Glycemic instability is common among the patients with type 1 diabetes, causing various problems, such as repeated ketoacidosis and/or severe hypoglycemias.
Moreover, insulin used for the treatment of diabetes is a high-risk medication. Insulin antibodies sometimes can cause glycemic instability.
Errors in insulin dosage are another problem, accounting for about 13% of all medication errors in the inpatient setting. These errors are not necessarily higher than with other medications, but consequences of insulin dosing errors can be severe and may seriously deteriorate the condition of the patient.
This could become an even bigger problem because of the epidemic of Type 2 diabetes that is one of the most pressing healthcare concerns nowadays.
A data from the World Health Organization (WHO) shows that over 8.5% of adults over the age of 18 have Type 2 diabetes. CDC reports that 30 percent of adults in the United States will have diabetes by 2050.
Most patients with diabetes are frequently admitted to hospitals for treatment of conditions other than diabetes. This is why insulin administration, glycemia management, and prevention of insulin dosing errors are the responsibility of primary care providers, including clinicians, nursing staff, and junior doctors, not just endocrinologists or diabetes specialists.
For this purpose, healthcare providers can use various mobile apps for the treatment of diabetes or general medical reference apps.
However, many of these apps may provide the guidelines that are too broad and not specifically related to the problem of insulin dosage decisions in hospitalized patients.
To solve this problem, the Agency for Clinical Innovation (ACI) developed the app named Thinksulin in consultation with the New South Wales Diabetes Taskforce, which tries to tackle the national shortage of endocrinologists by enhancing the capacity and capability of primary care providers, junior doctors, and nursing staff responsible for prescribing and administering of insulin to patients in hospital with diabetes.
Thinksulin is a point-of-care app that contains many clinical practice guidelines deployed as checklists and medical calculators within a user-friendly app interface.
The goal of the app is to provide information and decision support on blood glucose level targets, hypoglycemia and hyperglycemia management, blood glucose monitoring, basal-bolus calculations, charting and reviewing doses, and more.
Thinksulin app is free to download and it doesn't require users to register an account. Upon opening, the app displays exceptions of use, i.e. the patients that need a different approach, such as children and youth, patients with cystic fibrosis, patients on dialysis, pregnant women, etc.
The Home page is divided into two tabs: Guides and Definitions. The 'Guides' tab contains 'the meat of the app,' including guidelines, referrals, reviews for hyper- and hypoglycemia, charting doses of scheduled insulin, missed doses of insulin, calculators, ketone and blood glucose monitoring times, and more.
The 'Definitions' tab lists and explains some basic terms, such as basal-bolus, insulin types, types of diabetes, and more.
The user interface of Thinksulin app is responsive and intuitive, featuring built-in algorithms, calculators, definitions sections, checklists, charts, references, and more.
The app is well-referenced, comprehensive, and it comes from the reputable source. The content inside the app is evidence-based, it's provided by the experts in the field, and it covers a wide range of information regarding proper insulin prescribing and dosing in hospitalized patients.
It should be noted that the Thinksulin app mainly focuses on insulin in the hospital setting, i.e. it covers common inpatient and perioperative insulin management issues, using checklists, calculators, and referrals which may be just appropriate for the medical practitioners, from medical students to seasoned clinicians.
There's one thing missing in Thinksulin app tho. It has not covered DKA/HHS, i.e. diabetic ketoacidosis and Hyperosmolar Hyperglycemic Syndrome, the two acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes. I hope that the app developers would add this improvement in one of the future updates.
Another issue that might be a drawback to some users is the fact that the Thinksulin app uses the measurements and calculations which are based on international metrics (non-US). Another thing to fix in the next version of the app.
Finally, some of the tables and charts in the app are not mobile-friendly.
Apart from these issues, the Thinksulin is an outstanding app that deserves our recommendation. It is a comprehensive resource for all providers who treat diabetes in the hospitalized patients.
The intuitive, at-the-point-of-care use of checklists, calculators, and evidence-based guidelines should help to prevent medication errors from improper insulin dosing, as well as to handle the perioperative management of insulin, missed doses, etc.
Benefit: Any healthcare provider who administers and prescribes insulin for hospitalized patients would benefit from this app, including junior doctors, nursing staff, students, NP's, PA's, interns/residents in primary care specialties including endocrinology, family medicine, internal medicine, geriatrics, and emergency medicine.