2008 Clinical Practice Guidelines - Canadian Diabetes Association

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2008 CLINICAL PRACTICE GUIDELINES S196 Care Objective Target Self-monitoring of blood glucose Blood glucose control Blood glucose meter accuracy • Reinforce patient’s responsibility for regular monitoring as appropriate • Ensure patient can use glucose meter, interpret SMBG results and modify treatment as needed • Develop an SMBG schedule with patient and review records • Measure A1C every 3 months for most adults • Consider testing at least every 6 months in adults during periods of treatment and lifestyle stability, and when glycemic targets are being consistently achieved • Compare meter results with laboratory measurements at least annually, and when indicators of glycemic control do not match meter Preprandial (mmol/L) 4.0–7.0 for most patients 2-hour postprandial (mmol/L) 5.0–10.0 for most patients 5.0–8.0 if not achieving A1C target A1C ≤7.0% for most patients See “Targets,” p. S29 Hypertension • Measure BP at diagnosis of diabetes and at every diabetes clinic visit 15 years and age >30 years Dyslipidemia • Measure fasting lipid levels (TC, HDL-C,TG and calculated LDL-C) at diagnosis of diabetes, then every 1–3 years as clinically indicated. Test more frequently if treatment initiated Early detection and treatment ACR (mg/mmol) Normal: M 28.0 CKD if eGFR ≤60 mL/min Early detection and treatment If neuropathy present: foot care education, specialized footwear, smoking cessation If ulcer present: manage by multidisciplinary team with expertise Vascular protection: first priority in prevention of diabetes complications is reduction of CV risk by vascular protection through a comprehensive multifaceted approach: • All people with diabetes: optimize BP, glycemic control and lifestyle (weight, exercise, smoking) • People with diabetes and at high risk of CV event, additional interventions: ACE inhibitor/ARB antiplatelet therapy (as indicated) and lipid-lowering medication (primarily statins) Lipid targets for those at high risk for CAD: • Primary target: LDL-C ≤2.0 mmol/L • Secondary target:TC/HDL-C
Appendix 3 Examples of Insulin Initiation and Titration Regimens in People With Type 2 Diabetes 2008 CLINICAL PRACTICE GUIDELINES All people starting insulin should be counselled about the recognition, prevention and treatment of hypoglycemia. Consider a change in type or timing of insulin administration if glycemic targets are not being reached. Example A: Basal insulin (Humulin-N, Lantus, Levemir, Novolin ge NPH) added to oral antihyperglycemic agents • Insulin should be titrated to achieve target fasting BG levels of 4.0 to 7.0 mmol/L. • Individuals can be taught self-titration, or titration may be done in conjunction with a healthcare provider. • Suggested starting dose is 10 units once daily at bedtime. • Suggested titration is 1 unit per day until target is reached. • A lower starting dose, slower titration and higher targets may be considered for elderly or normalweight subjects. • In order to safely titrate insulin, patients must perform SMBG at least once a day fasting. • Insulin dose should not be increased if the individual experiences 2 episodes of hypoglycemia (BG
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2008 Clinical Practice Guidelines - Canadian Diabetes Association

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