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- May 16, 2008 |
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"Canadian Diabetes Association Guidelines - Update"Dr. Stewart Harris (biography)
English - 2002-11-16 - 41 minutes
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 | (23 slides) |
 | (45 slides) |
Summary :
In the late 2003, the CDA Expert Committee of the Canadian Diabetes Association will be publishing a revised set of evidence-based Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Many of the proposed changes reflect new evidence published since the 1998 set of guidelines were presented in a public forum recently at the CDA conference in Vancouver. This presentation will highlight some of the key changes and controversies that the Committee is currently considering in revising existing diabetes guidelines. This is part of the ongoing consultative process that is incorporated into the review and implementation of the CDA guidelines.
Some of the key proposed changes include the following:
- The importance of aggressive monitoring and screening of high-risk populations
- Emphasis on the relevant use of 75gm OGTT to screen for IGT and diabetes
- Earlier and more aggressive treatment of dysglycemia
- Simplified glycemic targets
- Elimination of the step-wise approach for glycemic management
- Early and aggressive initiation of antihyperglycemic combination therapy
- Early screening and treatment of dyslipidemia with simplified lipid targets
- Importance of aggressive and early screening of hypertension
- Emphasis on combination treatment to lower and maintain target BP
- Prioritization and targeting of vascular protection
- Simplified screening for nephropathy
This presentation will highlight these proposed changes along with the relevant literature. In summary, the 2003 revised guidelines will reflect new evidence in the literature emphasizing the need for earlier and aggressive screening and management of diabetes and related risk factors and complications. A number of controversial changes are being considered and will be included in the presentation for discussion and review.
Learning objectives :
To present and discuss some of the main changes to the Clinical Practice Guidelines of the CDA which are due to take effect in late 2003. The proposed changes include early and aggressive monitoring and treatment of dysglycemia and hypertension, new glycemic targets and management, and simplified screening for nephropathy.
Bibliographic references :
The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus.
Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M.
Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, 100 Collip Circle, London, Ontario N6G 4X8, Canada. jbbrown@uwo.ca
BACKGROUND: Few studies have explored the contextual dimensions and subsequent interactions that contribute to a lack of adherence in the application of guidelines for diabetes management. OBJECTIVE: The purpose of this qualitative study was to explore family physicians' issues and perceptions regarding the barriers to and facilitators of the management of patients with type 2 diabetes mellitus (DM). METHODS: Four focus groups composed of family physicians (n= 30) explored the participants' experiences in the management of patients with type 2 DM. A semi-structured interview guide began with questions on family physicians' experience of providing care and included specific probes to stimulate discussion about the various barriers to and facilitators of the management of type 2 DM in family practice. RESULTS: Participants clearly identified type 2 DM as a chronic disease most often managed by family physicians. The findings revealed distinct barriers and facilitators in managing patients with type 2 DM which fell into three domains: patient factors; physician factors; and systemic factors. There was a dynamic interplay among the three factors. The important role of education was common to each. CONCLUSIONS: The interactions of patient, physician and systemic factors have implications for the implementation of a diabetes management model. The care of patients with type 2 DM exemplifies the ongoing challenges of caring for patients with a chronic disease in family practice. The findings, while specific to the management of type 2 DM, have potential transferability to other chronic illnesses managed by family physicians.
Fam Pract 2002 Aug;19(4):344-9
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