From the Guidelines
The 2025 Canadian guidelines for diabetes diagnosis and management prioritize a comprehensive approach focusing on early detection, personalized treatment, and morbidity reduction, with diagnosis based on fasting plasma glucose, oral glucose tolerance test, HbA1c, or random plasma glucose with symptoms. According to the most recent evidence from 1, the management of diabetes should incorporate a person-centered shared decision-making approach, considering factors such as cardiovascular and renal comorbidities, effectiveness, hypoglycemia risk, impact on weight, cost, and individual preferences. Key aspects of management include:
- Early combination therapy for adults with type 2 diabetes to achieve individualized treatment goals, as suggested by 1
- Selection of pharmacologic agents based on individualized glycemic and weight goals, as well as the presence of other metabolic comorbidities and the risk of hypoglycemia, in line with recommendations from 1
- Use of SGLT2 inhibitors for adults with type 2 diabetes and heart failure to improve glycemic management and prevent hospitalizations, as recommended by 1
- A focus on weight management goals, with consideration of approaches that support weight management for adults with type 2 diabetes, as outlined in 1. The guidelines emphasize the importance of regular reevaluation and adjustment of the medication plan and medication-taking behavior to incorporate specific factors that impact choice of treatment, as stated in 1. Overall, the 2025 Canadian guidelines for diabetes diagnosis and management prioritize a patient-centered approach, individualization of treatment, and reduction of morbidity and mortality, with a focus on achieving optimal outcomes and reducing long-term complications, as supported by the most recent evidence from 1.
From the Research
Canadian Guidelines for Diabetes Diagnosis
There are no specific Canadian guidelines mentioned in the provided studies for the 2025 diagnosis of diabetes. However, the studies do provide information on the general diagnosis and classification of diabetes mellitus.
Diagnosis Criteria
- Fasting plasma glucose value of 7.0 mmol/l or higher can be used to diagnose diabetes 2
- Plasma glucose 2 h after 75 g glucose load of 11.1 mmol/l or higher can also be used to diagnose diabetes 2, 3
- Casual plasma glucose > or =11.1 mmol/l also indicates diabetic type 3
- HbA1c > or =6.5% suggests diabetes, but HbA1c below 6.5% alone should not be taken as evidence against the diagnosis of diabetes 3
Screening and Risk Factors
- Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors 4
- Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis 4
- Patients at higher risk should be screened with a fasting plasma glucose level 5
Management
- Patients with impaired glucose tolerance or impaired fasting glucose have a significant risk of developing diabetes and thus are an important target group for primary prevention 5
- Physicians should counsel patients to lose 5 to 7 percent of their body weight and engage in moderate physical activity for at least 150 minutes per week 5
- Drug therapy with metformin or acarbose has been shown to delay or prevent the onset of diabetes, but medications are not as effective as lifestyle changes 5