Nearly everyday here in “sunny” Tacoma, WA, I am asked by a patient to check their vitamin D levels. At our hospital, the vitamin D test is one of the most commonly ordered and most expensive tests. In fact, patients could literally purchase a 5 year supply of supplemental vitamin D for the cost of one vitamin D test per our chief lab officer. So why all the fuss with vitamin D? The issue is a matter of association and observational studies. Vitamin D isn’t just a vitamin, it is a hormone that is absolutely necessary for humans. Studies have demonstrated an association between vitamin D and various cancers, heart disease, bone and musculosketal disorders, asthma, and depression along with numerous other conditions. The issue of course is that association doesn’t ensure causation and numerous randomized controlled trials of vitamin D supplementation for many of the above listed conditions have not been conclusive (asthma, cancer) or were negative studies (sickle cell, infections, osteoarthritis, wheezing, postmenopausal women, chronic pain, hypertension, depression). The best data for vitamin D is for prevention of falls, strengthening bones, and breastfed infants. This hasn’t stopped patients from asking to be tested and providers complying. Choosing Wisely even has a recommendation in an attempt to stop the madness. If patients are determined to know their levels and track their intake, is there an app to help them?
Dr Micheal Holick, an endocrinologist, and author of the best-seller, The Vitamin D Solution, has worked with RobCo, Inc to create dminder. The app allows patients to track their vitamin D intake for diet, supplements, even sun exposure. The app attempts to calculate a patient’s vitamin D level based on demographics imputed when first opening the app and then updates the level based on either actual lab draws or data from the app. The app even uses the phone’s GPS and clock to determine the “best” time of the day for a patient to get the required sun exposure for vitamin D skin conversion.
A 25 year-old female with depression presents to your office. Her PHQ-9 score is 15. She denies suicidal/homicidal ideation. You refer the patient to your clinic psychologist for same-day initiation of cognitive behavioral therapy and start the patient on citalopram 20mg. Additionally, you check the patient’s TSH, CBC, and vitamin D level. All labs are normal except her vitamin D level which is 18 ng/ml. You discuss methods of replacement and prescribe the patient dminder to help.
Evidence based medicine
The vitamin D deficiency “epidemic” is one of the most controversial issues in primary care. This app doesn’t help solve this issue, but provides a unique method for patients to track their intake, “monitor” their levels, and determine the best times of the day to obtain “ideal” sun exposure for skin conversion. The app essentially lacks any evidence for its claims and or purpose, but to the authors’ credit, they are studying outcomes of using the app. App users can opt in to 1 of 2 studies right from within the app. I would be most interested in seeing the outcomes of these studies and hope they are published.
What providers would benefit from this App?
Patients who are proven to be vitamin D deficient or simply highly motivated to track and or attempt to increase vitamin D levels via diet, supplements and/or sun exposure. Providers could consider prescribing the app to patients who are deficient, but evidence provided by the app is scant and certainly no outcome data from the app (though studies are underway).
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Includes introductory video and step-by-step set-up.
- Ability to enter multiple sources of vitamin D intake and app calculates “likely” current level.
- Uses GPS of device and clock to determine “ideal” time for sun-exposure for vitamin D.
- Available for Android
- No references or links to studies to back-up any of its claims included in the introductory and user interface videos.
- Cannot change units while doing initial set-up of the app.
- Purpose and utility of “Events” function unclear.
dminder is a very interesting app that likely will prove popular with those obsessed with vitamin D. The app provides a novel mechanism for not only tracking intake but providing patients the knowledge of the ideal time for vitamin D exposure based on their location. The app is available for both iOS and Android platforms.
- Overall Score
- User Interface
Fairly intuitive with introductory video, self-guided set-up, single page for data (with upgrade).
- Multimedia Usage
App includes multiple helpful videos to assist with set-up and use of the app, uses GPS for sun angle, etc. but lacks any links/content on evidence based references for its content.
Basic version is free. The in-app purchase seems somewhat steep for what it provides.
- Real World Applicability
This app will likely be a big hit with patients considering the current attention surrounding vitamin D. However, it is concerning that the app may not provide accurate or evidence-based information. However, the likelihood of harm by tracking oral vitamin D intake and/or sun exposure for vitamin skin conversion is likely minimal and may actually help some truly deficient patients.
- Device Used For Review
iPhone 6S running iOS 10.3.1
- Available for DownloadAndroidiPhoneiPad