The tricky balance of diabetes-food-nutrition-exercise effects is “the last frontier that hasn’t yet been conquered,” according to longtime type 1 triathlete and advocate Cliff Scherb. His solution? Create an app for that!
Say hello to the newly released Engine1 app, developed by Scherb, who is from Connecticut but splits his time these days between the East and West Coasts working with the startup he founded in 2014, Glucose Advisors, aimed at bringing his years of intellectual property under one umbrella to build unique new D-support tools.
Engine1’s mission is to offer people with diabetes “the confidence to enable an active lifestyle without the fears of having a low or high blood sugar” based on a smart algorithm that takes all the variables into account when a PWD sets out to be active. It supposedly can predict your BG effects up to 6 hours in advance — wow!
You can check out the Engine1 YouTube video that Cliff created to introduce the new app, as well as this one below. It’s proclaimed to be the first-ever real-time decision-support tool aimed at type 1 diabetes, nutrition and physical activity — a big claim to make in this highly-saturated world of mhealth apps!
We caught up with Cliff recently to learn more about him, and what this new Engine1 app is all about:
An Interview with Engine1 Creator Cliff Scherb
DM) First, thanks for taking the time to talk, Cliff! Can you share your personal diabetes story?
CS) I was diagnosed with type 1 at age 9, so pretty much my whole life as I’m 37 now. My life has really been about trying to solve the riddle of how to be the best diabetic that I could be. That meant exploring my world through activity, exercise and nutrition. So I played a lot of sports growing up. But it wasn’t really until college that I fell in love with triathlons – after all the biking that I did as a kid, track that I did in high school. I then took on some long-term activities like Ironman.
I raced for many years and eventually became competitive, and had a chance to do that professionally in 2007. I later became a coach and age group athlete, and basically have worked with a lot of different type 1s and type 2s all over the world to teach them some of my own methods. I am involved in so many sports endeavors… I have a real hard time sitting still. I just enjoy exploring my world through that exercise.
You founded TriStar Athletes in 2006 – can you tell us more about that?
That’s the first company that I started when I quit my corporate job in pharmaceuticals at Merck. I was enjoying triathlons so much that I decided to leave that job. I became a full-time coach and was coaching and started the company, trying to draw on these concepts for athletes all over the world, mostly in an online portal and consulting role – by Skype or other web-based tools to engage with people. That’s myself and a couple of other coaches, and we work with about 30 to 40 athletes. We help aspiring, competitive, age-group athletes reach their goals. I started that in NYC, and there it was really more a personal coaching type role where I met more people in real life. I then moved it to Connecticut; built a studio where we had a lab for metabolic carb testing and some other biometrics for athletes.
Actually, until 2007, it wasn’t really focused on diabetes. I set the record for being the fastest type 1 at the Ironman distance competition. When that happened, I felt I wanted to open up more to the Diabetes Community. I was doing something no one else was, and at Tri-Star up until then no one except close friends and family really knew that I was living with type 1. At that point, I was excited to make that more public.
I’ve since expanded Tri-Star partly to California, and am working with folks in the LA tri-county area. It’s more of a virtual company, but we also a brick and mortar presence. That’s the way I set it up a long time ago, to have flexibility on location. I like to think in a lot of ways, I’m like air traffic control for athletes with type 1 and non-diabetics, from first-timers to professional athletes.
What was the motivation to found your startup Glucose Advisors?
All of my coaching and working with people through Tri-Star Athletes is what led me to creating this app and a decision-support system, with Glucose Advisors and Engine1. I really was getting overwhelmed with the amount of people I was helping on a daily basis.
Glucose Advisors was really formed in 2014 with the intent of housing the intellectual property that I’d been creating for years, to build out the technology for this Engine1 app. This is a project I’ve been working on, but we brought on some key people in the T1 realm for advice and consulting along the way — Benny Santina, Gary Scheiner, Dr. Mack McCorman. We’re looking to create decision-support tools for type 1, nutrition, and exercise.
What does the Engine1 app accomplish for PWDs?
It doesn’t matter if you’re a superstar athlete or someone just wanting to go for a walk around the block, it helps prevent low blood sugars, high blood sugars, and give you real-time feedback. The more info you put into Engine1, the more you get out of it — BG results, food, insulin info that’s all updated. You can even barcode scan food items to bring that into the app. It functions kind of like Strava or any other activity app that plots where you are on maps… You plug in how hard you want to work out, and it gives you a guided step-by-step process on how much you need to eat before that activity, how much glucose you need to carry into the activity, and ongoing info during the activity about what you need to do to stay in range.
How does it actually work?
The app allows you to enter in your basal regime in your Engine1 system setup. If you’re on injections, you’d just enter them manually as they happen. We also do have a live-share option, so you can share with family and friends and they can see on a map what you ate at this particular time, your exercise, and what happened to your blood sugar. It’s a good companion app for people to use, and you can also sync that to a web portal for more detailed analysis.
A lot of times in my experience through the years, it’s very frustrating to start exercise and then 10-15 minutes into it, you have to stop to eat a ton of carbs. Especially when you could have lined up more nicely beforehand.
The home screen allows you to scroll into the future, to see what your blood sugar might be as much as 6 hours later.
