Glucose monitoring app glitch exposes vulnerabilities in digital health tools
Some users in the UK are experiencing a disruption in the functionality of the FreeStyle Libre 2 blood sugar monitoring app following an update, and it underscores the vulnerability of our digital lives.
A popular app breaks for diabetics in the UK
Abbott, the company responsible for producing the FreeStyle Libre device, claims it is the most widely-used sensor-based glucose monitoring system worldwide. People use a compact sensor implanted in their bodies, transmitting data to a mobile app.
A broken diabetes app
But according to BBC News, after a recent app update, it stopped working on some iPhones -- but only for some people in the UK. Abbott offers no explanation for this, and insists that it is working for users in all other countries.
Abbott has also pulled the app from the UK version of the App Store, and says that there is an Android version still available.
FreeStyle Libre is used practically constantly by its users, as they rely on the app to monitor a crucial aspect of their health.
One user, David Burchell, said it was terrifying. "This equipment is supposed to save your life," he said. "I woke up yesterday morning, went to check my sensor thing... and basically it broke, just showing a white screen and I had a panic.
"I've spoken to [Abbott] many times as this sort of thing has happened before. They told me to delete the app, turn the phone off and on and reinstall... but when trying to redownload it they'd taken it off the App Store so I couldn't download it."
Abbott does say that it is working on the problem and intends to return the app to the App Store.
An ebike company close to bankruptcy
Meanwhile, VanMoof, a struggling e-bike startup, has gone into administration, raising questions about the future of its bikes. VanMoof's bikes are so dependent on their related phone app that it's needed for even starting the bike.
If VanMoof's servers go offline during their administration, riders would be left with a less than satisfactory e-bike, which barely works without its software key.
Administration refers to a process started when a company can't pay its debts and faces insolvency. In this state, an administrator is appointed to operate the company to rescue the business, restructure it, or recover funds for creditors.
However, Cowboy, a competitor e-bike company, developed an app called "Bikey" to enable VanMoof riders to generate their unique digital key and keep riding.
Infrastructure going offline
These incidents highlight the vulnerability of connected devices when the servers they rely on go offline. In the case of the diabetes app, users were left without a critical health monitoring tool.
For the e-bike riders, their bikes could become expensive hunks of metal without the necessary software key, although there are two non-app options to start the bikes. Fortunately, Cowboy was able to come to the rescue, but Freestyle Libre users are at the mercy of Abbott until it can fix the app.
It serves as a reminder of the importance of robust server infrastructure for connected devices and the need for contingency plans when things go wrong. As the world becomes more interconnected, the reliability of the servers that power our devices will grow in importance.
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Comments
No CGM system is a complete substitute for a pin prick test.
They are great for many things. Many good things but any strange or, in this case, zero readings, must be backed up by a pin prick test.
A PITA if you've become accustomed to a sensor/app combo but definitely not a life threatener, save for some really unstable patients.
We are more dependant on server side issues nowadays and quality control for certain apps is more pressing for some types of apps than others but a server going offline permanently isn't really all that different to 30 years ago when an app got abandoned and format support was lost.
That said, more legal protections should be put in place to give consumers more cover.
I can't imagine being in a position where a loss of the tech (monitor and app) threatens my life. People didn't stock a backup manual test kit?
A bike that doesn't work without an app? That's just foolish.
have the decency to read up on the facts before making inaccurate statements
get your facts straight
a person using the Libre2 system relies on low sugar level alarms going off during the night- IT IS LIFE SAVING !!!
No, I am not Type 1 diabetic but that does not mean I don't know what I'm talking about. I have 30 years of first hand experience with Type 1 diabetes. 30 years of having Glucagon in the fridge.
When treating diabetes, the key to avoiding long-term complications is tight glucose control. Initially, that was done with periodic spot checks using a fingerstick glucose monitor. For some time companies have made glucose monitors that have a long-term sensor applied to the skin. These allow for continuous glucose readings in they are also more discrete so you don’t have to take out a bunch of equipment, prick your finger, etc. Many diabetics also use insulin pumps that continually infuse insulin rather than giving intermittent boluses. These pumps were another advance that allow for better control.
