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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
A Pharmacist’s Guide to OTC Therapy:
Blood Glucose Meters for the Pediatric Population
An estimated 186,300 individuals younger than age 20 throughout the United States have been diagnosed with diabetes. 1 The majority of these patients have type 1 diabetes; however, as the obesity rates in the United States continue to escalate, type 2 diabetes, a condition that primarily occurs in adults over the age of 45, is becoming increasingly prevalent among those in the pediatric population.1 Many children newly diagnosed with diabetes and their families may face unique challenges when dealing with the everyday management of diabetes, including treatments, adapting to dietary changes, and the routine monitoring of blood glucose.
Many questions may also arise when selecting a blood glucose meter for pediatric patients. Pharmacists can be instrumental in assisting and educating both pediatric patients and their parents/caregivers in the selection and use of the various blood glucose meters available.
A variety of at-home blood glucose meters to meet the needs of patients with diabetes, especially those patients in the pediatric population, are currently on the market. Key factors that may be considered when selecting a meter include accuracy of the meter; size of the meter; small sample size required for testing; ease of use and easy-to-follow testing procedure; ability for alternate testing sites; quick testing time and availability of results; ease of portability to allow testing at school and during leisure time; easyto- read numbers on display; memory options; cost of meter and supplies.2,3 A helpful checklist to assist pediatric patients and their parents/caregivers in selecting a glucose meter is available on the American Diabetes Association (ADA) Web site at www.diabetes.org/ youthzone/choosing-a-bg-meter.jsp.
Throughout childhood and adolescence, a child’s ability to take an active role in the management of diabetes continues to vary and change due to growth and development, along with continual advances in motor skills, cognitive abilities, and maturity.4 Parents/caregivers have a crucial role in the management of diabetes as well.4 Results from various studies have reported that parental involvement is necessary throughout childhood and adolescence to ensure appropriate self-management and metabolic control.4
Parents/caregivers should be aware of the signs of hypoglycemia and know what to do in these cases, especially because preschool and early schoolaged children may be unable to identify and self-report episodes of hypoglycemia. 4 Safe management of pediatric patients may often require more frequent blood glucose testing, particularly if a child has not been eating well.4
Additional testing during periods of increased physical activity, stress, and illness also is very important.4 The ADA Web site, www.diabetes.org, has various teaching tools for parents, as well as children, to encourage them to get involved in the management of their condition. The Web site explains diabetes, as well as provides useful tips to successfully manage diabetes, including monitoring blood glucose.
In July 2009, Bayer Diabetes Care announced a new blood glucose meter for pediatric patients called the DIDGET, a blood glucose meter that plugs into the gaming systems Nintendo DS and Nintendo DS Lite. When patients consistently monitor their blood glucose levels with the DIDGET, it rewards them with points that they can use to buy in-game items and unlock levels in a game.5 Some of the key features of this glucose meter include5:
• 5-second test time
• Small sample size of 0.6 µL of blood required
• Saves the results of 480 tests
• Auto-detects control
• Provides 14-day average
• Summarizes 7-day high/low
• In advanced mode, children can identify tests done before/after meals and set a reminder to test after meals
The DIDGET is available in the United Kingdom, but is not yet available in the United States.
When assisting patients in the selection of a glucose meter, it is important that the proper testing protocol is clearly understood and that the patient and/or parent/caregiver is comfortable with using the monitor. Continual reinforcement of the importance of maintaining good glycemic control is crucial to the optimal management of diabetes. Ongoing patient education and patient involvement give pediatric patients and their parents/caregivers the necessary tools to effectively manage their condition throughout their adult lives, as well as help them improve the quality of their lives.
Pharmacists should emphasize the importance of adhering to recommended treatment plans, regular blood glucose monitoring, and establishing healthy eating habits and exercise routines.
Parents/caregivers should ensure that day care providers, school principals, teachers, and nurses are aware of their child’s diabetes and that trained personnel are available if needed. They should also be aware of how often and when the child should test blood glucose. Patients and their parents/caregivers should be reminded to keep a log of their blood glucose readings and discuss these results with their primary health care provider.
Pharmacists can also remind patients that a host of resources are available to assist them in managing their diabetes. For more information on diabetes and children, please visit the following Web sites:
• American Diabetes Association: www.diabetes.org
• Children with Diabetes Foundation: www.cwdfoundation.org
• National Institute of Diabetes and Digestive and Kidney Diseases: www2.niddk.nih.gov