2008 Clinical Practice Guidelines - Canadian Diabetes Association

2008 CLINICAL PRACTICE GUIDELINES
S192
PRIMARY PREVENTION
Several large primary prevention clinical trials published in
the past 5 years have shown that progression of IGT can be
prevented or delayed with lifestyle or pharmacological interventions.
In the Da Qing study (with 577 Chinese subjects
with IGT) and a Japanese study (with 458 Japanese subjects
with IGT), lifestyle interventions were associated with 46
and 67% reductions, respectively, in the incidence of type 2
diabetes (33,34). The Diabetes Prevention Program, a large
prospective randomized clinical trial in 3234 American
adults with impaired fasting glucose (IFG) or IGT, demonstrated
that lifestyle modifications reduced the incidence of
type 2 diabetes in a variety of high-risk racial/ethnic groups
(35). The recently published Indian Diabetes Prevention
Program demonstrated a relative risk reduction of 28.5%
with lifestyle intervention in native Asian Indians with IGT
who were younger, leaner and more insulin resistant than the
above populations (36). Progression of IGT to diabetes was
18.3% per year. In a 3-year follow-up, 55% of the nonobese
yet highly insulin-resistant Indian population with IGT developed
diabetes (23).
The complex interplay between cultural context and
lifestyle supports the use of ethnic-specific, community diabetes
prevention programs that focus on lifestyle modification.They
should be developed and delivered in partnership
with the target communities (5).
MANAGEMENT
The cultural dynamics influencing chronic illness management
are complex and deeply rooted in the cultural traditions
and fabric of ethnic communities.There is a growing body of
evidence supporting the use of ethnic-specific community
diabetes management programs that reflect the unique sociocultural
dynamics of and are delivered in partnership with the
target communities (5,24-26). Individuals from high-risk ethnic
populations develop diabetes complications, particularly
CVD and renal failure, much earlier than other populations.
Given the high CV mortality in South Asians, aggressive management
of risk factors, including hypertension and dyslipidemia,
is warranted to reduce morbidity and mortality (6).
RECOMMENDATIONS
1. High-risk ethnic peoples should be screened for diabetes
according to clinical practice guidelines [Grade D,
Consensus]. Ethnic-specific BMI and WC cutoff points
should be used for risk stratification [Grade D,
Consensus].Where access to screening by a family physician
is not available, targeted community screening programs
should be provided for those at high risk of
diabetes [Grade D, Consensus].
2. Community-based prevention and management programs
aimed at high-risk ethnic peoples should be developed
and delivered in partnership with target communities,
and should reflect the local ethnocultural representation
[Grade D, Consensus].
OTHER RELEVANT GUIDELINES
Screening for Type 1 and Type 2 Diabetes, p. S14
Prevention of Diabetes, p. S17
Organization of Diabetes Care, p. S20
Self-management Education, p. S25
Identification of Individuals at High Risk of Coronary
Events p. S95
Type 2 Diabetes in Children and Adolescents, p. S162
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