@eightzero said “I can't imagine being in a position where a loss of the tech (monitor and app) threatens my life.” What does he think a fingerstick glucose monitor is? Prior to continuous monitors that was all people used and a single point of failure with a finger stick monitor could have equally dangerous consequences. The fact of the matter is people with type one diabetes are dependent on technology for both quality of life and to avoid complications like kidney failure, dialysis, blindness and limb amputations.
Edit: gramar corrections
I have a Tesla and I follow some forums on their full self driving technology. Elon musk once commented that a self driving system would need to be tend to 100 times more reliable than a human. He’s correct in this because even if the actual accident rate of such a system was equal to the accident rate of human drivers people would look at the accidents and say “a human never would’ve made that mistake.” Ironically, the majority of accidents that humans get into also fall into that category yet we never say humans shouldn’t drive, we just except that humans are fallible. Why is it that an AI system needs to be not just more infallible than a human but significantly more infallible?
My wife has been Type 1 diabetic for nearly 40 years and is very unstable. She has had a 'silent' heart attack, has 30cm of stents, been in an insulin coma etc but gets by without a CGM.
She suffers from neuropathologies, has had laser treatment on eyes for years, bone problems. All the typical diabetes related issues, and then some, although to look at her (retired on health grounds) you would never know she was so 'ill'.
We are currently working our way through the approval process for a CGM which by pure chance will be the Freestyle system.
She is not particularly keen on having to wear a sensor but will give it a go, if finally approved.
The Freestyle range and AFAIK, every other CGM on the market, requires the user to fall back on lancet readings in some scenarios.
What seems to have gone completely over Trickydicky123's head is that the Freestyle system even has a reader device available for it which itself includes a lancet system for fallback checks. This negates the absolute need for a wifi connected phone app to get a reading.
He or she is clearly living in a world where everyone has access to high tech expensive monitoring systems.
The phone/app combo is a great option to have but it isn't the end of the world when it fails. Use the reader. Everything can fail. Including glucose meters themselves.
The reality is that the vast majority of type 1 patients get by just fine with old school pin pricks anyway. Even at night.
Now, there is a statistical minority (my wife is one of those patients) who do actually run a fairly high risk of 'asymptomatic' nocturnal hypoglycemia, although, even in her case she will normally wake up before things get so bad that she can't react to the situation. Even though she is often very low when that happens.
That is why I specifically touched on these patients in my original post. That is one of the key benefits of a CGM system for someone like my wife but, she remains in the minority of patients who have a real risk of nocturnal asymptomatic hypoglycemia. Of course, the bigger cause of damage is hyperglycemia and a CGM is perfect for awareness of that too. Even without a phone and just using the reader.
Most Freestyle CGM users will get by just fine in spite of whatever has gone wrong with the app. It's why the reader device exists after all.
I'm not poo-pooing the situation (these apps surely can be made better and I know they have issues) but without getting overly dramatic like Trickdicky123 did.
Unfortunately for my wife, her diabetes is notorious for being very difficult to manage but any information provided by a CGM would help.
Thank you for your clarifications.
Concur on the cost, but that's not a technological limitation - it is an economic one. Still, in fairness, it is one borne by the patient. Interesting the problem seemed to manifest itself in the UK where the cost of healthcare is assigned very differently than it is in the US. The costs worse for the US patients I think.
Hope to wait for solid state batteries before buying anything expensive (for safety, speed of charge, cost). Hope there will be retrofit kits to convert older liquid based electrolyte battery set ups to solid state (at a somewhat reasonable cost). VW claims a 900 mile range by 2027 (4 years), with a target of half the weight, half the cost, very fast charging, and much better safety. Still, doubt anything that stores that much energy will be totally safe. For comparison, a gallon of gasoline is the equivalent of 13 sticks of dynamite (which is why some terrorists use fuel oil and fertilizer bombs). Ever seen a refinery or fuel tractor trailer fire? Not much of the fuel carrier left after a fire, and almost impossible to put out the fire.
