Canadian Diabetes Association translates research into practical tools

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Dedicated to leading the fight against diabetes, the Canadian Diabetes Association—supported by a community-based network of volunteers, members, employees, healthcare professionals, researchers and partners—provides education and services, advocates on behalf of people with diabetes, supports research and translates that research into practical applications in order to better the lives of the more than nine million Canadians currently living with diabetes or prediabetes.

As such, in 2009, the Association created the Tool Kit for the Prevention and Management of Diabetes in Canada, a handy reference which bundles a comprehensive collection of six major themes from the 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Each theme consists of clinically oriented, practical information, as well as an accompanying patient tool, to help integrate evidence-based, diabetes prevention and management strategies from the 2008 Clinical Practice Guidelines into practice and inform diabetes care across the country.

Three of these themes—Cardiovascular Risk Assessment and Reduction; Organization of Care, and Protecting Mothers and Children—have already been released and distributed to more than 40,000 health-care professionals across Canada.

Cardiovascular Risk Assessment and Reduction

The first of these themes—Cardiovascular Risk Assessment and Reduction—focuses on cardiovascular risk factors and recommendations for reducing cardiovascular risk. Heart disease is currently the number one cause of death for Canadians living with diabetes. As such, the information included in the first installment of the Tool Kit emphasizes the importance of early diagnosis and management of diabetes and its associated cardiovascular risk factors.

Released in June 2009, this theme contains a number of evidence-based recommendations and clinically-oriented practical information about diabetes and cardiovascular risks of value to both patients and physicians, including:

• a synopsis of the key information on cardiovascular risk from the 2008 Clinical Practice Guidelines;

• a clinical tool with an algorithm to assist with risk assessment, vascular protection, and screening;

• a patient-focused tool to help Canadians living with diabetes better understand the risks of cardiovascular disease; and

• a patient-centered video—“Do your part, protect your heart”—to help educate patients about risk.

It was designed to not only update and provide further education about changes to the vascular protection recommendations from the 2003 Clinical Practice Guidelines, but to help identify individuals at high risk of vascular events; how to reduce the risk of cardiovascular events; and what coronary artery disease screening tests should be done for patients with diabetes.

Organization of Care

The second theme—Organization of Care—focuses on the importance of a systematic approach to diabetes care and how it can improve clinical outcomes. It provides a strategy for implementation in clinical practice and identifies five key components in how best to organize care for patients with diabetes:

1. Identify patients with diabetes

2. Have a diabetes registry3. Have a systematic recall process4. Use clinical flow sheets5. Consider diabetes-focused visits/group visits

It also includes a video that demonstrates how, in a usual eight-minute visit, physicians can review test results, discuss issues, review medications and make recommendations for patients so they can best manage their diabetes.

Protecting mothers and children

The third theme—Protecting Mothers and Children—is dedicated to ensuring that mothers who have had gestational diabetes mellitus (GDM) are getting tested for type 2 diabetes. Every year, between three to 20 per cent of pregnant women across Canada develop GDM. Although blood glucose levels usually return to normal following delivery, these women are at higher risk of developing type 2 diabetes. In fact, 20 per cent of women who have had GDM will develop type 2 diabetes within nine years of pregnancy and 30 per cent will develop diabetes within 15 years. However, less than half of all women who have had GDM are screened for diabetes after delivery.

This theme is primarily a reminder that women who have had GDM need to be tested for type 2 diabetes six weeks to six months after giving birth; when planning another pregnancy; and every three years or more depending on other risk factors for diabetes.

This theme also focuses on protecting children with diabetes, and includes an information booklet on the prevention of diabetic ketoacidosis (DKA) in children and youth, as well as a tear pad that outlines the early symptoms and warning signs of diabetes in children.

Each of the Tool Kit themes is designed to help supply efficient and effective diabetes care to patients and to build consensus-based evidence into diabetes practices across Canada.

The fourth theme, Physical Activity & Exercise, will be released in Summer 2011, followed by the final two themes, Foot Care and Diabetes Education.

For more information about the Tool Kit themes and to download the resources, visit www.diabetes.ca/for-professionals/.