GPAC guideline: Diabetes care

The Guidelines and Protocols Advisory Committee’s (GPAC) updated Diabetes Care guideline is available at www.BCGuidelines.ca. The updated guideline describes the care objectives for the prevention, diagnosis, and management of diabetes mellitus in adults who are 19 years of age or older. It focuses on the approaches and systems that are, ideally, in place to improve care for the majority of patients the majority of the time. Diabetes in pregnancy (gestational diabetes) is outside the scope of this guideline.

Key recommendations:
•    Diabetes care is centred on the person who is living with diabetes and should include an individualized management plan developed by the patient and their primary care providers. 
•    The five Rs describe the key components to consider when organizing diabetes care in the office or clinic: recognize, register, resource, relay, and recall. 
•    Glycosylated hemoglobin (A1C; $12.69*) or glucose testing (e.g., fasting plasma glucose [FPG; $1.46] or 2-hour plasma glucose [2hPG; $12.94]) can be used for diagnosis and screening. Best choice of test will depend on clinical circumstances. 
•    Individualized glycemic targets are based on the patient’s age, duration of diabetes, risk of hypoglycemia, cardiovascular disease presence, and life expectancy. 
•    Measure A1C every 3 months to assess glycemic goals are met. Consider testing every 6 months if targets are consistently met and treatment and lifestyle are stable. 
•    There are a number of new anti-hyperglycemic agents available for treatment of type 2 diabetes that can be considered as part of an individualized care plan. 
•    A systematic approach to vascular protection is recommended, including lifestyle management, glycemic control, blood pressure control, and pharmacological interventions.

* Prices as per the Schedule of Fees—Laboratory Services Payment Schedule as of 1 October 2015.