Medical apps are popular with both patients and clinicians, and many healthcare facilities often recommend the use of certain apps. While apps have the potential to enhance health management, gaps have been identified concerning efficacy and safety.
Badly designed medical apps are potential hazards. For instance, faulty medical calculators can recommend faulty dosages and adversely impact health outcomes. In such cases, using apps poses serious risks especially when it comes to medications like insulin. Incorrect dosages can lead to either hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose). Both are potentially dangerous situations and can lead to coma and even death without immediate clinical intervention.
AdvertisementGlobally and in India, people are increasingly turning to smartphone apps for diabetes management. Diabetes management is complex and requires keeping track of calories, medication dosages, blood glucose levels and BMI (body mass index). Availability of apps like the ones that calculate carbohydrate intake is popular among people with diabetes.
Dinesh*(33) who has Type 1 diabetes since the age of 19 says that he tried using a range of apps to calculate insulin dosage according to his calorie intake. He uses an app called "Track3" which includes an insulin calculator. He also finds the app's carbohydrate counter useful. However, he admits that he did experience "lows" due to incorrect calculation. He is not sure his clinician will recommend the use of apps.
Dr. Arpandev Bhattacharyya, endocrinologist and diabetologist at Manipal Hospital, Bangalore, does not currently recommend any app to his patients as he believes it is best to titrate the dosage manually. When doctors prescribe a particular insulin dosage, they take into account a number of related factors like age, height, weight, type of diabetes and other co-morbidities. Dr. Bhattacharyya feels that it is important to take all these factors into consideration while calculating an insulin dose. Simplistic calculations create more problems for the patient. The methodology of calculation is significant for insulin dosages.
Correlating to the above considerations, a recent study published in the BMC Medicine journal indicated that smartphone app insulin calculators may not be accurate and lead to incorrect dosage administration. Researchers Huckvale, Adomaviciute and Prieto et al. examined and analyzed the efficacy, accuracy and clinical safety of apps that calculate medication doses. They focused on insulin dose calculators used by people with diabetes.
The researchers conducted a systematic assessment of insulin dose calculators for iOS and Android for rapid/short acting insulin. They identified 46 simple mathematical dose calculators which calculated the insulin dose based on planned carbohydrate intake and measured blood glucose levels.
The researchers found that only 59% (n=27/46) included a clinical disclaimer while only 30% (n=14/46) provided documentation of the calculation formula. 91% (n=42/46) did not have a numeric input validation and 59% (n=27/46) allowed the user to calculate the dose even when one or more values were missing. 48% (n=22/46) lacked clarity in terminology and used ambiguous terms. 9% (n=4/46) lacked numeric precision and 4% (n=2/46) did not store the parameters correctly. Significantly, 67% (n=31/46) had a potential risk of calculating inaccurate dosage violating basic clinical assumptions (48% n=22/46). 14% (n=3/21) did not match the formula which was previously stated for calculation. 37% (n=17/46) lacked accurate updating in response to changes in user inputs. The result was only one iOS app which was issue-free according to the research criteria and parameters for clinical safety and efficacy.
The researchers concluded that insulin dose calculator apps carry potential risks either for overdose or suboptimal dose. This can cause serious issues for blood glucose control and management. Researchers suggest that clinicians exercise caution when recommending dose calculation apps which have not been properly evaluated. They also suggested that app safety should be addressed as a part of diabetes self-management education.