Practical Implementation of Diabetes Canada Guideline Updates for Type 2 Diabetes Management in Primary Care

Abstract

Type 2 diabetes (T2DM) is a growing global health epidemic identified by the World Health Organization (WHO) as a major public health challenge of the 21st century.1 By 2050, it is estimated that 1.31 billion people worldwide could be living with T2DM. Across Canada, T2DM affects >9% of our population (i.e., >3.6 million individuals), and age-adjusted prevalence is also increasing at an alarming rate averaging 3.3% per year. More than 90% of people living with diabetes have T2DM, and most of these individuals are cared for in the primary care setting. With rising rates of obesity and metabolic risk factors, along with an aging Canadian population, the burden of T2DM facing primary care is only expected to increase over time. 

T2DM care is complex, tailored to the individual, and rapidly advancing. A May 2023 survey commissioned by Diabetes Canada estimated that over one-third of family practitioners’ time is spent treating diabetes, and that most healthcare providers find T2DM challenging to treat.3 The Diabetes Canada Clinical Practice Guidelines (DCAN CPG) provides useful and practical guidance on T2DM management. It has recently shifted its update structure from a comprehensive overhaul every five years, to a select few focused chapter updates each year in recognition of the rapidly shifting body of evidence. More recently, updated chapters of the DCAN CPG include a Pharmacologic Glycemic Management of Type 2 Diabetes in Adults chapter in 2020; Blood Glucose Monitoring in Adults and Children with Diabetes chapter in 2021; Remission of Type 2 Diabetes special article in 2022; and Hypoglycemia in Adults chapter and Position Statement on DIY Automated Insulin Delivery special article in 2023. The purpose of this review is to provide a pragmatic overview of these recent chapter updates and to highlight priorities for T2DM management in primary care.