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Clinical Trial: Blockbuster Diabetes Treatment Not a Medication

Twine Health today announced a pioneering clinical trial that showed the best-ever published results in diabetes treatment. The unlikely treatment, which combines health coaching with a collaborative care platform grounded in learning science, contributed a much larger improvement in outcomes when added to a patient's regimen than any of the best and most expensive blockbuster drugs in the past decade.

The paper, “Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients”, which appears in Diabetes Technology & Therapeutics Volume 18, Number 2, 2016, details how experimental subjects starting insulin achieved an average 3.2 drop in HbA1c in only three months. By comparison, the control group receiving Joslin Diabetes Center’s world-class care, including support from diabetes specialists and certified diabetes educators, achieved a 2.0 drop in HbA1c. The traditional diabetes care model - periodic physician consults leveraging the same medications - typically helps patients achieve only a 0.5 to 1.0 drop in HbA1c over the course of an entire year.

In addition to Joslin’s leading protocols, patients in the experimental group used an iteration of Twine’s collaborative care platform to learn new self-management skills and to have frequent, light touch interactions in between office visits with their care team. The combination of coaching and Twine’s learning science-based application proves that diabetes patients can achieve unprecedented outcomes, very quickly. More timely medication adjustments, enhanced medication adherence, and significant diet and exercise improvements were all contributors to their success. The upshot is that even our oldest and cheapest medications for diabetes are extremely effective when paired with a new method of care delivery.

William Hsu, MD, an endocrinologist at Joslin Diabetes Center and the lead investigator for the trial highlighted the study’s key findings, “We proved three important outcomes: the drop in A1c for the group using the platform was greater than the control group, patient satisfaction was much higher, and, perhaps most importantly, it took less time for the healthcare providers to provide such good care.” Hsu added, “We have shown a direct translation into health outcomes, which will be increasingly important as healthcare moves toward patient-centeredness and value-based payment.”

John Moore, MD, PhD, co-founder and CEO of Twine Health described how health coaching and learning science combine to have such a powerful effect: “Learning science explores the cognitive, social, and cultural underpinnings of how people process information and make change, as well as how to design interventions to help people learn effectively. It’s largely been ignored by healthcare, as patients are typically viewed as recipients of care delivery, not active participants in managing their own health.”

Moore described how this approach to patient education and self-management differs from traditional approaches: “What we already knew was that people don’t learn about their health effectively through stressful lectures and scare tactics in a doctor’s office. Through years of research, what we have honed is how to maximize a person’s ability to make associations between their actions and outcomes, such as how their eating habits, exercise, and medications affect their blood sugar and A1c, on a day-to-day basis in the context of real life. A person’s motivation to change these actions is typically much greater when the associations are self-discovered, rather than when they are imparted through paternalistic instructions or academic reading materials. At the same time, people need social and medical support on a daily basis to maximize success.”

The Twine platform and synchronized patient and coach apps was designed to enable continuous, collaborative care between patients, health coaches and care teams. Moore stated, “We have developed tools for health professionals to most efficiently and effectively coach patients through the challenges that they encounter in the real world. The result of combining these learning-science based interventions and coaching insights is unparalleled patient engagement and confidence, leading to outstanding outcomes, satisfaction, and cost savings.” Twine’s platform was also used in a pioneering hypertension clinical trial with Massachusetts General Hospital showing that 100% of patients were able to achieve blood pressure control in only three months, compared to standard care in which only 30% of patients reach goal in a year.


About Twine Health
Twine Health's SaaS-based collaborative care platform enables risk-bearing organizations to implement high-performance health coaching programs, transitioning quickly and economically from episodic, office-based care to continuous, whole-person care. We believe that when patients lead, everyone wins. The Twine platform and coaching methodology have been rigorously studied with world-class healthcare organizations, proving that they improve health outcomes three-fold at one-third of the cost of standard care. Patients experience better quality of life, providers are more efficient and effective with more gratification in their work, and costs are minimized for payers. For more, visit

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Chris Storer

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