A recent study led by the Global eHealth Unit at the Imperial College London has found that the majority of insulin dosing apps are unreliable and put patients at risk of getting incorrect doses of insulin.
For patients on insulin, meal time dosing of short acting insulin is a challenging task. There are a lot of factors that go in to deciding how much insulin to administer – anticipated carbohydrate intake, pre-meal blood sugar, planned activities afterwards, and more. A simple calculator app to help out seems like a no brainer. And there are a lot of apps out there that claim to do that.
Huckvale and colleagues found 46 insulin dose calculator apps in the app stores. When they evaluated these apps, they found some pretty concerning patterns:
- Only 30% of apps documented their calculation formula
- 91% lacked validation techniques for numeric inputs (i.e. making sure values were reasonable)
- 67% carried a risk of inappropriate dose recommendations due to their calculations not matching the stated formula, failure to update appropriately to input changes, or violating basic clinical assumptions
- 24% crashed or froze unexpectedly
They also found a striking lack of transparency around these apps. For the apps that didn’t document an insulin formula, investigators contacted developers – and more than half of those contacted didn’t even respond.
And even with these issues, they found that the majority were paid apps. They also found that nearly 40% had not been updated in years; in other words, orphaned apps.
These are serious problems that should raise concerns for any healthcare professional. Insulin dosing is a high risk task – mistakes can have major consequences. And based on these findings, most insulin dosing apps on the market put patients at risk for errors.
Given the risk here, one may wonder whether these apps would fall under the FDA’s oversight. That’s not clear at this point. The FDASIA report, which includes the FCC and ONC in addition to the FDA, says that “most drug dosing calculators” would not be regulated.
At this point, the most important take away here is that physicians and other healthcare professionals need to know these apps are out there, they are untested, and may even be unsafe. Given the increasing number of patients using their mobile devices and apps to manage their health, it’s important that we be proactive and advise patients that they shouldn’t waste their time and money on these apps. It’s just a matter of time before well tested, well designed standalone apps appear in the market for this purpose. Until then, being proactive can help keep patients safe.