Maureen Clement

Use of Glycated Hemoglobin (A1C) in the Diagnosis of Type 2 Diabetes Mellitus in Adults

The Canadian Diabetes Association (CDA) reviewed the use of glycated hemoglobin (A1C) in the diagnosis of diabetes mellitus. An International Expert Committee, the American Diabetes Association, a joint statement from the American Association of Clinical Endocrinologists/American College of Endocrinology, and a World Health Organization Consultation each recommend an A1C of 6.5% or higher as a criterion for the diagnosis of diabetes (1-4). The relationship between A1C and retinopathy is similar to that of fasting plasma glucose (FPG) or 2-hour plasma glucose (2hPG) with a threshold at around 6.5% (5-8). Although the diagnosis of diabetes is based on an A1C threshold for developing microvascular disease, A1C is also a continuous cardiovascular risk factor and a better predictor of macrovasRonald M. Goldenberg MD FRCPC FACE, Alice Y.Y. Cheng MD FRCPC, Zubin Punthakee MD FRCPC, Maureen Clement MD CCFP

Policies, Guidelines and Consensus Statements: Pharmacologic Management of Type 2 Diabetes-2015 Interim Update.

The initial draft of this commentary was prepared by William Harper MD, FRCPC, Maureen Clement MD, CCFP, Ronald Goldenberg MD, FRCPC, FACE, Amir Hanna MB, BCh, FRCPC, FACP, Andrea Main BScPhm, CDE, Ravi Retnakaran MD, MSc, FRCPC, Diana Sherifali RN, PhD, CDE, Vincent Woo MD, FRCPC, Jean-François Yale MD, CSPQ, FRCPC, and Alice Y.Y. Cheng MD, FRCPC on behalf of the Steering Committee for the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

Diabetes and the Frail Elderly in Long-term Care

ABSTRACT Diabetes in long-term care is increasing in prevalence. This population of the frail elderly presents unique challenges in terms of barriers to care, pharmacologic management, glycemic control, monitoring and hypoglycemia, but few evidence-based guidelines are available to direct care. This paper reviews the current literature and presents 2 pilot projects that explore these issues.

Type 2 Diabetes, Hypoglycemia, and Basal Insulins: Ongoing Challenges

Hypoglycemia in people with insulin-treated type 2 diabetes can be a limiting factor for management and a barrier to optimizing glycemic control. Even mild episodes of hypoglycemia can affect an individuals quality of life, and fear of hypoglycemia can lead to underinsulinization. This article explores the prevalence and consequences of hypoglycemia in people with type 2 diabetes with a focus on those who use basal insulins, offering strategies for prevention and management. It also discusses the benefits and challenges associated with new basal insulins, and their potential role in reducing hypoglycemia risk.