The FDA approved the first, and currently only available, insulin self-management mobile application. In the spring of 2017, Amalgam Rx, a new digital health company, announced the release of a prescription-only mobile application for the automated titration of all brands of basal insulin, including Lantus, Levemir, Toujeo, Tresiba, and Basaglar.
The iSageRXTM app is available to both Android and Apple users, and it is intended to provide critical coaching support to patients newly diagnosed with diabetes—most of those patients being older persons with type 2 diabetes (T2DM). Unlike patients diagnosed with insulin-dependent diabetes who are trained in managing the disease earlier in life, the development of T2DM often occurs later in life, when patients may report more anxiety or uncertainty about how to cope with all the challenges of their insulin regimen. Although this app supports optimal basal insulin delivery, healthcare providers are not precluded from modifying insulin regimens to include additional rapid-acting insulin options (i.e., Aspart Novolog and Lispro Humalog) as medically and clinically indicated. Caution must be exercised, however, when evaluating the actual amount of insulin used when it is different than that recorded by the app.
The mobile app is a software approved for use in adults diagnosed with T2DM who are 21 years of age and older. It is used for support in titrating basal insulin. The coaching support provided by the app is projected to be a critical element to enhancing management success in these patients. The importance of comprehensive initial training, together with additional, ongoing education on the appropriate use of insulin, including determining dose, developing an optimal technique, and avoiding hypoglycemia cannot be overemphasized. Hypoglycemic events are reported to be among the most common causes of emergency-room visits and hospitalizations in older patients who use insulin to manage their disease.
The iSage RX app provides alerts and health guidance intended to prompt behavioral and logistical insulin-management support, not only making the initiation of insulin easier, but also rendering dose increases less challenging. In the May press release, Philip A. Levin, MD, endocrinologist at Baywest Endocrinology Center in Baltimore, Maryland, expressed similar concerns. “Initiating and intensifying insulin are two of the more daunting challenges in managing patients with type 2 diabetes. This is particularly true in primary care where insulin initiation is often delayed up to 6 years. And, when patients do start insulin, they tend to stay on a sub-optimal dose for too long,” said Dr. Levin.
This app is not only for patients; it also provides tools to providers, allowing a full spectrum of options to customize insulin regimens based on whatever insulin product is prescribed. Although technology learning curves may initially appear daunting, an increased familiarity with this new application by patients and clinical- and office-support staff would be expected to decrease the overall burden currently reported in medical practices that manage high volumes of patients with diabetes.