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Die vorliegende Leitlinie nimmt Bezug auf die Indikation und praktische Umsetzung der Insulintherapie bei Typ 2 Diabetes, insbesondere auch im Hinblick auf die unterschiedlichen Formen der Insulintherapie.

Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.

This position statement is based on current evidence available on the safety and benefits of continuous subcutaneous insulin infusion therapy (CSII, pump therapy) in diabetes with an emphasis on the effects of CSII on glycemic control, hypoglycaemia rates, occurrence of ketoacidosis, quality of life and the use of insulin pump therapy in pregnancy. The current article represents the recommendations of the Austrian Diabetes Association for the clinical praxis of insulin pump treatment in children, adolescents and adults.

Gestationsdiabetes (GDM) wird als Glukosetoleranzstorung definiert, die erstmals in der Schwangerschaft entdeckt wird. GDM ist mit einer erhohten fetomaternalen Morbiditat sowie Langzeitkomplikationen bei Mutter und Kind assoziiert. Frauen, die die Kriterien eines manifesten Diabetes bereits in der Fruhschwangerschaft erfullen (Nuchternplasmaglukose >126 mg/dl, Spontanglukosemessung uber 200 mg/dl oder HbA1c > 6,5 % vor der 20. Schwangerschaftswoche), sollen als Schwangere mit manifestem Diabetes klassifiziert und ebenso behandelt werden. Ein Screening auf unerkannten Typ-2-Diabetes bei der ersten pranatalen Kontrolle wird besonders bei Frauen mit hohem Risiko (Anamnese eines GDM oder Pradiabetes; Fehlbildungen, Totgeburt, wiederholte Aborte oder Geburtsgewicht uber 4500 g in fruheren Schwangerschaften; Adipositas, metabolisches Syndrom, Alter uber 35 Jahre, bei Gefaserkrankungen, Auftreten von Diabetessymptomen wie Glukosurie, ethnische Zugehorigkeit zu Gruppen mit hohem Risiko [arabisch, S‑ und SO-Asien, Lateinamerika]) empfohlen (Evidenzklasse B). GDM wird durch einen oralen Glukosetoleranztest (OGTT) oder durch Nuchternplasmaglukosekonzentrationen uber 92 mg/dl diagnostiziert. Bei hohem Risiko kann ein OGTT (120 min; 75 g Glukose) bereits im ersten Trimenon sinnvoll sein, ist aber in jedem Fall bei allen Schwangeren mit bis dahin unauffalligen Glukosewerten zwischen der 24. und 28. Schwangerschaftswoche vorgeschrieben (Evidenzklasse B). Auf Basis der „Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study“ und nach den aktuellen WHO-Empfehlungen liegt ein GDM vor, wenn der Nuchternplasmaglukosewert 92 mg/dl, der 1‑Stunden-Wert 180 mg/dl oder der 2‑Stunden-Wert 153 mg/dl uberschreiten (OGTT; Internationale Konsensuskriterien). Ein einziger erhohter Wert ist fur die Diagnose ausreichend und bedarf bereits einer strikten Stoffwechselkontrolle. Nach bariatrischer Operation wird aufgrund der Gefahr einer postprandialen Hypoglykamie die Durchfuhrung eines OGTT nicht empfohlen. Alle Frauen mit GDM erhalten eine Ernahrungsberatung und mussen ihre Blutzuckerwerte regelmasig kontrollieren. Ebenso sollte, falls nicht kontraindiziert, die korperliche Aktivitat erhoht werden. Falls die Blutzuckerspiegel nicht im Therapiebereich liegen (nuchtern

