The Greens App Scales Diabetes Management with a Focus on Teens from Vulnerable Communities
By providing an AI-based digital platform that offers culturally-focused meal prediction, positive reinforcement, and an inclusive community of care, the Greens app by Xplosion Tech makes adhering to a treatment plan easier for young diabetes sufferers and their parents.
Investors, learn how you can back Health Transformers like Kehlin Swain, Isis Ashford, and Jaylen James, PhD — the Xplosion Tech team behind the Greens app.
Challenge
A diabetes diagnosis comes with a necessary list of changes to lifestyle and eating habits. Overnight a person must begin thinking about checking their blood sugar levels, changing their diet, and taking insulin.
But changing health behaviors doesn’t happen overnight or after a single conversation with a doctor. In fact, changing habits may be the hardest part of a chronic disease diagnosis. There are a multitude of factors that come into play when it comes from translating clinical best practice into a daily routine of disease management.
Some of these factors are cultural. While diabetes can affect anyone, it has hit the Black community the hardest in the United States. According to the American Diabetes Association (ADA) the prevalence of diabetes in non-Hispanic Blacks is 11.7%, versus 7.5% in non-Hispanic whites.
Within the BIPOC and economically-disadvantaged community in the American South, a chasm has opened between what doctors recommend for a patient with diabetes and what patients feel they can carry out on their own. When cultural norms around food run deep, it can be extremely difficult to reconcile “healthy foods” with “tasty foods.” These issues are compounded when the patient lives in a “food desert” where healthy foods aren’t readily available.
The result is a feeling of failure. If a patient can’t quit eating rich foods that have been cultural traditions for generations, they’re demonized. If they aren’t changing habits fast enough, they’re told they must not value their lives. Too often, medical professionals approach chronic disease with an attitude of, “you either want to eat healthy or you’re willing to die,” rather than acknowledging the need for baby steps in habit change. This leads to patients not being honest about the foods they’re eating for fear of recriminations, which then puts their health at further risk and erodes trust between them and their physicians.
Meal tracking apps take care of part of the problem, helping people with diabetes track their food intake and stay on a healthy diet. But checking each piece of food independently is tedious and time consuming. This is particularly challenging when the patient is a teen, and parents end up doing a lot of guesswork.
So how can diet management and food tracking be made easy and accessible while also building a community of care that understands the cultural underpinnings of food and the challenges of behavior change? And for kids specifically, how could diabetes management be less overwhelming and parental concerns over their teen’s wellbeing be alleviated as they navigate this disease?
Founders of the Greens app pulled from their own experiences to solve these challenges.
Origin Story
Just before the pandemic, electrical engineer Isis Ashford’s father was diagnosed with Type 2 diabetes. He needed to completely change his diet and learn a variety of things he had never done before. It seemed simple enough when talking about it in the doctor’s office but putting these changes into real-life practice felt almost insurmountable, especially when part of this lifestyle change required remembering the nutritional information of the foods he was eating to understand how much insulin he needed to take and when to take it.
There was also a cultural disconnect from what the doctor was prescribing and what Ashford’s father was used to doing. Being from a small town in Alabama, Ashford’s dad grew up eating and loving greens of all kinds: collard, mustard, turnip, etc. Kale, however, was not one of them. Doctors kept pushing Ashford’s father to eat kale, but no matter how many ways the family prepared it, he couldn’t get behind it. He wanted “his” greens and physicians couldn’t understand what difference it made.
The whole family rallied to help him, and they wanted to support his wellness journey, but the divide between his habits and lifestyle and what physicians were recommending was wide. Instead of taking his current diet and coming up with creative ways of improving it, medical professionals took an all-or-nothing approach: “Either stop eating that food or your diabetes gets worse.” He was demoralized.
At the time, Ashford was running Xplosion Technology with fellow co-founders, computer engineer Kehlin Swain and mechanical engineer Jaylen James, PhD. Operating in the biomechanics space, this digital health platform focused on improving athlete performance using image detection on joints to lower sports injuries.
