New clinical guidelines drive better health outcomes, empower care partnerships

Ram Krishna was a patient contributor to the  2018 Guidelines  and helped to make them “patient friendly.”  Supplied

Ram Krishna was a patient contributor to the 2018 Guidelines and helped to make them “patient friendly.” Supplied

Like others with the disease, Ram Krishna admits that diabetes is challenging to manage – but he adds that learning from others has made an immense difference. “Attitude is key – looking at solutions rather than the problems.” 

His thinking has been influenced by many people, he says, including his endocrinologist, other health-care providers and patient groups. By being conscious about what he calls the “four pillars” (meal planning, monitoring, medication and activity), he has maintained healthy blood sugar levels, vastly reducing his risk of future complications. As a Canadian of South Asian descent, Mr. Krishna is in a high-risk genetic group. (Two of the four brothers in his family have diabetes.) A volunteer with Diabetes Canada, he also connects with others in the South Asian community who are living with diabetes. 

For the Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines), released in April of this year, Krishna was a patient contributor. “We worked with family physicians, endocrinologists, nurse practitioners, pharmacists and cardiologists – and all of the other specialties with which diabetes is associated,” he says.

A key aim is empowering people with diabetes to become educated partners in their own care. This is why each of the 38 chapters in the 2018 edition has easy-to-read key messages written specifically for people living with diabetes. “The Guidelines are designed to be patient friendly,” says Krishna. 

The Guidelines provide multiple points of access for all Canadians, says Dr. Robyn Houlden, chair of the Diabetes Canada Guidelines. “Our webpage is a rich repository of information for both health-care providers and for people living with diabetes. It includes information sheets and instructional videos related to all aspects of care, and has specific information for various groups of patients, including children and adolescents, pregnant women, older people and Indigenous people.”

The 2018 edition includes a new focus on ethnocultural diversity and its importance in diabetes care, says Dr. Houlden. “There is encouragement to take culture, faith traditions, values and beliefs into consideration in diabetes education, and to deliver it in a specific population’s preferred language, ideally within their own community, including their community leaders.”

This edition also includes greater involvement from Indigenous authors and organizations, as well as health-care providers who work with Indigenous populations. “The Guidelines reference the recommendations of the Truth and Reconciliation Commission and recognize the legacy of colonization and residential schools, which contributes to the high rates of diabetes in these populations,” says Dr. Houlden.

Other new elements include a focus on the importance of individualizing glycemic targets, pregnancy preparation for women with diabetes, and drugs that are heart-protective while lowering blood sugar. 

“Knowledge is power,” Dr. Houlden says. “The more you understand about how to live well with diabetes, the more successful you can be in managing it.”

“It’s a challenge for even the most research-savvy people to keep up with the evidence about the pros and cons of different tests and treatments,” says Dr. Noah Ivers, a family doctor at Women’s College Hospital and co-chair of the Guidelines Dissemination and Implementation Committee.

“This is especially true today, when you simply can’t trust much of what you read online or see on TV.” 

He stresses that the Guidelines involve thousands and thousands of volunteer hours during which well-trained professionals systematically comb through the research evidence. 

“We’ve worked hard to turn this evidence into specific recommendations, with clear and meaningful take-home points,” he notes. “And we’ve worked hard to update our website – – with tools to make it easier to put the recommendations into practice. We know that guidelines don’t self-implement.

“People with diabetes should feel empowered to ask for more,” says Dr. Ivers. “They should ask their health professionals if there is more that can be done to prevent future complications, to keep them safe from adverse effects of treatment, or if resources are available to help them better take care of themselves.”

The goal of the Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada is closing the current health-care gap. is the place for current diabetes-related research. As the source for the best-in-class treatment recommendations, the information provided can help improve outcomes for people living with diabetes, cutting the risk of complications – such as stroke, heart attack and amputation – in half.