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.
Globally 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
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