The 2013 Canadian Diabetes Association Clinical Practice Guidelines are coming!

Wednesday, July 25, 2012

Alice Y.Y. Cheng, MD, FRCPC
Endocrinologist, Credit Valley Hospital and St. Michael’s Hospital
Assistant Professor, Dept of Medicine, University of Toronto

image Every five years, since 1998, the Canadian Diabetes Association has published recommendations for healthcare professionals for the prevention and management of diabetes in Canada. These guidelines, called the Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, are developed under the umbrella of the Clinical & Scientific Section of the Canadian Diabetes Association. The guidelines are developed by a team of expert volunteers (called the Clinical Practice Guidelines Expert Committee), and are published by the Association in the Canadian Journal of Diabetes.

These guidelines have been a helpful resource for anyone caring for people with diabetes and are recognized, not only in Canada, but around the world, as high quality evidence-based clinical practice guidelines. In fact, a recent review by Johns Hopkins University showed that the Association’s Clinical Practice Guidelines (CPGs) are among the best in the world. A team at Johns Hopkins reviewed all English-language clinical practice guidelines published after July 2007 that contained recommendations on oral medication use in type 2diabetes. They screened 1,000 publications and, of those, only 11 guidelines met the criteria that they set out. Of these 11 sets of guidelines, six were from the United States, two were jointly produced (one by the American Diabetes Association and the European Association for the Study of Diabetes; the second by the American Diabetes Association and the Egyptian Diabetes Center), one was from the International Diabetes Federation, one was from the National Institute of Health and Clinical Excellence (NICE) in the United Kingdom, and one was from the Canadian Diabetes Association.

The reviewers at Johns Hopkins took an in-depth look at the 11 sets of clinical practice guidelines to see whether the guidelines agreed with seven conclusions from the evidence about the proper use of oral medications in type 2 diabetes. These seven conclusions were published in 2007 from a thorough review of scientific research papers and evidence.  The team also rated the quality of each of the guidelines based on two areas (these were called: “rigour of development” and “editorial independence”) from the tool: “Appraisal of Guidelines Research and Evaluation (AGREE II) Instrument”. The Association’s CPGs scored 100 per cent on agreement with the conclusions of the systematic review, 100 per cent on Editorial Independence and 97.6 per cent on the Rigor of Development; second only to the NICE guidelines. This is a true testament to the strength of our guidelines process and the hard work of all those involved!

It is that time again; our Expert Committee has been working hard to produce the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.  Volunteer members of the committee are assessing the scientific evidence that has been published since 2008 relevant to the prevention and management of diabetes, and incorporating the evidence into revised recommendations. 

A number of important changes have occurred for the 2013 clinical practice guidelines:

  • Expansion of the Expert Committee to include 115 healthcare professional volunteers from across Canada. Expert Committee members bring expertise from diverse practice settings and include professionals from family medicine, endocrinology, internal medicine, infectious disease, neurology, nephrology, cardiology, urology, psychology, obstetrics, ophthalmology, pediatrics, nursing, dietetics, pharmacy, exercise physiology and others
  • Inclusion and active participation of people with diabetes on the Expert Committee to ensure that their views and preferences inform the guideline development process and the recommendations
  • Update and expansion of previous chapters;
  • Inclusion of drug cost within tables listing pharmacologic therapies as a reference for clinicians;
  • An updated and expanded process, including updating literature searches throughout the development of the guidelines, and expanding our Duality of Interest policy to ensure that authors are not biased by other activities in their lives;
  • Including “Practical Tips” boxes in many chapters of the guidelines to make it easier for busy doctors to read and use the recommendations;
  • Collaborating with other organizations to make sure that recommendations are consistent, including: Canadian Hypertension Education Panel (CHEP), Society of Obstetrics and Gynecology of Canada (SOGC), Canadian Cardiovascular Society (CCS), and C-CHANGE;
  • Expanded strategy to distribute the new 2013 Clinical Practice Guidelines, with an increased use of new technology to make it easier for physicians to receive and use the guidelines.

The 2013 CPGs will be released in the spring of 2013. We hope that primary care physicians, other healthcare professionals who care for people with diabetes or those at risk of diabetes, and certainly people with diabetes will continue to find the evidence compiled in these upcoming guidelines a vital aid and resource in their efforts.

To view the 2008 Clinical Practice Guidelines, please visit http://www.diabetes.ca/for-professionals/resources/2008-cpg/