Dr. Steve Wong (biography and disclosures)
Editor’s note: The use of smartphones and mobile, handheld computing devices like the iPhone, iPod Touch and others among physicians is remarkable. In 2011, 81% of US physicians own a mobile device1, 54% of physicians access medical information on their smartphone during patient visits2. Currently, the most popular devices are Apple iOS devices (32% iPhone/iPod Touch, 22% Blackberry, 16% Palm, 9% Windows, 4% Android, 2% Symbian1).
In response to reader requests and the increasing interest in mobile apps, we are launching a series of articles highlighting useful iPhone apps. These will appear approximately once every three months.
If you have app suggestions, or if you use an Android device and would like to submit an article, please email us at firstname.lastname@example.org.
We hope you enjoy this series of articles.
What I did before
A large part of my practice is focused on the management of diabetes. A key recommendation from the CDA guidelines is the achievement of A1C targets of 7%. Also, when appropriate, I encourage patients to perform self-monitoring of blood glucose levels. I try and teach all my patients what the role of the A1C is as well as how to use their home measurements to guide treatment.
More often than not, patients either don’t test at home at all, or if they do, they test only in the fasting state in the morning, which may give falsely reassuring results as they assume the rest of the day looks similar.
In followup visits, when patients are reviewing their lab results, I often found that patients assumed the A1C is a numeric average of their own glucometer readings (eg. “My A1C is 7.2 – my average glucose must be around 7”). I advise them that the A1C has a nonlinear correlation with average glucose readings over the last 3 months. In fact, when I point out to them that an A1C of 7.0% (eg. “at target”) represents an average glucose level of 8.6 mmol/L, many patients respond with surprise and say “wow, that’s actually pretty high.”
These kinds of discussions have been useful in encouraging adherence to therapy and improved understanding of disease pathophysiology, however, I often found myself guesstimating values, which obviously introduces a potential for misleading advice.
A free app called Pocket A1C makes it extremely easy to illustrate to patients the relationship between their A1C and average glucose readings. They can immediately see that I’m not simply making up a number, but more importantly, the real-time, animated sliderule really seems to impact patients when they see me scrolling up and up to get to an A1C of 9.2 as well as see their average glucose of 12 mmol/L.
Get Pocket A1C here (free):
What I do now
I now use Pocket A1C several times a day. This direct illustration from a lab value (A1C) to a number they may be intimately familiar with (their own glucometer readings) greatly increased patient acceptance of recommendations for intensification of treatment. I also found the app saved me time in explaining the utility of the A1C assay.
Pocket A1C has helped me achieve targets in patients who may have been reticent to accept more intense treatment and I believe helped me educate my patients more effectively about their diabetes.
1. Manhattan Research
2. SDI’s Mobile and Social Media Study, 2010