Insulin dosing errors in hospitalized patients are a common source of patient errors and serious inpatient morbidity and mortality. The National Academy of Science/Institute of Medicine have been reporting on the frequency (epidemic?) of medical errors for decades. Some authors have even argued that medical errors are the 3rd leading cause of death. Despite that controversial article, most authorities agree that medical errors are a problem in the inpatient setting and insulin along with anticoagulants are too common culprits. Simultaneously, the epidemic of Type 2 diabetes has asserted itself as one of our most pressing healthcare concerns. Recently released statistics from the World Health Organization (WHO) shows a quadrupling of the prevalence of diabetes since 1980. Now over 8.5% of adults over the age of 18 have Type 2 diabetes. According to the CDC, 1 in 3 adults in the United States will have diabetes by 2050.

So how can providers prevent insulin dosing errors in the hospitalized patient? For providers looking for mobile apps for the general treatment of diabetes, we still would recommend any of our first line general medical reference apps such as Dynamed/Dynamed Plus, UpToDate, Essential Evidence and/or Medscape. However, for quick access to current Type 2 diabetes treatment recommendations additional options include the online ADA Standards of Medical Care and the recently reviewed AACE 2016 Diabetes Algorithm app. The Endocrine Society has recently updated their excellent website and app called Accurate Insulin Decisions, but the app has been orphaned with the Apple mandate for 64-bit apps. A great new app to deal specifically with insulin dosing decisions in hospitalized patients is called Thinksulin. The app comes from the UK via the New South Wales Diabetes Taskforce and the Agency for Clinical Innovation. The app contains many CPGs cleverly deployed as checklists and calculators within a user-friendly app interface. With a national shortage of endocrinologists, primary care providers must become more comfortable with prescribing insulin for their patients, especially those in the hospital.

 

Evidence-based medicine

The app delivers evidence-based and expert/consensus based-information regarding proper insulin prescribing and dosing in hospitalized patients. The app is well referenced, comes from a reputable UK source and provides content any medical student up to seasoned attending could benefit from having available at the tips of their fingers. The app covers common inpatient and perioperative insulin management issues with clear guidance, easy to follow checklists, and helpful definitions.

Who would benefit from this App?

Any healthcare provider who prescribes insulin for hospitalized patients including students, NP’s, PA’s, interns/residents in primary care specialties including internal medicine, family medicine, geriatrics, endocrinology and emergency medicine.

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.

  • Price
    • Free.
    • Responsive user interface with built in checklists, algorithms, and definitions sections.
    • Comprehensive, well-referenced content covering a wide range of insulin topics.
    • Available for Android.
  • Dislikes
    • Some recommendations clearly expert/consensus opinion.
    • Doesn’t cover DKA/HHS.
    • Calculations use international metrics.
  • Overall

    The Thinksulin app from the New South Wales Diabetes Taskforce and the Agency for Clinical Innovation is a comprehensive resource that makes an outstanding addition to both iOS and Android for providers who treat hyperglycemia from virtually any cause in the hospitalized patient. The app’s clever use of checklists, calculators, and expert/evidence based guides should help to prevent medication errors from improper insulin dosing. The app has several novel sections not seen easily explained in other apps such as the perioperative management of insulin, handling of missed doses, etc.

  • Overall Score
  • User Interface

    Intuitive interface with many checklists, definitions, and calculators that is easy to navigate.

  • Multimedia Usage

    The app contains many charts, checklists/algorithms, references, calculators, etc. most of which are easy to use/see on the iPhone, but some would benefit from a large screen.

  • Price

    App is free.

  • Real World Applicability

    This app fills several gaps since Accurate Insulin Decisions is no longer available and Thinksulin focuses on insulin in the hospital setting. The calculators and checklists for basal dosing, perioperative management, etc. will be useful to many providers. The only downside is the use of non-US glucose measurements. The app comes from a reputable source, and is well referenced along with details on the experts who created the guidelines the app is based upon. This app will improve the dosing and safety of insulin in hospitalized patients.

  • Device Used For Review

    iPhone 8 running iOS 11.4

  • Available for DownloadAndroidiPhoneiPad