Control solution needs to be better understood by patients, pharmacists, providers

ORLANDO — Control solution is an important tool in the armamentarium against diabetes, but a recent survey presented at the American Association of Diabetes Educators annual meeting suggests that all parties involved — providers, pharmacists and patients — need more education on its use.

“Control solution is not being used and it’s not well understood or it’s not valued to be used. As health care professionals, I would like to believe that we are concerned and value patient care and outcomes and then patients, on the flip side are concerned about their health care so that leads me to believe it’s more than educational issues,” Katherine O’Neal, PharmD, BCACP, CDE, BC-ADM, of the University of Oklahoma College of Pharmacy, said in her presentation. “If we as diabetes educators really want to improve adherence and ultimately impact glycemic control, we need to do a better job of educating patients. That’s one thing that was very evident with us with this project. An alarming percentage of our patients said they just didn’t know about control solution.”

O’Neal and colleague Jeremy Johnson, PharmD, BCACP, CDE, BC-ADM, looked at 25 pharmacies (20 chain, five independent), 60 patients and 29 providers in an effort to determine the level of awareness about control solutions as well as the level of use. They did so through an audit of each pharmacy, telephone interviews with pharmacists and patients and a web-based survey of providers.

Manufacturers recommend using control solution any time inaccuracies are suspected, but also whenever a new pack of strips or a new meter is first used, Johnson said, explaining that with the recent reports of inaccuracies, this should be a routine occurrence.

“A lot of people aren’t using control solution to determine that there are inaccuracies. If no one knows there’s an issue, there’s nothing to complain about,” he said.

Upon visual inspection of the pharmacies, Johnson and O’Neal reported that only one out of the 25 pharmacies had visible control solution available. Of the 23 pharmacists interviewed, 100% were familiar with control solution and 61% felt it should be used in routine practice, but only 14% always recommend it. Forty-three percent recommended it in certain situations and 43% never recommend it, the researchers reported.

Those that never recommend reported that it was not a high priority, patients never asked, there were time constraints and it was not stocked, they said.

Of the 39% that did stock control solution, five said they stocked behind the counter, three said they stocked it with the over-the-counter diabetes supplies – though O’Neal noted that only one was visible to the auditors – and one did not know. Additionally, 87% of pharmacists said they can order control solution if the patient asks.

Yet, of the patients interviewed – even though 72% reported receiving formal diabetes education – 48% said they were unaware of control solution. Only 14 (23%) of patients reported using control solution; those 14 report seeing a diabetes specialist.

When broken down by age, O’Neal showed that 39% of pediatric patients were using control solution, as opposed to just 17% of adult patients. When broken down by type, 38% of those with type 1 were using control solution while 15% of those with type 2 were doing so.

Of the 77% of patients who do not use control solution, 31 do not use because they are unaware (P=.05), 13 said they lack understanding of control solution and one said the pharmacy does not stock the product.

Of the providers surveyed, there were 13 residents, 18 faculty and one endocrinologist. Thirteen were in family medicine, eight in internal medicine, eight in pediatrics and one in pediatric diabetes.

When surveyed, 62% of providers were familiar with control solution, 50% of those felt it should be used routinely. Of those that wanted routine use, 44% never recommended it due to the following reasons: they were unsure it was necessary with new technology, they were using a clinic glucometer to compare for accuracy and/or they did not think about it.

“Pharmacists may have a lack of understanding of the importance or the logistics of using control solution, and pharmacies just aren’t stocking it. Patients may have a lack of understanding, as well, of the importance or may not know how to go about purchasing it. And then providers may also have a lack of understanding,” O’Neal said.

For more information: Johnson J; O’Neal K. W13C. Presented at: The American Association of Diabetes Educators Annual Meeting 2014; August 6-8, 2014; Orlando, Fla.

Disclosures: Johnson and O’Neal report no relevant financial relationships.