Clinical Practice Guidelines
Introduction

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The Challenge of Diabetes

Diabetes mellitus is a serious condition with potentially devastating complications that affects all age groups worldwide. In 1985, an estimated 30 million people around the world were diagnosed with diabetes; in 2000, that figure rose to over 150 million; and, in 2012, the International Diabetes Federation (IDF) estimated that 371 million people had diabetes (2). That number is projected to rise to 552 million (or 1 in 10 adults) by 2030, which equates to 3 new cases per second (2). Although

Delaying the Onset of Type 2 Diabetes

Prevention of type 1 diabetes has not yet been successful, but remains an active area of research. However, there is good evidence that delaying the onset of type 2 diabetes results in significant health benefits, including lower rates of cardiovascular disease and renal failure (4). In 2007, the IDF released a “Consensus on Type 2 Diabetes Prevention” and called upon the governments of all countries to develop and implement a National Diabetes Prevention Plan (4). The IDF proposed that

Optimal Care of Diabetes

Effective diabetes care should be delivered within the framework of the Chronic Care Model and centred around the individual who is practicing, and supported in, self-management (see Organization of Care chapter, p. S20). To achieve this, an interprofessional team with the appropriate expertise is required, and the system needs to support and allow for sharing and collaboration between primary care and specialist care as needed. A multifactorial approach utilizing an interprofessional team

Research

Canada continues to be a world leader in diabetes research. This research is essential for continued improvement in the lives of people with diabetes. Regulatory agencies should not apply these guidelines in a rigid way with regard to clinical research in diabetes. It is suggested that study protocols may include guideline recommendations, but individual decisions belong in the domain of the patient-physician relationship. The merits of each research study must be assessed individually so as to

Cost Considerations

When it comes to the issue of cost, caution is required when identifying direct, indirect and induced costs for treating diabetes (10). In fact, the 2011 Diabetes in Canada report from the Public Health Agency of Canada could not report the total economic burden of diabetes, but concluded that the costs will only increase substantially as the prevalence of the disease increases over time (3). Nonetheless, in 2009, the Canadian Diabetes Association commissioned a report to evaluate the economic

Other Considerations

In Canada, the glycated hemoglobin (A1C) continues to be reported using National Glycohemoglobin Standardization Program (NGSP) units (%). In 2007, a consensus statement from the American Diabetes Association, the European Association for the Study of Diabetes and the IDF called for A1C reporting worldwide to change to dual reporting of A1C with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) SI units (mmol/mol) and derived NGSP units (%) with the hope of fully

Dissemination and Implementation

Despite the strength of the evidence supporting the multifactorial treatment of people with diabetes to reduce complications, a recent national cross-sectional survey conducted around World Diabetes Day (November 14, 2012) demonstrated that only 13% of 5123 patients with type 2 diabetes had achieved all 3 metabolic targets (glycemia, lipids and blood pressure) (17). Therefore, a care gap remains and the effective dissemination and implementation of these 2013 clinical practice guidelines is

Clinical Practice Guidelines and Clinical Judgement

“Neither evidence nor clinical judgment alone is sufficient. Evidence without judgment can be applied by a technician. Judgment without evidence can be applied by a friend. But the integration of evidence and judgment is what the healthcare provider does in order to dispense the best clinical care.” (Hertzel Gerstein, 2012)

People with diabetes are a diverse and heterogeneous group; therefore, it must be emphasized that treatment decisions need to be individualized. Guidelines are meant to aid

Conclusions

Diabetes is a complex and complicated disease. The burgeoning evidence on new technologies and therapeutic treatments is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenging for physicians and other healthcare professionals who care for people with diabetes. These 2013 clinical practice guidelines contain evidence-based recommendations that provide a useful reference tool to help healthcare professionals translate the

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