Rodney Buckley has lost 100 pounds in less than a year, not by using a GLP-1 drug but with the help of a digital twin. Last March, the 55-year-old retired firefighter turned village mayor of Third Lake, Illinois, was 376 pounds. He had tried different diets over the years and would typically lose some weight but eventually gain it back. When his wife’s employer started offering a program from startup Twin Health, he thought he would give it a try.
With demand for Ozempic and other GLP-1 drugs soaring, employers are grappling with their high costs. At around $1,000 to $1,500 a month per person, these medications represent a rapidly increasing health care expense. It’s why some employers are turning to non-medication alternatives to help people go off, reduce, or avoid GLP-1s entirely.
Mountain View, California–based Twin Health’s approach uses a combination of wearables, AI, and on-demand health coaching to help manage diabetes, prediabetes, and obesity. The company sends users a kit with a continuous glucose monitor, blood pressure cuff, smart scale, and fitness tracker. Together, the devices collect data points on blood sugar, weight, stress, blood pressure, sleep, and activity and feed them into a single app. Using a predictive AI model, the app analyzes all this information to generate a virtual replica of the user’s metabolism—the digital twin.
A clinical trial found that Twin can help people with type 2 diabetes control their blood sugar with fewer medications and lose weight. The program has led to medication savings for asset manager Blackstone, which has been using Twin Health for several years, while helping employees there lose weight.
“We are making an impact on people, and we are sustaining the health outcomes,” says Jahangir Mohammed, cofounder and CEO of Twin Health. He says he was inspired to start the company in 2018 because type 2 diabetes runs in his family.
The company has enrolled tens of thousands of people across nearly 200 employers. Twin gets paid only when users achieve certain clinical outcomes, such as lower blood sugar, weight loss, or the reduction of metabolic medications.
Users log what they’re eating throughout the day by scanning food labels, taking pictures of their meals, or recording meals via voice. The app uses AI to analyze nutritional content and identifies foods as “green,” “yellow,” or “red”—green being the healthiest options and red being foods to avoid. Those colors can change as a person’s metabolic health improves. A food that was once red might eventually turn yellow or green.
Based on logged meals, the app predicts a person’s blood sugar response to those foods. It also makes personalized recommendations throughout the day, such as adjusting portion size, choosing a different food combination, or taking a walk after eating. Users can accept or ignore these suggestions—maybe broccoli isn’t their favorite food, or they prefer to exercise during a particular time of the day. The app uses AI to adapt to their preferences over time. Users can also chat with human coaches if they have specific health questions.
For Buckley, Twin Health has helped him make healthier choices, such as swapping out frozen, prepackaged breakfast sandwiches for homemade breakfast burritos with low-carb, high-fiber wraps. He no longer drinks soda, and he walks several miles a day.
“When I first started the program, I could barely make it a mile before my back was hurting, my knee was hurting. Now I’m doing six and a half miles every morning,” he says.
He likes getting instant feedback from the app and also tracking his biometrics over time. He can see that his body fat percentage and blood pressure have been trending downward.
“That’s where I get my motivation to keep walking and keep doing the work,” he says.
Buckley reached his initial weight goal of 300 pounds and is now around 275. After being on blood pressure medication for decades, his doctor recently suggested a lower dose.
When Twin Health approached the Cleveland Clinic’s health plan about using its program, staff endocrinologist Kevin Pantalone was initially skeptical. He decided to conduct a study himself.
“We have really struggled to implement lifestyle modification in a very effective manner. Patients often require numerous therapies to control their diabetes,” he said. “So I was certainly very interested.” Despite the age-old advice of simply exercising more and eating healthy, most Americans struggle to get the recommended amount of weekly physical activity and have difficulty sticking to a healthy diet.
Pantalone and his colleagues recruited 150 participants with type 2 diabetes, randomly assigning 100 people to the Twin program and the rest to a control group. On average, participants were 58 years old with obesity and had a blood glucose level, or A1C, of 7.2 percent. A level of 6.5 percent or higher indicates diabetes. The goal of the trial was to see if participants could reach an A1C of less than 6.5 percent with fewer medications.
After 12 months, 71 percent of the study participants using the Twin app achieved that blood sugar level with fewer medications, whereas only 2 percent of people in the control group did. The people using Twin also lost more weight—8.6 percent of their body weight versus 4.6 percent in the control group.
At the beginning of the study, 41 percent of those using Twin were on a GLP-1 medication, but by the end of the study, only 6 percent still were. In the control group, 52 percent of participants started off on a GLP-1, and at the end of the study that increased to 63 percent. The results were published in the New England Journal of Medicine Catalyst last year.
“I think it’s the continuous, individualized recommendations in real time that help the patients to change behavior and to reinforce those changes in behavior,” Pantalone says. “Historically, when we refer patients for nutrition counseling, they’re often overwhelmed.”
One of the study participants lost 25 pounds, went off all his diabetes medications, and was able to go hiking for the first time in 10 years, he says.
For some people, the data collection aspect of Twin’s program may feel invasive. Weighing in or taking waistline measurements can be emotionally triggering. Those who have found success on GLP-1 drugs may be hesitant to get off them, especially if lifestyle changes haven’t worked for them in the past.
While employers do not have access to identifiable, granular health information about individuals, they do receive an aggregated, anonymized report from Twin that tracks enrollment in the program and health outcomes over time. As a health care provider, Twin is required to comply with the Health Insurance Portability and Accountability Act (HIPAA), as well as state privacy laws. The company says it conducts independent third-party security assessments.
Bernard Zinman, a diabetes expert and professor emeritus in the department of medicine at the University of Toronto who was not involved in the Cleveland Clinic study, is excited about the potential of digital twin technology.
“It’s an interesting approach, and I think it’s taking full advantage of digital health,” he says. “One of the things that we do know for sure is that all these interventions—diet and exercise being the most important—are more effective early in diabetes.” If more people had access to this kind of technology, they could potentially reverse their diabetes or prevent it from occurring in the first place, he says.
Pantalone thinks that’s where the field is moving. “I do think we’re going to see this type of technology being used by more people with overweight and obesity,” he says. “The hope is that the access to these types of interventions is going to improve with time.”
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