Table 5:

Diagnostic strategies: New or updated recommendations in the 2018 C-CHANGE harmonized guideline*

RecommendationSource guideline (key supporting reference)
Diabetes
Diabetes should be diagnosed by any of the following criteria:

  • FPG ≥ 7.0 mmol/L

  • A1C ≥ 6.5% (for use in adults in the absence of factors that affect the accuracy of A1C and not for use in those with suspected type 1 diabetes)

  • 2hPG in a 75 g OGTT ≥ 11.1 mmol/L

  • Random PG ≥ 11.1 mmol/L

DC (31)
Heart failure
We recommend that BNP/NT-proBNP levels be measured to help confirm or rule out a diagnosis of heart failure in the acute or ambulatory care setting in patients in whom the cause of dyspnea is in doubt.HF (32)
We recommend that patients who receive potentially cardiotoxic cancer therapy undergo evaluation of LVEF before the start of cancer treatments known to cause impairment in LV function.HF†
Hypertension
Routine laboratory tests that should be performed for the investigation of all patients with hypertension include the following:

  • Urinalysis

  • Blood chemistry (potassium, sodium, and creatinine)

  • Fasting blood glucose or A1C

  • Serum total cholesterol, LDL-C, HDL-C, non–HDL-C, and triglycerides; lipids may be drawn fasting or nonfasting

  • Standard 12-lead electrocardiography

HC (34)
Standardized office BP measurement should be used for follow-up. Measurement using electronic (oscillometric) upper arm devices is preferred over auscultation.HC (25)
In patients with large arm circumference when standard upper arm measurement methods cannot be used, validated wrist devices (used with arm and wrist supported at heart level) may be used for blood pressure estimation.HC†

  • Note: 2hPG = post-load glucose, A1C = glycosylated hemoglobin, BNP = B-type natriuretic peptide, BP = blood pressure, C-CHANGE = Canadian Cardiovascular Harmonized National Guideline Endeavour, DC = Diabetes Canada (formerly Canadian Diabetes Association), FPG = fasting plasma glucose, FRS = Framingham Risk Score, HC = Hypertension Canada, HF = Canadian Cardiovascular Society – Heart Failure, HDL-C = high-density lipoprotein cholesterol, LDL-C = low-density lipoprotein cholesterol, LV = left ventricle, LVEF = left ventricle ejection fraction, NT-proBNP = N-terminal pro B-type natriuretic peptide, OGTT = oral glucose tolerance test, PG = plasma glucose.

  • ↵* All recommendations are considered strong recommendations (Box 1); the quality of evidence supporting each recommendation varies (see Appendix 1 for a detailed discussion of the supporting evidence. Key references are indicated in this table.)

  • ↵† Based on consensus opinion.