Susan Blank, Class of 1995 alumna and endocrinologist has recently created a motivational text messaging program, BEATDiabetes, to help patients suffering from Type 2 diabetes make lifestyle changes that helps them manage the disease — and do so at a potentially lower cost than pharmaceutical options of a similar efficacy. The program provides tips and motivation to patients outside the clinic and encourages them to regularly make healthy lifestyle choices, ultimately improving their prognosis. Blank hopes that BEATDiabetes will help those in areas with limited access to healthcare and plans to partner with employers to be able to offer the program as part of employee wellness programs. While working as an endocrinologist, Blank noticed a pattern among her patients diagnosed with Type 2 diabetes. “I was trying to figure out ways to support [patients] between visits,” Blank said. “As a doctor, I would see somebody every three or four months and ... I would think that we're both on the same page ... and then they would go back into their regular lives and gradually go back to what they were doing before.” She became concerned and wanted to help her patients make the choice to lead a healthier lifestyle. After reading an article about how text messaging helped pre-diabetic patients avoid becoming diabetic in India, she was inspired to use texting as a platform to help her patients. Her additional interest in behavioral economics was the third major ingredient that led to the development of BEATDiabetes. The program consists of text messages and financial incentives for participating patients. Patients begin the process by signing up online or on paper and answer a questionnaire about their individual condition and preferences for the program. The information from the questionnaire is used to personalize messages — such as ensuring that a disabled patient does not receive a text reminder to take a walk — and to schedule custom messages, such as inspirational song lyrics, Blank explained. Patients receive text message tips about three to five times a week. Some examples of these texts include saying to fill half your plate with vegetables or to drink water before meals to feel fuller. Patients can opt to receive more reminders for things such as checking blood sugar or taking medications. “The hard part about diabetes is you just make so many choices in the course of your day about what you eat, how much you eat [and] how much you move,” Blank said. Because of this, she said, it seems helpful to remind patients once in a while about healthy choices to make. Another problem Blank mentioned is the lack of motivation in many Type 2 diabetes patients due to the lack of major health consequences for 10 to 20 years. This apathy commonly found in many patients led Blank to add financial incentives to the program in order to further encourage patients to make lifestyle changes. One example involves lowering hemoglobin-A1C, a protein quantified in diabetes patients as a measure of blood sugar levels. If patients can lower their A1C by one point or lower it to the target of seven while in the program, they are entered for a $1,000 drawing. In order to confirm the patients’ progress, the BEATDiabetes program has access to patients’ clinical records with their consent on a release of information form. The information is analyzed for awarding financial prizes as well as to shift text messages if patients start to show signs of improving their condition. Blank first launched the program in the fall of 2017 and ran a one-year pilot with 44 Charlottesville patients who were identified as being part of a high-risk population with an average A1C of 9.3. Blank explained that the pilot also included financial incentives to patients. She wanted to determine if adding this feature to the program would be a beneficial choice at larger scales. According to Blank, the average A1C of patients in the program for 12 months decreased by 0.8. For reference, she said that studies have shown that a one point drop in A1C is associated with a 37 percent reduction in microvascular complications and a 21 percent reduction in diabetes-related death. After the successful pilot, Blank applied to the iLab’s Incubator program — a program that provides resources and mentorship to start-up ventures. Jason Brewster, director of the Incubator program, explained why Blank and her program seemed promising. “What she found is that the outcomes [of providing financial incentives] could be as good or better, dollar-for-dollar, than somebody taking medicine," Brewster said. According to Brewster, this finding and the pilot’s success were indicators of a good fit for the Incubator program. “Once you have early indications of success, then our program is very good at helping you figure out what you need to do next, [and] how you start thinking about this around scale and support,” Brewster said. Blank said that she found the program helpful from the perspective of someone outside of business and further added that she enjoyed working with others like her who were facing similar struggles with their start-ups. “Along with the personal relationships with mentors and fellow participants, I think my main takeaway was a framework to think about entrepreneurship,” Blank said. Blank decided to make BEATDiabetes a non-profit organization, with current funding coming mostly from grants. Patients do not have to pay any fees to participate, as she wanted to target those who may be facing financial hardships and are not able to afford expensive medicines to manage their diabetes. In the future, she hopes to receive government funding, as well as include her program as a part of employer wellness programs offered by companies. In terms of the future outlook of the program, Blank hopes that it can help bring care and attention to patients with little access to healthcare. "I think especially for patients who have limited access to care, who live in rural areas, telehealth, text messaging … anything that you can use to help reach patients who may not otherwise have any access to care is super helpful," Blank said. Brewster also expressed high hopes for Blank and BEATDiabetes, saying that entrepreneurial success relies on “who you are, what you know and who you know” and that Blank exemplifies the interweaving of these qualities in her program. “She's a physician, she's classically trained, she knows the problems, the indicators, the complications of diabetes,” Brewster said. “And she knows how people can improve their lives — people who are diabetics or pre-diabetics,” he continued. Harrison Professor of Medicine and endocrinologist Ananda Basu, who works at the Center for Diabetes Technology at the School of Medicine, also said that the program is a good approach that leverages the power of technology to help patients. The CDT consists of faculty as well as biomedical engineers who do research and come up with technological solutions — such as the artificial pancreas — to help patients with Type 1 and Type 2 diabetes. Basu also expressed concern over patients’ ability to afford treatment options, including technological devices such as glucose monitors that have been shown to be effective in multiple studies. According to Basu, insurance coverage is the single largest limiting factor for patients. “I see that the majority of my patients don’t have insurance or are on Medicaid or Medicare or are on financial assistance,” Basu said. “And the majority of my patients cannot afford these simple technological devices just because they have to pay a large amount out of pocket.” In this vein, Basu said that a program like BEATDiabetes could be very powerful, saying that all diabetes patients could benefit from lifestyle changes. "The hope for the program is, if you do it for a year, that these changes become habits,” Blank said. “And we had one lady who told us, 'Now I'm even checking my blood sugar before I get the text message.' And that's what you want to see, that it becomes routine and habit and even when you take away the prompts and even when you take away the extra motivation of money, that people will continue on that same trajectory."