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Canadian Pharmacists Association
Canadian Pharmacists Association
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Revisions Since 2008

Canadian Diabetes Association 2013 Clinical Practice 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%)

See Chapter 3: Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome

Organization of Care

See Chapter 6: Organization of Diabetes Care

Glycemic Targets
  • Individualization of glycemic targets with the 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 a less stringent target of A1C 7.1% to 8.5%

See Chapter 8: Targets for Glycemic Control

Self-Monitoring of Blood Glucose (SMBG)

See Chapter 7: Self-management Education

Nutrition Therapy
  • Continued emphasis on balanced, individualized nutritional therapy with the inclusion of alternative dietary patterns as options

See Chapter 11: Nutrition Therapy

Pharmacologic Management of Type 2 Diabetes
  • Achieve target A1C within 3 to 6 months of the diagnosis of diabetes
  • New algorithm for the pharmacologic 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

See Chapter 13: Pharmacologic Management of Type 2 Diabetes

In-hospital Management
  • New glycemic targets: preprandial blood glucose (BG) 5.0 to 8.0 mmol/L and random BG <10.0 mmol/L for the majority of noncritically ill patients
  • BG 8.0 to 10.0 mmol/L for critically ill patients
  • BG 5.0 to 10.0 mmol/L in the perioperative period

See Chapter 16: In-hospital Management of Diabetes

Vascular Protection
  • New, simplified definitions of who should receive statins, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), or aspirin
  • No need to assess for high risk as suggested in 2008

See Chapter 22: Vascular Protection in People with Diabetes

Chronic Kidney Disease

See Chapter 29: Chronic Kidney Disease in Diabetes

Diabetes and Pregnancy
  • New criteria for the screening and diagnosis of gestational diabetes

See Chapter 36: Diabetes and Pregnancy

Diabetes in the Elderly
  • New recommendation for glycemic targets among the frail elderly - A1C ≤8.5% and a fasting and preprandial BG of 5.0 to 12.0 mmol/L

See Chapter 37: Diabetes in the Elderly