Diabetes Canada 2018 clinical practice guidelines: Key messages for family physicians caring for patients living with type 2 diabetes

Abstract

Objective: To summarize the 2018 Diabetes Canada clinical practice guidelines, focusing on high-priority recommendations for FPs managing people who live with type 2 diabetes.

Quality of evidence: A prioritization process was conducted to focus the efforts of Diabetes Canada's guideline dissemination and implementation efforts. The resulting identified key messages for FPs to consider when managing patients with type 2 diabetes are described. Evidence supporting the guideline recommendations ranges from levels I to IV and grades A to D.

Main message: Three key messages were identified from the 2018 guidelines as priorities for FPs: discussing opportunities to reduce the risk of diabetes complications, discussing opportunities to ensure safety and prevent hypoglycemia, and discussing progress on self-management goals and addressing barriers. A theme cutting across these key messages was the need to tailor discussions to the needs and preferences of each person. These important guideline recommendations are highlighted, along with information about relevant tools for implementing the recommendations in real-world practice.

Conclusion: High-quality diabetes care involves a series of periodic conversations about self-management and about pharmacologic and nonpharmacologic treatments that fit with each patient's goals (ie, shared decision making). Incorporating these conversations into regular practice provides FPs with opportunities to maximize likely benefits of treatments and decrease the risk of harms, to support patients in initiating and sustaining desired lifestyle changes, and to help patients cope with the burdens of diabetes and comorbid conditions.

Figure 1.

Prioritization of key messages from the Diabetes Canada 2018 clinical practice guidelines D&I—dissemination and implementation. ^*Consisting of primary care practitioners, endocrinologists, diabetes educators, other specialists, and people living with diabetes.

Figure 2.

Individualizing HbA_1c targets for patients with diabetes CKD—chronic kidney disease, HbA_1c—hemoglobin A_1c. ^*Lower limit applies only if the patient is taking antihyperglycemic agents with the risk of hypoglycemia. ^†At the end of life, HbA_1c measurement is not recommended. Avoid symptomatic hyperglycemia and any hypoglycemia. Adapted from the Diabetes Canada Clinical Practice Guidelines Expert Committee.

Figure 3.

The ABCDES3 of routine diabetes visits ACEI—angiotensin-converting enzyme inhibitor, ARB—angiotensin receptor blocker, ASA—acetylsalicylic acid, GLP1RA—glucagon like peptide 1 receptor agonist, SGLT2I—sodium glucose transporter 2 inhibitor. Adapted from the Diabetes Canada Clinical Practice Guidelines Expert Committee.