On the other main item in the article (glucose monitors): I'm not diabetic (or pre-diabetic), but until a totally non-invasive system is available, think I'd stick with pin prick method. Not wild on the idea of having a small sensor wire under the skin for prolonged periods. Seems like a possible site of infection. Also, the price seems outrageous. Did have a LOT of pin pricks while in the hospital and rehab for a major MRSA infection about 5 years ago. These may be very useful in patients hospitalized for critical care.
Have read that cost on similar items can be about $2,300 per year (insurers probably negotiate a lower price, but likely contributes to high healthcare costs, and higher costs for private/group insurance, medicare, medicaid).
I do know that reader devices are available for all Freestyle CGMs so phones/internet aren't necessary to get sensor data. I just don't know if they are in the box as stock.
As I mentioned above, there are some scenarios where a CGMs will require you to use a pin prick and lancet so users (especially type 1 users) will have a regular glucose meter on hand anyway.
That means no type 1 user should be in danger even if the entire Freestyle system were to fail.
Of course, the advantage of a CGM is the continuous and less invasive nature of the device and, combined with a smartphone app, really is a helpful tool. With that mind, I'm sure a lot more can be done, both to improve the robustness of the connection protocols and to add layers of redundancy. Losing that functionality is a PITA though.
For those patients like my wife, I would suggest Abbott allow a second phone to be connected to her account so that if a reading is not received on her phone or the server for whatever reason, an alert can be sent to the second phone. Then a general toggle and basic alert management could be set up.
Just a off the top of my head situation but I'm sure there are many possible ways to deal with these situations.
Re cost - I suspect that even in countries with socialized medicine the purchase/reimbursement of durable medical equipment is still regulated and restricted to a specific amount or frequency. Even in cases where you are allowed exceptions they typically take some time for approval.
I'm in a kind of hybrid public/private health-care situation where, at the end of the day, a private company covers my needs in line with a contract signed with government. That same company covers fully private clients too. It's their core business.
As a result I get virtually no waiting lists, instant appointments and very quick diagnostics.
Last year I booked a regular checkup with a cardiologist that gave me an ECG and ultrasound as part of the standard visit.
This was a Thursday afternoon. She saw something that she wanted to check out in more detail and the next day (Friday) I was having a blood test a few KM from home. The following Monday I was in the hospital for a nuclear TAC and the Thursday of the same week I was back with her and all the results.
I'll admit that I'm very lucky to have all of that for 'free'. On the regular health service it would have taken months to do (but also all free of course).
As part of the system, we do pay a part of the cost of medicines. Even with my wife being early retired on health grounds has to pay. That side would be all free on the regular health service.
This means that she pays around 2€ per five pack of insulin pens.
The private healthcare company provides the materials (glucose meter, lancets and needles) for free.
In the past we used the Bayer Breeze 2 system which was perfect as it was a disc system that loaded the lancets without the patient needing to touch them. Perfect for people with neuropathologies who find lancets fiddly. I would buy them and twice a year the company would reimburse me.
Then the company signed an agreement with Abbott and everything switched to their system (Freestyle). All still free.
Bayer sold their system to Panasonic and then it became Ascensia. I believe the disc system was discontinued somewhere along the way.
As my wife is a prime candidate for a CGM we have decided to apply for it. As part of the contract with the government, it is difficult for the company to say no but they, (as a private company focused on profit), will do everything possible to drag their feet over what is an expensive treatment for them to cover. My wife is their worst nightmare in terms of medical costs. We have already presented the first round of medical reports and this September will present the second round. We are in no rush, though so we can take it easy.
In this case it is the government and the private company that are bearing the cost. We only pay for the subsidised insulin.
We could get everything for free by switching into the regular health service but that is a bit overstretched and wait times are far longer.
All in all, we are fortunate. I hear horror stories about people in the US that cannot afford insulin. That is crazy if true but diabetes is big business for some.