Adherence to Canadian Diabetes Association Clinical Practice Guidelines

27 Nov

type 2 diabetes mellitus


Diabetes mellitus affects over 2 million Canadians. Type 2 diabetes accounts for 90% of these cases, and its incidence is increasing dramatically. Complica­tions include cardiovascular disease, stroke, hyperten­sion, dyslipidemia, nephropathy, neuropathy, and retinopathy. Diabetes and its complications cost the Canadian health care system an estimated $13.2 billion every year.

It has been established that improvements in the management of diabetes can reduce the occurrence and progression of many complications. To provide a framework for the management of diabetes in Canada, the Canadian Diabetes Association (CDA) developed its “Clinical Practice Guidelines [CPGs] for the Prevention and Management of Diabetes in Canada,” the most recent version of which was published in 2003.

Several Canadian studies have assessed adherence to the CDA CPGs. Groups in both Newfoundland and Ontario found poor adherence to the monitoring frequencies and laboratory targets recommended by the CDA in its 1992 CPGs. Likewise, Toth and others, working in Alberta, found poor adherence to laboratory targets and variable receipt of medications recommended in the 1998 version. More recently, a national study also reported poor adherence to the 1998 laboratory targets. In contrast to this evidence of poor adherence, Conway and others found that the laboratory targets outlined in a draft of the CDA’s current (2003) CPGs were, in fact, attainable in practice.

A quality assessment of adherence to current practice guidelines for patients attending the Diabetes Education Centre at the authors’ hospital has not previously been performed. Lions Gate Hospital is a 246-bed community acute care facility in North Vancouver, British Columbia. The hospital’s Diabetes Education Centre is an outpatient facility serving a population of 169 000. Each year, patients newly diagnosed with type 2 diabetes are referred by a general practitioner or an endocrinologist to attend a series of 5 educational sessions that span 20 months (Appendix 1). The Diabetes Education Centre is staffed by nurses and dietitians who educate patients, document progress at each session, and send feedback to physicians (by fax) when necessary. A lifestyle consultant and a pharmacist each provide an educational lecture to patients.

The objective of this study was to determine the percentage of patients for whom monitoring frequencies, laboratory targets, and medications, as recommended in the 2003 CPGs of the CDA, were achieved. To the authors’ knowledge, no other studies have measured adherence to the 2003 CPGs since their publication, and none have comprehensively assessed all 3 of the aforementioned sets of outcomes with respect to any version of the CDA’s CPGs.