from Roche Diagnostics
The number of people with diabetes is skyrocketing. It’s estimated that by 2020, close to one in three Canadians will be living with either prediabetes or diabetes.
By Mike Boivin, BSc.Phm.
These patients are seen frequently in pharmacy practice, so all pharmacists must be comfortable discussing and managing common issues.
Self-monitoring of blood glucose (SMBG) is an important tool for ensuring optimal glycemic control and reducing the risk of complications, and is a valuable educational tool that can help patients self-manage their diabetes. These benefits will only be realized when the patient is using this tool correctly and appropriately.
How can pharmacists maximize the benefit of SMBG in their patients?
1. Provide them with their targets and testing times. Testing just for the sake of testing or recording a number in a log book is of little value to the patient. Patients should know the recommended targets for SMBG. For most patients, these are 4.0-7.0 mmol/L fasting/pre-meal and
2. Recommend a testing frequency and when to adjust it. Far too often you will open a patient’s log book and see a single test every morning before breakfast. Many of these patients do not use these test results to change any aspect of their diabetes management. We should be providing patients with a testing frequency based on the current Canadian Diabetes Association guidelines.
Remember, it’s important to adjust this frequency based on the needs of the patient. If the patient is not reaching glycemic targets, is experiencing episodes of hypoglycemia, illness, stress, is starting a new medication, or is newly diagnosed, we should increase the SMBG testing frequency. If they are reaching glycemic targets, consider decreasing testing frequency. SMBG, like everything else in diabetes, should not be static and should be adjusted to meet the needs of your patients.
3. Know your guideline recommended testing frequency. Some patients are not testing as often as recommended by guidelines. Any patients using insulin therapy should be testing AT LEAST as often as they administer insulin. For example, a patient taking two injections of insulin per day should test at least twice daily.
4. Look for patterns. You don’t have to be a certified diabetes educator to notice patterns with SMBG testing. Many patients apply too much emphasis on one or two readings that are high and outside of the target range. By helping to identify specific patterns, we can educate patients on how to self-manage these readings, adapt or change their therapy and discuss how these patterns impact overall glycemic control.
5. Remember, A1C and SMBG complement each other. Some patients may question the need for doing both A1C and SMBG testing. A high A1C reading tells us we have to make a change; using this with SMBG data tells us the best change (lifestyle/medication or both) to make. Also, there are conditions like anemia, chronic renal or hepatic disease that can affect a patient’s A1C value.
6. Ensure proper diabetes management for both your patient and the pharmacy. Patients with diabetes are important clients for most community pharmacies. They are usually on multiple medications and purchase supplies from their local pharmacy. By helping your patients manage their diabetes with tools such as SMBG, you are showcasing your role in helping your patients self-manage their condition. By working collaboratively with these patients, you can ensure their loyalty to the pharmacy but most importantly improve their health and reduce their risk of diabetic complications.