Bereits vor 30 Jahren forderte die St. Vincent Deklaration, dass Schwangere mit vorbestehendem Diabetes mellitus vergleichbare Schwangerschaftsergebnisse wie gesunde Frauen erreichen sollen. Dennoch bestehen bei Frauen mit konzeptionell manifestem Diabetes nach wie vor hohere Komplikationsraten und eine hohere perinatale Morbiditat und Mortalitat. Eine fehlende oder zumindest unzureichende Schwangerschaftsplanung und prakonzeptionelle Betreuung mit Optimierung der Stoffwechsellage vor Konzeption sind dafur verantwortlich. Alle Frauen mit Diabetes sollen im Selbstmanagement der Insulintherapie mit Anpassungen der Insulindosis geschult sein und eine stabile Stoffwechsellage vor Schwangerschaftsbeginn aufweisen. Eine Schilddrusendysfunktion, Hypertonie oder diabetische Komplikationen vor der Konzeption sollten ausgeschlossen bzw. adaquat behandelt sein, um das Risiko einer moglichen Progression der Komplikationen und Begleiterkrankungen sowie insgesamt mutterliche und fetale Risiken zu minimieren. Ein Ziel der mutterlichen Stoffwechselkontrolle ist das Erreichen von Normoglykamie und normalen HbA1c-Werten, falls dies ohne Risiko fur Hypoglykamien moglich ist, da eine schlechte Blutzuckereinstellung mit diabetischer Embryopathie und diabetischer Fetopathie assoziiert ist. Das Hypoglykamierisiko ist speziell bei Typ 1 Diabetes mellitus in der Fruhschwangerschaft deutlich erhoht, nimmt aber mit den hormonellen Veranderungen und der Zunahme der Insulinresistenz im Schwangerschaftsverlauf deutlich ab. Eine weltweit steigende Adipositaspravalenz fuhrt zusatzlich zu einem Anstieg von Muttern mit Typ 2 Diabetes. Dieser Trend ist auch bei Frauen mit Typ 1 Diabetes zu beobachten und aggraviert die Metabolik und die perinatalen Ergebnisse. Eine funktionelle, intensivierte Insulintherapie mit multiplen taglichen Insulininjektionen oder eine Insulinpumpentherapie tragen zum Erreichen einer guten mutterlichen Stoffwechselkontrolle wahrend der Schwangerschaft bei. Orale Antidiabetika (Metformin) konnen vor allem bei Typ 2 Diabetes und Adipositas helfen die Insulinsensitivitat zu verbessern, sollten jedoch aufgrund der Plazentagangigkeit und ungewissen Langzeitergebnissen bei den Nachkommen mit Bedacht verordnet werden.

Die Leitlinie nimmt Bezug auf die Diagnostik, einschlieslich begleitender Autoimmunerkrankungen, bei Typ 1 Diabetes mellitus, die Insulintherapie und die glykamischen Zielwerte.

Lebensstil, insbesondere regelmasige korperliche Aktivitat ist ein wichtiger Bestandteil in der Pravention und Therapie des Typ 2 Diabetes mellitus und sollte fester Bestandteil jeglicher Betreuung von Patienten sein. Es besteht breiter Konsens, dass eine effiziente Diabetes-Pravention und Therapie in den meisten Fallen auch von einer Modifikation des Lebensstils begleitet sein muss. Ziele der Forderung der korperlichen Aktivitat sind zunachst das Training des Herz-Kreislaufsystems, Kraftigung der Muskulatur, Steigerung des Energieverbrauchs und die Reduktion von Inaktivitat. Fur einen substanziellen gesundheitlichen Nutzen sind wochentlich mindestens 150 min aerobe korperliche Aktivitat mit mittlerer oder hoherer Intensitat und zusatzlich muskelkraftigende Bewegungen erforderlich. Der positive Effekt von Bewegung steht in direktem Verhaltnis zum Grad der erreichten kardiorespiratorischen Fitness, der erreicht wird. und halt nur so lange an, wie diese aufrechterhalten werden kann. Der Effekt von Bewegung ist alters- und geschlechtsunabhangig und reproduzierbar. Korperliches Training im Speziellen hat die Potenz nicht nur positiven Einfluss auf die Glykamie durch Verbesserung der Insulinresistenz und funktionelle Verbesserung der Insulinsekretion zu nehmen, sondern ist auch in der Lage, das kardiovaskulare Risiko zu senken. Inaktivitat per se gilt unabhangig vom Konstrukt der korperlichen Aktivitat als Risikofaktor. Insbesondere langandauernde sitzende Tatigkeit soll vermieden werden. Angeleitete Bewegungsprogramme sind bestens geeignet, um ein ausreichendes wochentliches Ausmas an gesundheitsfordernder korperlicher Aktivitat zu erreichen. Groses Potential liegt in standardisierten, regionalen Bewegungsangeboten, jedoch gibt es aktuell noch viele Barrieren in der Verordnung von korperlicher Aktivitat. Um dieser Herausforderung gerecht zu werden, fordert die Osterreichische Diabetes Gesellschaft die Position des Bewegungsberaters als fixen Bestandteil eines multidisziplinaren Behandlungsansatzes.