Faced with the challenges they were seeing in the life of Ashford’s father, and compounded by Swain’s experience growing up with a cousin with Type 1 diabetes, the trio figured out how to use their biomechanics experience to help people with diabetes. They began their research in collaboration with the National Science Foundation (NSF) and after speaking to 100 potential customers — diabetics ranging from gestational to Type 1, Type 2, and more — they began seeing an opportunity. There was a clear differentiation between those who had the tools and ability to manage their condition and those who didn’t.
Some interviewees were on government aided insurance, some were covered through private carriers. Those with access to insulin pumps and CGMs (continuous glucose monitors) had a better time managing their condition and food intake, while those who didn’t have access to the devices not only had difficulty but had no other systems or solutions available to them, causing them to fall through the cracks. Another realization was that of those interviewed, 90% were patients of color. A 2021 National Institute of Health (NIH) study showed a vast disparity between instances of diabetes in the adult non-Hispanic white population and minority communities.
The trio took these insights and began developing a mobile app to help overlooked populations manage their diabetes better. Using the same image detection they created for athletes — this time modified for carb counting — the team could disseminate information through a smartphone or tablet to countless sufferers of the disease, helping them control blood sugar spikes and informing them of how much insulin is needed to stay in a healthy range.
This led to a second inflection point when they went to Camp Searle Harris, a diabetes camp, for one of their first pilots. It was here they discovered another layer of diabetes: diabetes distress.
While carb counting was an issue for the kids they spoke to, a key contributor to diabetes distress was familial and social connections — the misunderstanding of the condition, feelings of isolation that no one understands or is going through the same thing as them, and so forth. Hearing these concerns and disconnects led to the team creating a solution that not only helped manage diet but provided a support system that incentivized users to stay on track.
While the technology works for anyone with diabetes, they decided to hone in on a high-need audience: children in the Southeastern part of the United States. This region has a high concentration of diabetes among people of color and high rates of childhood obesity. They launched their mobile app and called it “Greens” in honor of one of the biggest cultural disconnects Ashford’s father faced as he navigated changing his diet.
Under the Hood
At its core, the Greens app is aimed at addressing health literacy and medication adherence among Medicaid adolescents and families managing their diabetes.
While most apps geared towards people with diabetes are reactive, the Greens app is proactive, reaching out to predict the needs of the young person on the app. It all starts with a natural, contextual chat conversation. Thanks to advances in generative AI, the text exchange between the user and the app is trained to be culturally-appropriate and highly personal. Young people can text as they would talk to a friend about the meals they are preparing to eat and the barriers they’re facing to following their treatment plan. The app responds with easy-to-follow images and prompts that help the user understand nutritional information, solve problems, and plan their insulin regimen.
Greens also saves doctor prescriptions and shares the teen’s meal information with parents so they can see their progress. This way, they can provide familial support and encouragement when they see their young adult is having a hard time and give positive reinforcement when they are doing well.
Geared toward communities that have been traditionally overlooked, Greens does more than keep patients to a diabetic-friendly diet. It also seeks to alleviate diabetic distress by providing a fun, empathetic community of care. It accomplishes this through anonymous compliments for positive behavior from others in the diabetes ecosystem and helps parents and siblings give positive and encouraging support to their family members.
The food monitoring and medication adherence data collected through the app is able to be shared with managed care organizations (MCOs) to help with quality incentives and value-based programs.
Our Take
We’re excited to see how the team at Xplosion Technology is thinking about partnerships and go-to-market strategy. From My Community Health Insurance Plan, to Children’s Hospital of Alabama, to Camp Seale Harris, to Texas Children’s Hospital and Baylor College of Medicine, the company is aligning itself with some of the most important names in the youth diabetes space. They are also expanding the Greens app potential in unique ways by working with the United States Air Force to assist with managing the diet of active service members to ensure they maintain their weight and BMI requirements.
But we’re particularly bullish on the Greens app because of the team, their vision and their focus. They’ve taken their learnings building a digital health solution for athletes and reimagined it to support vulnerable populations with diabetes. They’ve also built on their personal experiences to design a user experience that people can trust.
We are proud to welcome the Xplosion Tech team behind Greens — Isis Ashford, Kehlin Swain, and Jaylen James, PhD— to the StartUp Health community.
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Published: Aug 9, 2023