Say you want to start exercising now, and it says you have to eat 80 grams of carbs – that’s a lot of carbs and you may not want to eat that. So if you scroll into the future, Engine1 allows you to put the amount of food in you’re eating now and it will show you how much less you’ll have to eat later. You can enter that into your calendar for a reminder. There’s also an event-specific program where you can use it for a particular activity.
Where can people find this Engine1 app? And what’s the cost?
We rolled out iOS at the end of June, but we’re still very early on. We have Android coming out by the end of July. We restricted the initial launch to a few select countries, but we’re mostly targeting the U.S. at the moment.
It’s a free app to download, and you can do a trial period for a week. After that, you can use some social media tools to extend the free trial for another month. You can share on Facebook, Twitter, email, to keep extending the premium subscription.
We have a couple options for subscriptions: Three months for $23.99, six months for $43.99, one year for $69.99, and a lifetime subscription for $149.99. We really wanted to make this an app that people could access and use, but also be competitive with other apps.
Doesn’t this get into that tricky area of “decision support” that’s restricted by the FDA?
We’re going into the early forays of giving health recommendations. We can pull in Dexcom CGM data through HealthKit, and we’re in discussions about real-time data integration. It will be exciting to have that, as we’d be able to have people act on the information directly without them needing to manually input blood sugars into the app.
This first version of Engine1 essentially gives recommendations of glucose levels rather than insulin recommendations; we can’t quite do that yet. That was part of my early meetings with FDA about making this idea come to fruition. The hurdle was much lower for suggesting what glucose level you need based on the data, versus telling people specifically what to do about insulin dosing. Underneath the hood, there’s a lot going on. But we tried to keep it as simple on the top as possible.
How does it predict your blood sugar up to six hours in advance?
Part of what the app looks at is insulin on board (IOB), and with the food it’s also calculating protein effects and ongoing carbohydrates. So we have what’s called GlucoNavigator as part of the app, and if you tap it on the top right corner it shows you the direction your blood sugar may be heading over the next 6 hours. That’s based on food input and insulin, as well.
There’s no conceptual piece to it yet as to insulin effects, but definitely that’s what we hope for in the future. Right now, it’s focused on amounts of insulin people are taking and how to pair with the right amount of glucose, in order to avoid low and high blood sugars.
In some ways, it sounds similar to the SoftCGM app that predicts blood sugar trends…
Yes, I do think we’re both part of the same trend of providing what CGMs have traditionally done alone, but now we’re seeing that more often in smartphone apps. If I were to give my summary of how I figured this out: I basically did an N of 1 study my entire life, and on top of that I worked with athletic type 1s that allowed me to help them with dosing and recommendations. My learning on that was all accelerated over the course of many years. So it will be interesting to see that, if you’re relying just on the mathematical-modeling, how does that trump real-world experience and the outcomes we see? Really, these trends don’t fit any mathematical model I know of, because it depends so much on a person’s physiology and doesn’t allow you to fit people into a particular box.
Are you interested in collaborating with others for diabetes apps and device integration?
Yes, we’re definitely open to that. At the moment we haven’t partnered with anyone in particular. At some point, we would like to find it liberalized to share information; it just depends on who the partners are.
We’re definitely early to the decision-support side of things on giving recommendations. One of the burdens that’s still out there is manually entering information. As the Dexcoms of the world start giving us real-time data, and companies like OmniPod give us Bluetooth-connected information about insulin, and really the last piece would be entering in food… All of that’s a part of this, and once you have those you can have a really robust system that can give you accurate information about what to do with nutrition and exercise at any given point.
We’re seeing interest in different areas – some think it’d be great to talk with Dexcom, or the pump systems, or even the insulin pens. We’re just not sure yet.
So you’re a supporter of an open diabetes ecosystem?
Certainly, we recognize that one of the things you have to balance in this open community is that there’s a ton of enthusiasm to constantly want to push things into the open for everyone to share. Tidepool does a great job on that and they’ve been a supporter of what I’m doing for many years. Right now, we’re trying to figure out how we fit in and what ecosystems we can be a part of. But first, we want to get this into the hands of people to see how they feel about it and what they want out of this.
Our app is a standalone logbook, too. You can enter hydration, notes and things like that. But how many people want to have Engine1 and another diabetes app, and their insulin pump and CGM? Before you know it, you have six different places for information and no coordination of care. That’s where I see the value of Tidepool or someone else, pulling it all together.
We definitely want to get it to the point where there’s less user input needed, and maybe weave ourselves into the Dexcom ecosystem to become a bit more of an app in their system. We really want to master the dosing side too. In the future, we’d like to do a study to flip Engine1 to… being proactive on suggestions about what insulin you’d need to take (or not take) for a particular type of activity. We really want Engine1 to be able to take more of the guesswork out of diabetes management. Long-term, we’ll want to find strategic partners to bring Engine1 into integrated systems.
It’s really an exciting time. This activity side of things is kind of like the last unknown frontier that hasn’t been conquered, and we’re hoping to move that forward. I like all the progress we’re seeing now, and we have to keep hitting the stride!
Thanks for taking the time, Cliff. Can’t wait to see what happens when folks start to rev up Engine1!
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