Diabetesschulung und Selbstmanagement nehmen eine zentrale Rolle in der Diabetesbetreuung ein. Das dabei angestrebte Patientenempowerment zielt auf die aktive Beeinflussung des Diabetesverlaufs durch Selbstkontrolle und Therapieanpassung sowie die Befahigung der Betroffenen, den Diabetes in ihren Alltag zu integrieren und an ihre Lebensumstande entsprechend anzupassen. Eine Diabetesschulung ist allen Personen mit Diabetes zuganglich zu machen. Um ein strukturiertes und validiertes Schulungsprogramm anbieten zu konnen, sind adaquate personelle, raumliche, organisatorische und finanzielle Voraussetzungen zu schaffen. Neben dem Zuwachs an Wissen uber die Erkrankung konnte gezeigt werden, dass eine strukturierte Diabetesschulung ergebnisorientiert Parameter wie Blutzucker, HbA1c, Blutdruck und Korpergewicht positiv beeinflussen kann. Neuere Schulungsmodelle betonen neben der Ernahrung die korperliche Bewegung als wichtigen Bestandteil der Lebensstiltherapie und bedienen sich interaktiver Methoden, um die personliche Verantwortung herauszuarbeiten. Spezifische Situationen (z. B. verminderte Hypoglykamieerkennung, Krankheit, Reisen) und technische Neuerungen wie Glukosesensorsysteme und Insulinpumpen bedurfen zusatzlicher Schulungsmasnahmen durch Informationsaustausch in Kleingruppen, unterstutzt durch adaquate elektronische Hilfsmittel (Diabetes-Apps, Diabetes-Web-Portale).

This position statement represents the recommendations of the Austrian Diabetes Association regarding the clinical diagnostic and therapeutic application, safety and benefits of continuous subcutaneous glucose monitoring systems in patients with diabetes, based on current evidence.

Metabolische Erkrankungen beeinflussen das Leben von Mannern und Frauen in den verschiedenen Lebensabschnitten in unterschiedlicher und vielfaltiger Weise und stellen eine grose Herausforderung fur das Gesundheitssystem dar. Die behandelnden Arztinnen und Arzte sind mit den unterschiedlichen Bedurfnissen von Mannern und Frauen im klinischen Alltag konfrontiert. Geschlechtsspezifische Unterschiede beeinflussen Screening, Diagnose und Behandlungsstrategien sowie die Entwicklung von Komplikationen und die Mortalitatsraten. Veranderungen im Glukose- und Lipidstoffwechsel, die Regulation von Energiehaushalt und Korperfettverteilung sowie damit assoziierte kardiovaskulare Erkrankungen werden stark von Steroid- und Sexualhormonen beeinflusst. Zusatzlich spielen Erziehung, Einkommen und psychosoziale Faktoren eine wichtige Rolle bei der Entstehung von Adipositas und Diabetes und mussen bei geschlechtsspezifischer Betrachtung mitberucksichtigt werden. Manner weisen im jungeren Alter und bei niedrigerem BMI ein hoheres Risiko fur Typ-2-Diabetes auf als Frauen, die wiederum von einem starken Anstieg im Risiko fur Diabetes-assoziierte kardiovaskulare Erkrankungen nach der Menopause betroffen sind. Frauen durften durch Diabetes auch etwas mehr Lebensjahre verlieren als Manner, wobei die hohere Mortalitat hauptsachlich auf vaskulare Komplikationen zuruckgefuhrt werden kann. Bei Mannern mit Diabetes scheint dafur der Mortalitatsanstieg durch Krebs gewichtiger als bei Frauen zu sein. Bei Frauen sind Pradiabetes und Diabetes meist mit mehr vaskularen Risikofaktoren assoziiert wie erhohte Inflammationsparameter, prothrombotische Veranderungen und hoherem Blutdruck. Sie weisen deshalb ein relativ hoheres vaskulares Risiko auf. Frauen sind ofter stark ubergewichtig und weniger korperlich aktiv, obwohl sie sogar noch mehr als Manner von einem hoheren Bewegungsausmas in ihrer Gesundheit und Lebenserwartung profitieren durften. In Gewichtsreduktionsprogrammen verlieren Manner haufig mehr Gewicht als Frauen. Frauen und Mannern profitieren gleich gut von Praventionsprogrammen mit etwa 40 % Risikoreduktion fur Typ-2-Diabetes nach 3 Jahren. Langzeitdaten konnten bisher eine Reduktion der allgemeinen und kardiovaskularen Mortalitat nur bei Frauen zeigen. Frauen weisen ofter eine gestorte Glukosetoleranz, Manner hingegen erhohte Nuchternblutzuckerspiegel auf. Eine Anamnese eines Gestationsdiabetes oder PCOS sowie hohere Androgenspiegel stellen bei Frauen, das Vorhandensein einer erektilen Dysfunktion oder erniedrigter Testosteronspiegel bei Mannern, wichtige geschlechtsspezifische Diabetesrisikofaktoren dar. Viele Studien zeigen des Weiteren, dass Frauen in der Therapie weniger oft die Zielwerte fur HbA1c, LDL-Cholesterin oder Blutdruck erreichen, wobei die Ursachen unklar sind. Generell sollen in der medikamentosen Behandlung geschlechtsspezifische Unterschiede in der Wirkung, Pharmakokinetik und in den Nebenwirkungen mehr Beachtung finden.

