New Canadian Practice Guidelines For DiabetesThursday, April 11, 2013
Earlier this week, the Canadian Diabetes Association released the newest version of the Canadian Practice Guidelines for Diabetes.
The online release includes the full text of all 38 chapters and an appendix.
Each chapter comes with a slide set and a brief video highlighting the key recommendations.
There are also accompanying tools for health care providers and resources for patients.
The following are the main recommendations for weight management:
- An interdisciplinary weight management program (including a nutritionally balanced, calorie-restricted diet; regular physical activity; education; and counselling) for overweight and obese people with, or at risk for, diabetes should be implemented to prevent weight gain and to achieve and maintain a lower, healthy body weight [Grade A, Level 1A]
- In overweight or obese adults with type 2 diabetes, the effect of antihyperglycemic agents on body weight should be taken into account [Grade D, Consensus].
- Adults with type 2 diabetes and class II or III obesity (BMI ≥35.0 kg/m2) may be considered for bariatric surgery when lifestyle interventions are inadequate in achieving healthy weight goals [Grade B, Level 2]
While the recommendations with regard to pharmacotherapy reflect the lack of effective medications for obesity in Canada, they do highlight the role for bariatric surgery in heavier patients with type 2 diabetes.
There is also a useful checklist for weight management programs:
- The program assesses and treats comorbid conditions.
- The program provides individualized nutritional, exercise and behavioral programs and counselling.
- Nutritional advice is provided by qualified experts (e.g. registered dietitians) and diets are not less than 900 kcal/day.
- Exercise is encouraged but physical activity is promoted at a gradual pace.
- Reasonable weight loss goals are set at 1 to 2 lb/week.
- Cost is not prohibitive, and there are no financial contracts.
- There is no requirement to buy products, supplements, vitamins or injections.
- The program does not make unsubstantiated claims.
- The program has an established maintenance program.
The complete guidelines are accessible here.
Thursday, April 11, 2013
Dear Dr. Sharma,
It is with great interest that I read the latest from CDA regarding Type 2 diabetes. I have a BMI of 27.5 but more importantly my gender, ethnic background, waist circumference, family history, A1c glucose 5.9% puts me in a type 2 diabetes risk group. For the past two years I have been on a self imposed calorie restrictive ~1200 cal/day diet and daily (yes daily) cardio strength training program. Despite that i am not being able to achieve a healthier weight. My question is how does one convince their doctor to refer them to or educate the patient to a guided ‘interdisciplinary health management program’.
I personally feel that i have metabolic syndrome but am unable to convince my doctor to test me for glucose intolerance. The best advice my doctor has given me is to increase the blood glucose test to once a year as in his words although my fasting glucose is only 4.8 mmol/l I am part of the demographic disposed to Type 2 diabetes. It will be valuable to get your opinion on whether it is important to properly manage before or after one becomes diabetic. Thank you, I really find your articles informative and helpful. i actually learned a lot about exercise and MET minutes from one of your postings.