Pharmacists' Role as Ketone Monitoring Reaches Clinics

At the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, Massachusetts, Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at the Massachusetts College of Pharmacy and director of cardiometabolic services at Well Life Medical in Peabody, Massachusetts, addressed 2 topics from her Annual Forum sessions: keeping patients on obesity therapy through adverse effects and integrating emerging ketone data into diabetes care.

On adherence, Goldman said the key to preventing side-effect-driven discontinuation is preparing patients before problems arise, with as much upfront education as possible. She counsels patients that glucagon-like peptide-1 (GLP-1) therapy restores a feeling of fullness they may not have had in some time, using a local analogy: a patient accustomed to 3 or 4 slices of pizza should eat 1 and gauge how they feel, since overeating will cause nausea. She also emphasized that the drugs help patients feel full, but they still must eat—asking what a patient ate the prior day, because undereating can likewise cause nausea. Nausea from either cause generally resolves over time, she said, and patients should contact her if it becomes intolerable because it can be managed. Critically, she cautioned pharmacists not to advance to the next dose until side effects resolve.

On continuous ketone monitoring, Goldman noted that a dual glucose and ketone monitor has been approved in the US, though its full implications remain unclear. Continuous glucose monitoring continues, with ketone data adding a danger signal for diabetic ketoacidosis risk. She said pharmacists must learn not only to interpret the data but also to act on it and educate patients—building a provider-informed plan defining what specific ketone ranges mean, what to do at each, and when to seek emergency care.