Die unter der Kategorie „andere spezifische Diabetesformen“ zusammengefassten Storungen des Glukosestoffwechsels stellen pathophysiologisch und therapeutisch eine sehr heterogene Krankheitsgruppe dar. Umfasst werden Diabetesformen, die im Rahmen von anderen endokrinologischen Erkrankungen auftreten (z. B. Akromegalie, Cushing-Syndrom), pankreoprive Formen (z. B. postoperativ, Pankreatitis, Pankreastumoren, Hamochromatose, zystische Fibrose), medikamentos induzierte Diabetesformen (z. B. Antipsychotikatherapie, Glukokortikoidtherapie, HAART), genetische Formen (z. B. i. R. eines MODY, neonataler Diabetes, Down-Syndrom, Klinefelter-Syndrom, Turner-Syndrom), Infektionen (z. B. kongenitale Rotelninfektion) und seltene autoimmune Formen (z. B. Stiffman-Syndrom). Nicht nur pankreoprive Formen, sondern auch Typ 1 oder langjahriger Typ 2 Diabetes mellitus sind haufig mit einer exokrinen Pankreasinsuffizienz assoziiert.

Diabetes mellitus and other noncommunicable diseases (NCDs) represent an emerging global public health challenge. In Germany, about 6.7 million adults are affected by diabetes according to national health surveys, including 1.3 million with undiagnosed diabetes. Complications of diabetes result in an increasing burden for individuals and society as well as enormous costs for the health care system. In response, the Federal Ministry of Health commissioned the Robert Koch Institute (RKI) to implement a diabetes surveillance system and the Federal Center for Health Education (BZgA) to develop a diabetes prevention strategy. In a two-day workshop jointly organized by the RKI and the BZgA, representatives from public health institutes in seven countries shared their expertise and knowledge on diabetes prevention and surveillance. Day one focused on NCD surveillance systems and emphasized both the strengthening of sustainable data sources and the timely and targeted dissemination of results using innovative formats. The second day focused on diabetes prevention strategies and highlighted the importance of involving all relevant stakeholders in the development process to facilitate its acceptance and implementation. Furthermore, the effective translation of prevention measures into real-world settings requires data from surveillance systems to identify high-risk groups and evaluate the effect of measures at the population level based on analyses of time trends in risk factors and disease outcomes. Overall, the workshop highlighted the close link between diabetes prevention strategies and surveillance systems. It was generally stated that only robust data enables effective prevention measures to encounter the increasing burden from diabetes and other NCDs.

Bei kritisch kranken Patienten kommt es haufig zum Auftreten einer Hyperglykamie, welche eindeutig mit einer gesteigerten Mortalitatsrate assoziiert ist. Der aktuell verfugbaren Datenlage entsprechend sollte eine intravenose Insulintherapie bei Blutzuckerwerten >180 mg/dl begonnen werden und ein Zielbereich zwischen meist 140–180 mg/dl angestrebt werden.

Aims/hypothesis Evidence for the effectiveness of interstitial glucose monitoring in individuals with type 1 diabetes using multiple daily injection (MDI) therapy is limited. In this pre-specified subgroup analysis of the Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial’ (IMPACT), we assessed the impact of flash glucose technology on hypoglycaemia compared with capillary glucose monitoring. Methods This multicentre, prospective, non-masked, RCT enrolled adults from 23 European diabetes centres. Individuals were eligible to participate if they had well-controlled type 1 diabetes (diagnosed for ≥5 years), HbA1c ≤ 58 mmol/mol [7.5%], were using MDI therapy and on their current insulin regimen for ≥3 months, reported self-monitoring of blood glucose on a regular basis (equivalent to ≥3 times/day) for ≥2 months and were deemed technically capable of using flash glucose technology. Individuals were excluded if they were diagnosed with hypoglycaemia unawareness, had diabetic ketoacidosis or myocardial infarction in the preceding 6 months, had a known allergy to medical-grade adhesives, used continuous glucose monitoring (CGM) within the previous 4 months or were currently using CGM or sensor-augmented pump therapy, were pregnant or planning pregnancy or were receiving steroid therapy for any disorders. Following 2 weeks of blinded (to participants and investigator) sensor wear by all participants, participants with sensor data for more than 50% of the blinded wear period (or ≥650 individual sensor results) were randomly assigned, in a 1:1 ratio by a central interactive web response system (IWRS) using the biased-coin minimisation method, to flash sensor-based glucose monitoring (intervention group) or self-monitoring of capillary blood glucose (control group). The control group had two further 14 day blinded sensor-wear periods at the 3 and 6 month time points. Participants, investigators and staff were not masked to group allocation. The primary outcome was the change in time in hypoglycaemia (

