Introduction

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Alice Y.Y. Cheng MD, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Introduction

Our Clinical Practice Guidelines (CPG) Expert Committee, consisting of professional volunteers, reviewed and assessed all relevant evidence published since 2008 regarding the prevention and management of diabetes. The data were then incorporated to update the chapters and revise recommendations to aid physicians in caring for the more than 9 million Canadians currently living with diabetes or prediabetes. In the spirit of collaboration and harmonization, the 2013 guidelines are harmonized with the Canadian Hypertension Education Program (CHEP), the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Cardiovascular Society (CCS) and the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE).

The 2013 guidelines utilize the same methodology and grading system (see Methods; Tables 1 and 2). As this document may be utilized by a global audience, it is important to note that the glycated hemoglobin (A1C) in Canada is still reported in National Glycohemoglobin Standardization Program (NGSP) units (%) and not International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) SI units (mmol/mol). To convert to the IFCC units, the following formula can be used:

IFCC = 10.93(NGSP) - 23.50

This executive summary provides a general overview of the 2013 guidelines and highlights some of the important additions and revisions that have occurred since 2008. Unless otherwise noted, all tables and figures are from the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.

Highlights of Revisions

Some of the highlights and major changes since 2008 are listed 68 below:

  • Diagnosis
    • Use of A1C for the diagnosis of diabetes (A1C ≥6.5%)
    • Use of A1C for the diagnosis of prediabetes (A1C 6.0% to 6.4%)
  • Organization of Care
    • New “Diabetes Patient Care Flow Sheet”
  • Glycemic Targets
    • Individualization of glycemic targets with the vast majority of people with diabetes continuing to target an A1C ≤7.0%
    • Better definition of scenarios in which one may consider a target of A1C ≤6.5% or less stringent target of A1C 7.1% to 8.5%
  • Self-monitoring of Blood Glucose (SMBG)
    • Recommendations for frequency of SMBG for those with type 2 diabetes not receiving insulin therapy
  • Nutrition Therapy
    • Continued emphasis on balanced, individualized nutritional therapy with the inclusion of alternative dietary patterns as options
  • Pharmacological Management of Type 2 Diabetes
    • Achieve target A1C within 3 to 6 months of the diagnosis of diabetes
    • New algorithm for the pharmacological management of type 2 diabetes with emphasis on individualization of agent choice
    • Metformin may be used at the time of diagnosis
    • A1C ≥8.5% at the time of diagnosis should receive immediate pharmacological therapy and consideration for use of ≥2 antihyperglycemic therapies and/or insulin
    • Inclusion of cost table for antihyperglycemic therapies
  • In-hospital Management
    • Targets preprandial blood glucose (BG) 5 to 8 mmol/L and random BG <10 mmol/L for the majority of noncritically ill patients
    • BG 8 to 10 mmol/L for critically
    • BG 5 to 10 mmol/L in the perioperative period
  • Vascular Protection
    • New, simplified definitions of who should receive statins, angiotensin converting enzyme (ACE), angiotensin II receptor blocker (ARB), or aspirin
    • No need to assess for high risk as suggested in 2008
  • Chronic Kidney Disease
    • New definition of microalbuminuria of albumin-to-creatinine ratio (ACR) ≥2.0 for both men and women
    • New “Sick Day Management” document for acute illness
  • Diabetes Pregnancy
    • New criteria for the screening and diagnosis of gestational diabetes
  • Diabetes in the Elderly
    • New recommendation for glycemic targets among the frail elderly A1C ≤8.5%-fasting and preprandial BG of 5 to 12 mmol/L

References

  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 188 Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2013;37(suppl. 1). S1-SXX.

 

Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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