Diabetes
Diabetes Canada still prints blood pressure <130/80. In Québec use systolic <130, no diastolic target.
Screening
Who to test- INESSS Institut national d'excellence en santé et services sociaux
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| Roster screening | ≥40 every 3 years Fasting plasma glucose and/or HbA1c.
Diabetes Canada chapter 4 opens in a new tabQuébec · no guideline |
| Unattached adults | ≥15 and at least 2 risk factors Unattached adults 18–75 only. Not roster screening.
How often
|
Diagnose
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| Diagnose | Any of these tests
Confirm
|
| Diagnostic thresholds | |
| ≥6.5% | Prediabetes 6.0–6.4% Diabetes Canada |
| ≥7.0 | Impaired fasting glucose 6.1–6.9 Diabetes Canada |
| ≥11.1 | Impaired glucose tolerance 7.8–11.0 Diabetes Canada |
| ≥11.1 | With classic symptoms Diabetes Canada |
| Treatment target | |
| ≤7.0% | Most adults
Adjust
|
Investigate
After the diagnosis is confirmedBaseline tests for complications and cardiovascular risk. Repeat kidney and lipids on the yearly interval, not at every titration visit.
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| Lipids | At diagnosis
Diabetes Canada chapter 25 opens in a new tabINESSS opens in a new tabQuébec · no lipid CPG |
| Electrocardiogram | Resting electrocardiogram every 3–5 years If age >40, duration >15 years and age >30, end-organ damage, or at least one cardiovascular risk factor. |
| Eyes | Type 2 at diagnosis
Repeat
|
Treat
- RAMQ Régie de l'assurance maladie du Québec
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| First-line type 2 | Metformin Start 250–500 mg PO BID with meals.
Titrate slowly.
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| Insulin now | Do not wait on HbA1c Metabolic decompensation or severe symptomatic hyperglycemia. Diabetes Canada 2024 chapter 13 |
| After Metformin | |
| ASCVD | GLP-1 RA or SGLT2 inhibitor even if HbA1c is at target.
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| Heart failure | SGLT2 inhibitor even if HbA1c is at target.
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| CKD | SGLT2 inhibitor even if HbA1c is at target.
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| >1.5% | Metformin plus a second class at the start
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| No cardiorenal priority | Individualize the second class
Do not
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| Still above target | Basal insulin Keep Metformin, incretins, and SGLT2 inhibitors.
Diabetes Canada 2024 chapter 13 opens in a new tabRAMQ drug list opens in a new tab |
| Drug | Dose | Duration |
|---|---|---|
| Metformin | 250–500 mg PO BID with meals | Ongoing |
| Metformin XR | 500–1000 mg PO DIE at supper | Ongoing |
Usual add-on starts are INESSS PMN 628004 examples for older or frail adults. Titration and eGFR live in that protocol. Check RAMQ.
| Drug | Dose | How often |
|---|---|---|
| SGLT2 inhibitors | ||
| Empagliflozin | 10 mg PO | DIE, morning |
| Dapagliflozin | 5–10 mg PO | DIE, morning |
| Canagliflozin | 100 mg PO | DIE, morning |
| GLP-1 receptor agonists | ||
| Dulaglutide | 0.75 mg SC | 1×/sem |
| Liraglutide | 0.6 mg SC | DIE |
| Semaglutide | 0.25 mg SC | 1×/sem |
| Sulfonylurea | ||
| Gliclazide | 40–80 mg PO with meals | BID |
| Basal insulin | ||
| Insulin NPH or Glargine | 4–10 units | DIE |
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| HbA1c | Every 3 months until at target
then every 6 months
|
| Kidney | Creatinine, eGFR, and uACR at least yearly
|
Blood pressure
Québec, not Diabetes Canada- INESSS Institut national d'excellence en santé et services sociaux
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| <130 | Systolic <130, no diastolic Diabetes is high cardiovascular risk, so drugs from systolic 130–139. <130/80
Chapter 26 opens in a new tabDiabetes Canada 2018 |
Reviewed 24 August 2026 against the official sources below.
Sources
Blue square: Québec · red round: Canada. The code names the body; each section's key gives its full name.