1998 clinical practice guidelines for the management of diabetes in Canada
Supplement to CMAJ 1998;159 (8 Suppl)
© 1998 Canadian Medical Association
Summary
These are the first evidence-based clinical practice guidelines for diabetes to be published in the Americas. The method used to develop them included the review and grading of the scientific evidence for many of the recommendations, but it also revealed specific areas where evidence to support clinical practices was lacking.
Outpatient management of diabetes using a shared-care team approach is addressed in a comprehensive manner. Unsettled issues relating to such controversial areas as the treatment of GDM and the management of diabetes in Aboriginal Canadians are explicitly acknowledged and identified as targets for further investigation or strategy development.
There has been an overwhelming commitment by many key stakeholders in this process. Their desire to improve the health of Canadians with diabetes and to continue the effort begun with publication of the first guidelines in 19929 was evident from the intensity of their efforts and the amount of time they committed to their tasks. They are confident that the recommendations contained in these revised clinical guidelines will lay the groundwork for significant improvement in diabetes care, and they trust that publication of these guidelines will enhance the quality of life of Canadians with diabetes. Before this can happen, the critical challenge will be to implement these guidelines in a scientific way so that the information can be used to further enhance health policies for diabetes.
This document is an executive summary of all the recommendations of the 1998 revision of the clinical practice guidelines for management of diabetes mellitus. It will be followed by in-depth assessment of each area in the form of technical review articles that will be published subsequently.
In addition to those who contributed to the development of this document, the process benefited from the valuable insights and comments of numerous national and international experts who reviewed these guidelines in detail. The members of the Clinical and Scientific Section and the Diabetes Educator Section of the Canadian Diabetes Association (CDA) and attendees at the CDA Professional Sections Conference, London, Ont., October 1997, provided valuable insight as part of the consensus process. Their contributions in enhancing the quality of this information are gratefully acknowledged. An enormous amount of work was done by the staff of the CDA; particularly important support came from Donna Lillie, director of research and professional education. The expert secretarial assistance of Shirley Grundy and Mary Richardson, the fundraising support of Nowshad Ali and the administrative details carried out by numerous other CDA staff, as well as the medical writing assistance of Arthur Tan are much appreciated. It was also of great benefit to have the funding support of our sponsors to pursue this process with the intensity required.
Note added in proof: The benefits of improved glucose and blood pressure control for the prevention of long-term complications in those with type 2 diabetes have been confirmed by recent reports of the results of the United Kingdom Prospective Diabetes Study.298,299,300,301,302 This landmark study of over 5000 people with type 2 diabetes over 20 years confirmed the prevention of microvascular complications through improved glucose control and highlighted the major effects of blood pressure control on micro- and macrovascular complications of diabetes. After further evaluation, a position statement will developed by the CDA on the implications of this study, which may include revision of the grading of some of the recommendations in these guidelines.
