Challenges to managing type 2 diabetes in British Columbia: Discordant guidelines and limited treatment options

Type 2 diabetes is a common metabolic condition that requires a multifaceted approach to reduce associated complications. Management is challenging because of the progressive nature of the condition and the growing availability of different classes of antihyperglycemic agents. Unfortunately, general practitioners and specialists looking for guidance in the complex pharmacological management of type 2 diabetes in BC can find themselves frustrated by contradictory recommendations from these three bodies: Diabetes Canada, the British Columbia Guidelines and Protocols Advisory Committee, and the Therapeutics Initiative. These three bodies differ in composition and the methodology that they use to prepare recommendations. Diabetes Canada is a national organization supporting a large number of volunteers from many health professions as they develop clinical practice guidelines. The Guidelines and Protocols Advisory Committee consists of representatives from the Ministry of Health and Doctors of BC who oversee working groups that develop BC-specific guidelines on important clinical topics, including diabetes care. The Therapeutics Initiative is an organization funded by the Ministry of Health and the University of British Columbia that completes assessments of drug therapy and publishes the findings in bulletin form. Receiving conflicting information is difficult for physicians and can result in a wide variability in quality of care, as well as clinical inertia, such as failure to implement or intensify a beneficial therapy. Furthermore, despite growing evidence of significant clinical benefits for many diabetes drugs, most require special authority approval or, in the case of newer agents, are not covered at all by BC Pharmacare, which makes it difficult for physicians to manage their patients with diabetes using the most up-to-date and robust evidence.