Undermyfork Uses an Instagram

Mar 26, 2023

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When a person has Type 1 diabetes (T1D), they live in a cycle of constant healthcare decision making. They’re constantly dealing with insulin while taking into account current blood glucose levels and recent and upcoming physical activity. And every few hours of their day, they have to make important decisions about what to eat and how much insulin to use with their meals.

Thanks to technology like continuous glucose monitors (CGMs), it's now easier than ever for people with diabetes to keep track of their blood sugar levels throughout the day. CGM devices have a key metric to help patients estimate the quality of their diabetes management: time in range, the amount of time in a day they spent in their target blood glucose range. Included in ADA's Standards of Care in 2019, time in range (TIR) is the second most important metric of diabetes wellbeing after A1C.

Yet, even with all the advantages that CGM provides, it is still incredibly difficult for its users to accurately get a clear picture of how insulin doses, blood glucose, and activity correlate with the food they consumed. The Undermyfork team decided to focus their efforts on exactly this problem.

"We asked ourselves: Can we unlock the full potential of CGM devices?" says Mike Ushakov, CEO of Undermyfork. "Can we help CGM users not only watch their blood glucose graph change but actually make lifestyle choices based on this graph?"

Mike Ushakov, Eugene Molodkin, and Nikita Shulaev are unlikely health tech founders. Serial entrepreneurs, they previously worked together on a browser extension company called Metabar that helped shoppers save money and find online deals. They sold their first company to Yandex, a European tech giant. From there, they were one of the world's first experimenters in the currently overheated chatbot space, developing Forksy, a natural language engine and an AI-powered nutritionist that helps people log and track their food in a conversational form. The user could text their AI with a message like, "I had a burger and Coke, how many calories did I just eat?" and the AI persona would reply with a calorie estimate and also provide some basic nutrition advice.

As a team with a consumer tech background, Ushakov, Molodkin, and Shulaev were always driven by the goal of product simplicity: how to design tools that could be adopted easily by millions (or, as they say, even hundreds of millions) of users.

"We call it a ‘grandmother's test’," says Ushakov. "The product is good enough only when your 80-year-old grandmother can start using it in several minutes. There's usually a huge gap between an ordinary user of technology and an ordinary developer of technology, a gap in their ability to understand the tech products from the first glance. In a lot of situations normal people tend not to grasp product details that might just seem so obvious and straightforward for those who develop these products. That gap creates an unnecessary and an unjustifiable burden on those who are supposed to use the technology every day, and the gap should be crossed before the product reaches the mass market."

As they worked on their AI nutrition coaching platform, they quickly realized that there is one particular group of their users who really needs and utilizes food logging on a daily basis: people with diabetes. Digging deeper, they saw a striking disconnect between their meal log and the ability to easily evaluate the effect of those meals on their blood glucose levels. Doing further research, they discovered — to their surprise — that there were two dominant ways of informing the diabetes patient about their wellbeing. The typical software either just showed the user several diabetes management parameters, without further explanation and actionable advice on how to deal with these data. Or, on the other side of the spectrum, the products looked like they were designed for NASA's mission control room. There seemed to be nothing in the middle. In short, they saw nothing on the market for T1D that passed their grandmother test.

"Imagine, when four years ago we checked 100+ different diabetes apps, either made by well respected manufacturers, or by independent developers, we only saw one or two apps overall that were allowing the user to do a supposed-to-be-simple operation: scroll the blood glucose graph back to the data from a week or month ago," says Molodkin, CTO of Undermyfork.

They set out to change the status quo and quickly recognized the common time, labor, and accuracy challenges of food logging. How could they make it elegantly simple for people to correlate what they ate to their CGM data? In this case, a picture turned out to be truly worth a thousand words. They realized that instead of manually entering data for each bite of food — a laborious and confusing process — people could upload photos of their meals, tag the food on the plate, and then this meal photo could be classified by its impact on blood glucose and whether it achieved time in range.

By creating a personal library of meals for each individual user, with those meals color coded by their impact on blood sugar, someone could understand at a glance the impact of their choices — which meals brought them out of range and which meals kept them in it.

Undermyfork is a diabetes management app that automatically combines glucose data from CGMs or BGMs with meal photos and calculates postprandial (after a meal) time in range (TIR). People with diabetes can compare their glycemic response to various meals and situations to quickly make informed decisions about what to eat. The app also allows endocrinologists and diabetes educators access to the same data, providing both a big picture overview — highlighting, for example, hypoglycemic events — and the ability to zoom into the data and examine meal details, insulin data, and glucose measurements.

Undermyfork is an official digital health partner of Dexcom, which means they’re able to seamlessly integrate data from the Dexcom API. By partnering with the leading CGM manufacturer in the world, they have a strategic advantage as the mass adoption of CGMs for diabetes care continues. Plus, as more and more research comes out supporting time in range as an indicator of better clinical outcomes and life quality, the more value a companion app that helps users achieve time in range becomes.

Last year they completed their own first real-world-evidence pilot study, presented at the scientific sessions of Diabetes Technology Meeting (DTM) in November 2022. The study results supported their initial hypotheses: that patients with below-average time in range were able to successfully improve their clinical outcomes when using the Undermyfork app. The company is currently collecting more clinical evidence to prove the efficacy of their tool.

In their next phase of business development, they are looking for industry partners: to build distribution and referral networks through hospitals and health plans and to integrate their product with established products from diabetes tech manufacturers. They also have their eye on the Type 2 diabetes space — it is becoming more and more common for T2D to incorporate CGMs into their disease management, which opens up a huge opportunity to reach a larger market.

The global nature of this market brings the team back to their grandmother test: how could they build something so clear and straightforward so that it could be applicable for as many markets as possible? Their first answer? Use photos, graphs, charts, and numbers that easily translate across language and cultural divides. The team itself is situated across Europe — even the partners live in different cities, with Ushakov in Amsterdam, Molodkin in Budapest, and Shulaev in Lyon. But they are, in Molodkin's words, "a small group of good people. We are very comfortable with each other and try to take care of each other even in the intensity of the work."

As the co-founders reflect on their move into the healthtech space, they acknowledge the best part of the work is the impact on their users. Initially, they thought their product would appeal to people newly diagnosed with diabetes, but they have found that patients who have been walking through the disease for many years have greeted Undermyfork with open arms.

"We got the best email of our lives the other day from a 60-year-old person with Type 1 diabetes. He said, ‘I’ve been waiting for something like this for a long, long time — about 45 years,’" Ushakov shared. "We get messages like this every week, and it helps us understand that we are really on to something and we need to be very responsible to make it work."

Undermyfork takes a complicated task for people with diabetes — monitoring, assessing and correlating their daily food intake with their glucose numbers — and makes it manageable. The platform helps people quickly understand what foods in their diet keep them in their ideal blood sugar range. Thanks to the visual modality of the design that reduces language barriers, we see Undermyfork as poised to scale quickly as CGM use multiples across the global market.

Please join us in welcoming the Undermyfork team to the StartUp Health global army of Health Transformers and our T1D Moonshot Fellowship community.

Are you a scientist or innovator focused on T1D innovation who would benefit from education about how to navigate and build a company that will be successful in attracting mission-aligned capital, customers, and collaborators to pursue scientific discoveries in the field of Type 1 diabetes? Learn more and apply for a T1D Fellowship.

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