Opinion: I’m using not-FDA-approved software to manage my diabetes. I’ve never felt better

Dana P. Goldman, founding director of the USC Schaeffer Institute for Public Policy and Government Service, has been managing his type 1 diabetes for over three decades using a glucose monitor linked to an insulin pump. Regular upgrades to these devices, which are FDA-approved and covered by his insurance, have occurred roughly every five years. Despite these advancements, his glucose control has gradually worsened over time. Recently, however, his physician suggested he consider an alternative: open-source software designed to enhance the functionality of his current medical devices. This software, developed independently by individuals frustrated with the limitations of FDA-regulated apps, offers a level of precision in insulin delivery that Goldman claims surpasses what is achievable through conventional methods. By running on his iPhone, the software provides real-time adjustments that align with clinical guidelines he previously struggled to meet. His experience highlights both the potential benefits and risks associated with using unregulated medical software. Goldman acknowledges that relying on this software involves a degree of risk. Medical software typically falls under FDA regulation, ensuring it meets safety and efficacy standards. However, the approval process is often slow and costly, leading to delays in bringing innovative solutions to market. The FDA's current regulatory framework, established over half a century ago, is ill-suited for the fast-paced nature of modern software development. As a result, the agency struggles to keep up with the rapid evolution of digital health technologies. In seeking advice, Goldman consulted Lowell Schiller, a former FDA policy official. Schiller pointed out that the FDA has initiated several measures to modernize its approach to regulating software. These include exemptions for lower-risk applications and programs that facilitate quicker approvals for incremental software updates. Nonetheless, the agency faces significant challenges due to outdated statutes that were originally crafted for physical medical devices rather than digital platforms. To address these issues, Goldman suggests legislative intervention. A potential solution lies in expanding the FDA’s pre-certification pilot program, initially introduced during the first Trump administration. This initiative allows for streamlined or waived reviews if developers demonstrate robust quality assurance and adherence to best practices. Such a model could enable faster access to innovative software while maintaining safety standards. However, implementing this program requires congressional support. The FDA is currently engaged in discussions with industry stakeholders to establish performance benchmarks tied to funding mechanisms that cover part of the agency’s operational costs. These negotiations, slated for submission to Congress in early 2027, present an opportunity to enact meaningful reforms that could reshape how medical software is reviewed and approved. Without legislative action, the trend of patients turning to self-developed or open-source solutions is likely to continue. This shift creates an uneven playing field, disadvantaging traditional medical device manufacturers who must navigate complex and time-consuming regulatory pathways. The growing reliance on non-regulated software underscores the urgent need for updated regulatory frameworks that can accommodate the realities of contemporary healthcare technology.