1998 clinical practice guidelines for the management of diabetes in Canada
Supplement to CMAJ 1998;159 (8 Suppl)
© 1998 Canadian Medical Association
Diabetes is a common chronic disease. It also meets all 3 criteria for a public health disorder: "a high disease burden, changing burden suggesting preventability, and fear that things are unknown and out of control."1,2,3
Currently, the diagnosis of diabetes has been made in approximately 5% of Canadians or 1.5 million people.1 This number is expected to reach 2.2 million by the year 2000 and 3 million by 2010.2 Moreover, because United States statistics demonstrate that for every person with known diabetes there is someone with undiagnosed diabetes, these numbers most likely underestimate the prevalence of the disease. Assuming that the same situation is true in Canada, up to 10% of Canadian adults may currently have diabetes.
Diabetes is a serious health problem. It is a major cause of coronary artery disease (CAD), which is the leading cause of death in Canada. It is also a leading cause of new cases of blindness and kidney disease in adults. The disease often disables people in their middle years and, as a group, people with diabetes die younger than those not affected by it. 4
Diabetes is costly both to the affected person and to society. In general, people with diabetes have poorer health and spend more on managing their health than people without diabetes. Although the actual cost of diabetes in Canada remains unknown, data from the United States suggest that diabetes and its management consume approximately 1 in 7 health care dollars.5,6 These high costs, in addition to economic analyses showing that early interventions are cost-effective, emphasize the importance of the appropriate management of diabetes to society as a whole.7,8
In 1992, the Canadian Diabetes Advisory Board produced the first Canadian clinical practice guidelines9 to address the educational needs of primary care physicians and other members of diabetes health care teams involved in the management of people with diabetes. New developments since then led the Clinical and Scientific Section of the Canadian Diabetes Association (CDA) to develop revised guidelines to provide ongoing support and guidance to health care professionals.
These guidelines are presented here as recommendations, graded according to the level of supporting evidence and accompanied by a brief explanation or description of their context. To be concise and to increase the utility of these guidelines for clinicians, only summaries of the recommendations are presented. More detailed discussion will appear in a subsequent series of articles. Although these guidelines are not meant to be a textbook on diabetes care, they address key issues or areas of controversy related to outpatient diabetes care.
