Our Mandate to Optimize Diabetes Care and Management

Abstract

One of the Canadian Journal of Diabetes's mandates is to focus on relevant current issues in an attempt to improve and optimize diabetes care and management. Thematic issues have been published since 2012 to highlight topics that are of interest to the diabetes community at large and at the same time relevant to best practice. Several themes have been identified by our editorial board as areas in which knowledge translation to best clinical practice has been lagging, and that could be addressed. This first such theme, the in-hospital management of patients with diabetes, is presented in this issue. Significant gaps exist between current standards of care, as recommended by 2013 evidence-based Canadian Diabetes Association clinical practice guidelines (http://guidelines.diabetes.ca/), and successful implementation of point-of-care tools, such as order sets and protocols, in optimizing glycemic control and overall diabetes management. The guest editors for this issue, led by Dr. Alice Cheng, have admirably assembled articles that address a wide array of topics, from glycemic targets and barriers to implementation, to practical perspectives and point-of-care tools, including clinical templates and protocols, so as to promote optimal management of hospitalized patients with diabetes in Canada. The next issue's theme will focus on the primary-care management of diabetes. Because most of the Canadian provincial and territorial health authorities fully embrace and implement the chronic care model as part of their long-term healthcare objectives, diabetes has become a prototypical model of a complex chronic disease. It follows naturally that the management of diabetes should gradually transition from a shared-care model between specialists and family physicians to one that is delivered mainly by primary care practitioners, which in many provinces are composed of a team of interprofessional healthcare workers. The primary care management issue will provide insights into diabetes surveillance in primary care settings and how well diabetes management is integrated in primary care models. As the prevalence of diabetes is rising not only in adults but also in children and youths, new challenges arise for the management and prevention of diabetes in the pediatric population. This subject will be addressed in greater depth in a future issue devoted to pediatric diabetes. Another area that merits greater attention in clinical practice is the rising prevalence of chronic kidney disease in diabetes. Management of patients with diabetic kidney disease is complex and challenging from multiple perspectives. Providing guidance for primary care practitioners with respect to glycemia, blood pressure and lipid management in people with early to advanced diabetic chronic kidney disease, as well as management and prevention of diabetic nephropathy, will be the focus of a theme issue devoted to diabetes and the kidney. CJD aspires to become the “go-to” authoritative and reliable source of information for the diabetes community in Canada and abroad. We just launched the Clinical Resource Centre, a new feature that is now available at our website (http://www.canadianjournalofdiabetes.com/). This initiative attempts to interact with our readers by providing innovative and interactive educational resource materials in a variety of formats (video clips, slides, research and review articles, case studies and point-of-care tools) to assist healthcare professionals to update their best practices. The role of the kidney in glucose homeostasis is the first topic selected for the launch. We introduce our readers to a novel mechanism of insulin-independent glucose lowering by inhibiting glucose reabsorption in the proximal renal tubules, resulting in increased urinary glucose excretion. Inhibitors of sodium-coupled glucose co-transporter-2 (SGLT2 inhibitors) belong to a new class of oral antihyperglycemic drugs, which will soon become available for the management of type 2 diabetes in Canada. In countries where they have been approved, such as the United States and the European Union, SGLT2 inhibitors have become popular second-line glucose-lowering agents after metformin. As always, we welcome suggestions and comments from our readers on “hot” and controversial topics that are relevant to clinical and best practices.