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ORLANDO -- Control solution for ensuring the proper function of glucose meters didn't appear to be a priority among physicians, pharmacists, or patients, researchers reported here.

In a survey, only 23% of diabetes patients said they use control solution, , and , of the University of Oklahoma in Tulsa, reported at the American Association of Diabetes Educators meeting

But lack of patience compliance isn't the only problem -- only 14% of pharmacists and 56% of physicians consistently recommend using control solution, O'Neal and Johnson reported.

O'Neal said their study results provide an opportunity for diabetes educators to make sure that patients are using control solution.

The solution contains a set amount of glucose that reacts with test strips to prompt a readout in the glucose meter. The reading should match a specific range listed on the test strips, and if it doesn't, patients know there could be a problem with the strips or with the reader.

Manufacturers recommend that patients use control solution when they suspect a malfunction, and every time a new glucometer or a new pack of test strips is used.

Control solution may also become more important as the FDA tightens criteria on glucometers, the researchers said. The agency's criteria are based on guidelines from the International Organization for Standardization (ISO), which in 2003 required 95% of meter results to fall in the range +/- 20% of the true value. But in 2013, those criteria were upgraded to 99% of those results falling within the +/- 15% range.

With more stringent requirements, control solution may become more critical, the authors stated. They surveyed patients, pharmacists, and providers to identify barriers to its use.

In the first part of the study, they visited 25 pharmacies in the Tulsa metropolitan area to see if they stocked control solution.

They then conducted phone interviews with pharmacists and with 60 diabetes patients from their institution's electronic medical record system.

Finally, they conducted a Web-based survey of 32 physicians at their facility.

During the pharmacy inspections, they found that only one of the 25 pharmacies had control solution displayed where patients could see it for purchase.

All of the pharmacists who were surveyed said they were familiar with control solution, and 61% thought it should be part of routine practice, but only 14% said they always recommend it.

The majority said they never recommend it (43%) or that they only recommend it in certain situations (43%). Only 39% said they regularly stock control solution.

Only 23% of patients said they actually use control solution, and 67% said they didn't use it because they didn't know about it.

Although use of control solution didn't seem to differ by years since diagnosis, formal diabetes education, testing frequency, or the level of diabetes control, O'Neal said there may be a relationship with diabetes type -- 38% of type 1 diabetics surveyed said they used control solution, compared with only 15% of type 2 patients (P=0.03).

In the physician survey, 62% said they were familiar with control solution, but only about half (56%) said they recommend it to their patients.

Among physicians who never recommend control solution, many thought it was not needed with newer devices, O'Neal said.

The authors concluded that diabetes educators have an opportunity to educate patients about the need for control solution because physicians and pharmacies may lack an understanding of its importance.

Many of the educators in the audience noted that the solution is not currently provided in test strip kits, but should be included.

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