. The data dashboard on the web application will allow HCPs to monitor patient progress and identify high-risk individuals that need immediate intervention. Thereafter, regular feedback can be provided to keep glucose levels in control with diet and exercise through video consultations and text messages. By offering a medium to provide individualized care, our solution can improve HCP satisfaction as shown in research conducted of other telemedicine solutions. Meanwhile, by remotely connecting HCPs with women with gestational diabetes, we want to safeguard the health of both of these groups from COVID-19 that can put patient and their HCPs at risk.