Accurate Insulin Decisions (AID) App, a primary care decision support tool on mealtime insulin

One in 10 US adults has diabetes now. But, CDC predictions regarding this disease are grim. According to their analysis, 1 in 3 US adults will have diabetes by 2050[1]. This will add additional burden on morbidity and mortality. According to WHO, diabetes directly caused 1.5 million deaths back in 2012.  Diabetes will also increase health care system costs, which were more than $240 billion in the US alone, in the same year.

These alarming numbers show how critical it is to change the course of type 2 diabetes. Improving our lifestyle choices on healthy eating and physical activity are some of the steps we could take. Although they can't eliminate diabetes, proper diet and physical activity still can reduce the risk of diabetes and help to control the condition in people who already have it.

Mealtime insulin proved to be a good treatment approach for many people living with diabetes. This approach requires insulin dose adjustments during the mealtime to keep blood sugar levels in the normal range. This approach, along with any insulin prescriptions and adjustments, requires that diabetes patients consult with their physicians. Due to a national shortage of endocrinologists, the burden of prescribing insulin for their patients falls on primary care providers' shoulders.

The Endocrine Society, along with six other health care organizations, eased that burden a bit by developing a mobile app called Accurate Insulin Decisions (AID), which is a great addition to their well-made and informative website of the same name. The Accurate Insulin Decisions app is designed for primary care providers dealing with prescribing insulin regimens for Type 2 diabetics who are unable to be controlled with lifestyle modification and oral medications.

This app, developed by endocrinologists and partially funded by some manufacturers of various insulin products, provides useful resources in order to help people with diabetes to better manage their disease. Both AID app and the website provide decision support tools, which can be used by both patients and physicians. These tools help to set realistic goals regarding easier adjustment of their insulin dosage. They also help physicians determine whether their patient could benefit from mealtime insulin, which is usually a difficult decision, especially for primary care providers. 

For example, there could be a number of indicators telling you it's time for your patient to move beyond basal insulin. But, there are many factors you should consider before deciding to make this transition. The decision support tools provided within the Accurate Insulin Decisions app will help you decide whether this treatment approach would help your patient or not.

The AID app is designed in a form of questionnaires, and that's what's you'll see when you start the app.  The home screen offers several options, from initial decision to move beyond the basal insulin to the questionnaire about the efficiency of the mealtime insulin approach. 

First two options expand further, offering more specific questions, data, and charts, weighing in pros and cons of the decision to move beyond basal insulin, as well as helping providers to set A1c goals.

If you're medical provider you probably know that there are several insulin options people who have diabetes can choose from.
First, there's a long-acting insulin or basal insulin that lasts up to 24 hours.
Next option is mealtime insulin or bolus insulin that works rapidly to control spikes in blood sugar after meals.
Finally, patients can also use premixed insulin that combines rapid or regular acting with long-lasting insulin (such as Humalog or Novolog Mix).

The AID app provides detailed description and characteristics of each insulin option, which is great information for both patients and primary care providers who are learning more about insulin prescriptions.

The app also helps with choices for mealtime insulin and provides a detailed guide for starting and adjusting both mealtime and premixed insulin.

After the decision to start bolus insulin, healthcare providers are guided through the example of motivational interview, which goal is to evaluate patient's adherence to the regimen and the efficiency of mealtime insulin approach.

Finally, users have an option to access interactive dosage calculator, which isn't embedded in the app, yet links to AID website (which is embedded in the app). While it works really well, we found this to be the weakest part of this app.

After you've been redirected to the website, you have an option to choose between two mealtime insulin options, rapid or premixed. Next question concerns your largest meal (breakfast, lunch, dinner). Upon choosing one, you'll be asked to check your blood sugar before your next meal and choose one of the three options that match your result, i.e. blood sugar under 80, between 80 and 130 and over 130. You'll get suggestions about mealtime insulin adjustments for the following day, depending on your answer.

As said, while this works fine, it would be better if the interactive calculator was made as a part of the app. Also, a calculator is directed more toward diabetes patients, than healthcare professionals. Finally, once you tap on the Back arrow, you won't be returned to the calculator's previous screen yet to the app's home screen, which is quite awkwardly implemented.

This small problem doesn't ruin the complete experience with the Accurate Insulin Decisions app. We found it to be a great evidence-based decision support tool, which provides well-referenced content regarding proper insulin prescribing and dosing in patients with Type 2 diabetes.

Benefit: Any healthcare provider who prescribes insulin for patients with Type 2 diabetes, including medical students, as well as patients who want to learn more about benefits of transition from basal to mealtime insulin.