Making Diabetes Guidance 'As Simple as Possible'

Jay H. Shubrook, DO: Hi. I am Jay Shubrook, family physician and professor at Touro University California. We are here in Orlando, Florida, at the 78th Scientific Sessions of the American Diabetes Association (ADA).

Today I have with me Lori Berard, RN, who was integral in [developing] the Canadian diabetes guidelines, both by being on the executive committee and as a chapter author. Welcome, Lori.

Lori Berard, RN, CDE: Thanks for having me.

Diabetes Canada Clinical Practice Guidelines

Shubrook: There is a lot of diabetes guideline controversy here in the United States. But there are many diabetes guidelines. You are intimately involved in the Canadian guidelines and I would like to hear a little bit more about them.

Berard: Sure. It has been a really great experience for me. I have now worked on three sets of guidelines. I have been a chapter author and I have sat on the executive committee and steering committee. I really understand the process. Our guidelines are evidence-based. We only produce them every 5 years, although that is probably going to change because the evidence in diabetes changes so much.

We really focus on primary care as the target audience. Like other countries, many parts of allied health are becoming intricately involved in guidelines. I think one of the highlights this time around from Diabetes Canada is that there was a lot of input from all allied health members. Laypeople were involved in a couple of chapters in the guidelines, specifically on diabetes in the indigenous population.

Shubrook: That is really important because diabetes care is provided by a broad range of providers, and certainly it is a disease that is largely self-managed. If we do not get the patient population involved, we are missing an opportunity.

Berard: We did a couple of things this time that were really integral. We have always had key messages for healthcare professionals, but no one typically reads the preamble; they go straight to the recommendations. All of our chapters now have key messages for people living with diabetes. If I am trying to disseminate information to my patients, I can take those key messages and help people understand what that chapter was about and why that message is important to them.

The other thing we have done really well with our Canadian guidelines is that we have a beautiful website with a large suite of dissemination tools and relevant things to help healthcare practitioners move forward in their diabetes management. We have case studies. We have case studies on psychological issues in diabetes. We have some infographics. We have some interactive decision tools for diagnosis and the pharmacologic algorithm for type 2 diabetes. One of my favorites is the self-monitoring of blood glucose algorithm. We really do a lot of work around that part of our guidelines as well as to make them come to life in the tools that we make.

Patient Tools and Education

Shubrook: That is great. Can patients go to the site as well?

Berard: Absolutely. The goal is that there will be as many patient tools as there are provider tools. Having said that, a couple of the interactive tools are meant for patients, but our patient resources lay there as well. For example, you can look for resources in type 1 diabetes or nutritional resources. Anything that is available for healthcare professionals is also available for people living with diabetes.

We have key things there as well: keeping people safe, preventing complications, and supporting self-management (which is a huge topic and one we are really recognizing). Under those key themes are the different tools that are helpful for people living with diabetes.

Shubrook: Do you find that your patients go to the site and utilize those tools?

Berard: Not yet. We still have a lot of work to do in Canada about dissemination of the guidelines. Like all countries, there is controversy about whether these evidence-based guidelines can really be put into clinical practice. We have a bottom-up approach where we try to attract individuals living with diabetes. But we are also engaging nurses, dietitians, pharmacists, and bedside people to say, "Go to this website. It can help you." Eventually we hope that when you Google "diabetes" in Canada, there will be a really good portal for people. But things like that always take time.

Shubrook: The healthcare professional team and patients can go to the website if they need good information about implementation of diabetes care.

Berard: Absolutely. We have evidence-based guidelines that strike across all the different areas. We have 38 chapters. It is not like we just deal in pharmacologic management. With the way chapters are broken down into tools that facilitate the evidence within the recommendations, and with key messages to healthcare professionals and people living with diabetes, we have tried to make diabetes as simple as possible.

Shubrook: Which is not simple.

Berard: No, not at all.

Shubrook: When was the last guideline produced?

Berard: We just launched our 2018 guidelines on April 9.Of course, they are already outdated because the evidence changed already in terms of some of the trials and some of the new agents that were not available in Canada when we put the guidelines out. Our group has really recognized that we need to change the way that we revise guidelines. Every 5 years is too long. I think you will start to see rolling guidelines come from Diabetes Canada. To be determined. Likely, major updates will occur every 1 to 2 years, with minor updates probably every 5 years for chapters that do not really change.

Shubrook: That is consistent with what ADA is doing now; they are making live guidelines. This is a good time to visit the recently updated Canadian guidelines. I really like the focus it has—not only on providers, but also the patients who are affected with diabetes.

Thank you so much for coming today.

Berard: Thanks for having me.