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An overview of The 2003 CDA Practice Guidelines for the Prevention and Management of Diabetes in Canada
Type 2 diabetes is a common chronic disease that will be increasingly seen in family physicians' offices, According to the National Diabetes Surveillance Strategy (NDSS), the physician-diagnosed prevalence of type 2 diabetes among Canadian adults is 4.8%. However, the Diabetes Screening in Canada (DIASCAN) study suggests many more people have the disease but have not yet been diagnosed, placing the true prevalence at greater than 7%, or close to 2 million people.
"It is a bad situation, and it's getting worse," says Dr. Lawrence Leiter of the University of Toronto. "Diabetes is a public health issue that is reaching epidemic proportions."
In the near future, an aging population, rising rates of obesity, and increasing immigration from high-risk populations will all contribute to an even greater prevalence of diabetes in this country. Family physicians will not only have to care for more patients with diabetes, but also for patients with diabetes who will live longer and with more advanced stages of the disease.
In light of the growing significance of this disease and recently published evidence related to the prevention and management of diabetes, the Canadian Diabetes Association recently revised its Clinical Practice Guidelines. More than two years in development, these evidence-based guidelines offer some 150 diagnostic, prognostic and therapeutic recommendations based on the latest diabetes research from around the world.
"The Guidelines include several key changes that reflect our new knowledge gained in the area of diabetes," says Dr. Leiter. "There is greater emphasis placed on screening, more individuals are considered to be in the at-risk group, and treatment is more aggressive. The Guidelines have moved away from the slow, stepwise approach to management and now encourage much earlier and more aggressive treatment."
SCREENING THOSE AT RISK
According to data from the DIASCAN study, almost 3% of people over the age of 40 have type 2 diabetes but do not know it, while close to another 4% have glucose intolerance and are at significant risk of developing diabetes and its macrovascular complications.
"One goal of the revised Guidelines is to identify people at risk of diabetes and cardiovascular disease who have been missed in the past," says...