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Canadian Diabetes Association 2013 Guidelines are Out!

>> Tuesday, April 9, 2013

Attention all diabetes health care providers and patients!  The
Canadian Diabetes Association 2013 Clinical Practice Guidelines are
now published and available online.

You can browse the executive summary here.

Helpful information for patients is available here.

Here is a summary of the key changes: (quoted from the CDA guidelines)

  • 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 for="" i="" ill="" majority="" mmol="" noncritically="" of="" patients="" the="">
    • 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

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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.



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