For patients, the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines) provide an opportunity to take control of their diabetes and share information with their health care team. For health care providers, they provide the most up-to-date recommendations for the management of diabetes based on the best available evidence.
However, the Guidelines won’t do anyone any good if they just sit on health care providers’ shelves. In order to affect change and create better patient outcomes and a better quality of life for the more than 10 million people in Canada who live with diabetes or prediabetes, they must be accessible and useful. To meet this goal, the committee responsible for Guidelines dissemination and implementation, under the leadership of Dr. Catherine Yu, has developed professional tools and materials, as well as patient resources.
The committee also identified five key areas that are essential for improving the quality of life for people living with diabetes, improving the quality of diabetes care, and reducing illness and death from diabetes and its complications. They are screening and diagnosis, vascular protection, blood glucose lowering, self-management education, plus team and organizing care. Here are tools from our web-based Guidelines that providers can incorporate into their daily practices.
In-hospital diabetes management
Diabetes is common in people who are in hospital for a variety of other diagnoses. Proper management of the diabetes in hospital can help improve certain outcomes. The nine recommendations within chapter 16 address the issues of organization of care, glycemic targets, and hypoglycemia (or low blood glucose) in different hospital populations. Hands-on tools include a how-to document and checklist, and template order sets/protocols for Subcutaneous Insulin Adult Inpatient Acute; IV Insulin Adult Inpatient Acute; Insulin Infusion Critical Care Adult;
Diabetic Ketoacidosis (DKA) – Adult;
Sick day medication list: SADMAN
When people with diabetes experience acute dehydration, it is important that they do not take certain medications as they can lead to serious conditions, such as acute kidney injury, low blood sugar, or high potassium. We developed the Sick Day Medication List in chapter 39 to remind health care providers and people with diabetes which medications should be temporarily held. It includes an easy-to-remember acronym, SAD MAN, which stands for sulfonylurea, ACE-inhibitor, diuretic, metformin, angiotensin receptor blocker, and non-steroidal anti-inflammatory.
The most significant update to this theme for the 2013 Guidelines is the addition of hemoglobin A1C for diagnosing diabetes (A1C ≥6.5%) and prediabetes (A1C 6.0-6.4%). The previous options of fasting glucose (≥7.0 mmol/L), oral glucose tolerance test (2 hour glucose ≥11.1 mmol/L), or high random glucose level (≥11.1 mmol/L) remain. An interactive Screening and Diagnosis Calculator allows health-care providers to enter a patient’s fasting blood glucose and/or A1C value(s) and to determine the proper diagnosis or the need to repeat specific tests
Vascular protection: Do your part, protect their hearts
Cardiovascular disease is the most common cause of death among people with diabetes. That is why reducing this risk is the first priority in managing diabetes. The Guidelines include the ABCDEs recommendations:
A is for A1C and the importance of achieving glycemic control;
B is for blood pressure control;
C is for cholesterol;
D is for drugs to protect the heart (for example, a statin, ACE-inhibitor or ARB or aspirin);
E is for exercise and eating properly;
S is for smoking cessation and stress reduction.
The criteria for determining which patients should be placed on a statin, ACE-inhibitor, ARB, or aspirin for vascular protection has been updated and can be determined using the Reducing Vascular Risk assessment.
Blood glucose lowering: Individualizing targets/Individualize
Lowering blood glucose levels reduces the risk of health problems later in life. There are many ways to do this, such as lifestyle and medications. One of the major themes of the Guidelines is the idea of “individualizing” blood glucose lowering choices based on the best fit for a particular patient. The Individualizing Your Patient’s A1C Target is designed to help health-care providers do this easily. There are also specific tools for type 2 diabetes, the frequency of self-monitoring of blood glucose, insulin use and more.
Self-management education: Help people take charge of their diabetes
Proper self-management of diabetes is critical to live healthily with diabetes. That’s where diabetes education services can help people get on the right track. Referring patients is important to consider as they prepare to leave the hospital. The Self-Management Education section provides a framework for assessing and teaching self-management, physical activity, and dealing with mental health issues.
Team and organizing care: Engage teams to promote self-management
The support people with diabetes receive from their health-care teams and their health-care systems (hospitals, family health teams, regions) has been shown to improve their care. A comprehensive discharge plan with clear communication between members of the interprofessional team is key. To encourage and support health-care providers, the Team & Organizing Care section includes health-care and patient resources, such as communication logs, diabetes flow sheets, and the video, “Angie’s Story: Building a Diabetes Care Team” about the roles and responsibilities of the various members of the diabetes team.
With the help of the Guidelines, more people with diabetes will be armed with the best information and, hopefully, an eagerness to take care of their diabetes. In addition, health-care providers will also be provided with the most up-to-date tools to provide effective care for people with or at risk for diabetes – and in the process, change outcomes and lives.
GUIDELINES ON THE GO
Prefer to access the Guidelines on your smartphone or tablet? Download the CDA CPG App which is available for Apple and Android platforms. The App provides access to the Guidelines and the most popular tools at your fingertips. Download it at http://guidelines.diabetes.ca/app.
Guidelines on the web
The online version of the 212-page, 36-chapter Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines) includes these additional features:
- A quick reference guide
- Downloadable resources for health-care providers and people with diabetes
- Case studies
- Slides and videos
- French resources
For more information, visit guidelines.diabetes.ca.