A Pharmacist's Guide to OTC Therapy: Monitors

Blood Glucose Monitors

Pharmacists are part of an essential health care team that helps diabetic patients manage their disease. They effectively counsel their patients on proper drug therapy and educate them on the variety of blood glucose monitors available. Currently, there are 2 types of monitors that measure blood glucose. They are based on either glucose oxidase (oxidation) or hexokinase activity.¹

First-generation meters use a photometric or reflectance measurement based on a dye-related reaction, such as the reagent-strip method. The patient places a sample of blood on a reagent strip, blots it, and inserts the strip into a meter, where it is read photometrically or calorimetrically.¹ Second-generation meters measure blood glucose with a biosensor that records an electric charge produced by a chemical reaction.¹

It is important for pharmacists to remind patients how crucial it is to routinely monitor blood glucose. The pharmacist can help patients select a monitor that can be easily incorporated into their daily routines (Table). Choosing a monitor that suits an individual's needs will greatly ensure a higher level of compliance. There are many factors that should be considered when assisting a patient in the selection of a blood glucose monitor:

• Expense of the meter and accessories
• Ease of use
• Accuracy
• Cleaning and maintenance
• Test time and method
• Portability
• Size
• Features for the visually or hearing impaired
• Testing sites (does the meter allow alternate sites?)

For more information on blood glucose monitors and their features, the pharmacist or patient can visit individual manufacturers' Web sites.

Cholesterol Monitors

Approximately 19% of adults in the United States have elevated cholesterol levels (Table 1). Twenty-six percent of women and 16% of men aged 55 to 64 have high cholesterol.¹ More and more individuals, however, are combating high cholesterol by being proactive in maintaining their cardiovascular health through various modifications in diet, weight loss, and exercise.

Adhering to a treatment plan may be challenging to some individuals, because high cholesterol is a condition that requires consistent lifestyle modifications and, in many cases, pharmacologic treatment. The National Cholesterol Education Program recommends that all persons 20 years or older should have their lipid profile measured at least every 5 years.^1,2 Individuals who are currently being treated for elevated lipid levels or those with risk factors (Table 2) associated with elevated cholesterol levels will require more frequent monitoring, as determined by their health care provider.

OTC cholesterol tests have been available since 1993. When used properly, they are ~95% accurate. They are available as single-use tests or reusable monitors (Table 3).³ Home cholesterol tests can help individuals to obtain a baseline cholesterol level or to routinely monitor their levels. Knowledge of cholesterol levels enables individuals to make modifications that can reduce the risk of a heart attack or stroke and indicate when it is time to seek the advice of their health care provider for more intensive testing, such as a complete lipid profile.

The majority of nonprescription cholesterol tests measure only total cholesterol. Some tests, however, measure low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides.¹

Before patients use any OTC cholesterol tests, it is imperative that pharmacists counsel them on proper usage. Patients who have hemophilia or are taking anticoagulants should be advised not to use these tests because of the risk of excessive bleeding from the finger stick. These patients should be encouraged to consult their health care providers to have their cholesterol checked. Patients should be advised to avoid doses of 500 mg or more of vitamin C and to avoid taking acetaminophen or naproxen within 4 hours of testing, because these agents may interfere with the results.¹ Individuals also should be encouraged to have follow-up testing with a physician if they have any further concerns, especially if their total cholesterol is =200 mg/dL, if their HDL-C is =40 mg/dL, or if their triglycerides are =150 mg/dL.¹

Ms. Terrie is a clinical pharmacy writer based in the northern Virginia area.

For a list of references, send a stamped, selfaddressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: astahl@ascendmedia.com.