Drug Topics - November 17, 2008 - (Page 3) Professional SPECIAL REPORT Martin Sipkoff Helping patients choose the right glucometer The crucial tool for controlling diabetes mellitus is data — the blood glucose numbers that inform patients about the effectiveness of medications, diet, and exercise. And pharmacists play a key role in steering patients to the right meter. “Pharmacists are the right people in the right place at the right time to advise diabetes patients about the importance of meters and how to use them,” R. Keith Campbell, PharmD, associate dean and professor of pharmacotherapy at Washington State University, said. “So it’s a professional responsibility to know how meters work and to be able to tell patients what the numbers mean to their lives.” Patients get data about their blood sugar levels two ways: self-monitoring of blood glucose (SMBG) and measurement of glyR. Keith Campbell, Washington State cosylated hemoglobin (HbA1c). The sucUniversity cessful long-term treatment of diabetes is evaluated through HbA1c data, based on the guidelines of the American Diabetes Association (ADA) and the American College of Endocrinology (ACE). ACE measurments are slightly stricter than the ADA’s, but they share the goal of tight glycemic control (see Kim Kelly, Johnson chart). & Johnson HbA1c measurements comes from a Diabetes Institute physician-controlled blood test that determines average blood glucose concentration over a few months. SMBG, on the other hand, uses one of the two dozen or so available glucometers, along with test strips, to determine daily blood sugar levels. Adjusting medication and lifestyle according to SMBG readings leads to tight glycemic control, which leads to lower HbA1c levels. “It is wide fluctuations in blood sugar that is the most damaging to patients,” Kim Kelly, PharmD, director of the Johnson & Johnson Diabetes Institute in Milpitas, Calif., said. “That is what makes SMBG so crucial, both before meals and three or four hours after meals. That’s what pharmacists often don’t know, need to know, and need to tell their patients.” In 2007, a global consensus conference of diabetes experts recommended SMBG be used by all patients with diabetes. SMBG frequency is determined by the needs and goals of each patient. The ADA recommends that SMBG be performed: At least three or more times per day among patients with type 1 diabetes (which results from absolute insulin deficienW W W.D R U GTO P I C S .C O M cy and affects 5 percent to 10 percent of patients), pregnant women, and patients using multiple insulin injections or insulin pump therapy; Less frequently among those on noninsulin therapy or medical nutrition therapy. According to ADA guidelines, Accu-Chek was rated highly. although the optimal frequency of SMBG is not specified for patients with type 2 diabetes not on insulin therapy, it should be often enough to reach the HbA1c goals set by their doctors. (Type 2 results from insulin resistance and affects 90 percent to 95 percent of patients.) Some situations may cause patients to monitor glycemic levels more frequently, such as the blood sugar spikes that can lead to hypoglycemia, as well as illnesses, medication changes, changes in physical activity, and dietary changes. Patient Resistance Notwithstanding the well-established value of SMBG — a drop of 1 percent in HbA1c levels results in a 21 percent reduction on deaths related to diabetes and a 25 percent to 37 percent reduction in microvascular complications, according to two major studies — far too few patients perform daily blood sugar checks, Campbell said. “Encouraging their patients to do [SMBG] is itself a responsibility,” he said. One reason for patient resistance is the physical and psychological discomfort associated with the finger-stick method of blood sampling. Glucometers are available that offer patients the choice of using either the traditional finger-stick method or a less painful alternative testing site, such as the forearms, palms, or thighs, to obtain blood samples. This raises the subject of meter choice, for which the wide range of choices makes the pharmacist’s role especially important. “There are several areas where patients may have different ideas about what they want, such as size of meter, what features it offers, cost, ease of use,” Kelly said. Increasingly sophisticated monitors are on the market, some designed for specific needs. For example, the Accu-Chek N OV. 17, 2008 COURTESY OF ACCU-CHEK DRUG TOPICS 3 http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - November 17, 2008 Drug Topics - November 17, 2008 Special Report: Helping Patients Choose the Right Glucometer Pharmacy-Related Bills Stalled in State Legislatures Drug Topics - November 17, 2008 Drug Topics - November 17, 2008 - Drug Topics - November 17, 2008 (Page 1) Drug Topics - November 17, 2008 - Drug Topics - November 17, 2008 (Page 2) Drug Topics - November 17, 2008 - Special Report: Helping Patients Choose the Right Glucometer (Page 3) Drug Topics - November 17, 2008 - Special Report: Helping Patients Choose the Right Glucometer (Page 4) Drug Topics - November 17, 2008 - Pharmacy-Related Bills Stalled in State Legislatures (Page 5)
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