This retrospective chart review study evaluated the effectiveness of the FreeStyle Libre Flash Glucose Monitoring SystemTM when used by adults with type 2 diabetes (T2DM) as their standard of care in a real-world setting. This study aimed to determine the effect of FreeStyle Libre when used for between 3 months to 6 months on HbA1c. The study population included adults on a basal-bolus insulin regimen for at least 1 year who had been using FreeStyle Libre regularly for at least 3 months (either self-funded or prescribed) and with HbA1c between 8.0 and 12.0% (64 to 108 mmol/mol). Pregnant patients were excluded, as were patients on dialysis. A total of 92 records from insulin using patients with T2DM from 6 hospital sites in Austria were included in this chart review. On average, HbA1c was 8.8±0.8% (72.2±8.9 mmol/mol), prior to FreeStyle Libre use, age was 64.4±9.7 years, BMI was 30.8±5.5 kg/m2 and average duration of insulin use 7.6±5.6 years (mean±SD), 79.3% of patients were on oral antidiabetic medications (metformin, TZD, DPP-4 or SGLT) and 54.3% were male. CVD and renal complications were reported by 34.8% and 27.2% of patients, respectively. HbA1c results were recorded between 91 to 194 days from the start of use of FreeStyle Libre, between September 2014 and July 2018. To minimise selection bias, all patients that had used FreeStyle Libre for at least 3 months from each study site were included in the analysis. After at least 3 months of using FreeStyle Libre, HbA1c (primary outcome) was significantly reduced by 0.9±0.8% (mean±SD); p Disclosure P. Fasching: None. H. Brath: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Novo Nordisk Inc., Servier. Speaker’s Bureau; Self; Amgen Inc., Ascensia Diabetes Care, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk Inc., Pfizer Inc., Sanofi. C. Ebenbichler: None. J.K. Mader: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Prediktor Medical, Roche Diabetes Care, Sanofi. Speaker’s Bureau; Self; Abbott, AstraZeneca, Dexcom, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; decide Clinical Software GmbH. C. Schelkshorn: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Speaker’s Bureau; Self; Abbott, Novo Nordisk Inc., Sanofi-Aventis Deutschland GmbH. Stock/Shareholder; Self; Lilly Diabetes. R. Weitgasser: Research Support; Self; Abbott.

Seit uber 30 Jahren wird die Rolle des LDL-Cholesterins in der Entstehung von kardiovaskularen Erkrankungen untersucht. Grose Studien mit Statinen zeigten in diversen Settings, dass der LDL-Cholesterinspiegel mit der kardiovaskularen Ereignisrate assoziiert ist. Diese Assoziation wird haufig als „LDL-Cholesterinhypothese“ bezeichnet. Neuere Studien zu Wirkstoffen mit ganzlich anderen Wirkmechanismen bestatigten diese Assoziation und zeigten daruber hinaus, dass es einen kausalen Zusammenhang zwischen geringeren LDL-Cholesterinspiegeln und besseren kardiovaskularen Outcomes zu geben scheint und man somit vom „LDL-Cholesterinprinzip“ sprechen kann. Es ist zu erwarten, dass derzeit laufende Outcome-Studien die Annahme eines kausalen Zusammenhangs weiter untermauern werden, mit der Aussicht den Behandlern ein besseres an die Bedurfnisse der einzelnen Patienten angepasstes Armamentarium zur Behandlung von Dyslipidamien und deren Folgen in die Hand zu geben.

Twenty-six years ago the St. Vincent Declaration aimed for an achievement of a comparable pregnancy outcome in diabetic and non-diabetic women. However, current surveys clearly show that women with pre-gestational diabetes still feature a much higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. In addition, obesity increases worldwide, contributing to a growing number of women with type 2 diabetes at a childbearing age, and a further deterioration in outcome in diabetic women. Development of diabetic embryopathy and fetopathy are known to be related to maternal glycemic control (target: normoglycemia and normal HbA1c, if possible without hypoglycemia). The risk for hypoglycemia is at its greatest in early pregnancy and decreases with the progression of pregnancy due to the hormonal changes leading to a marked increase of insulin resistance. Intensified insulin therapy with multiple daily insulin injections and pump treatment are equally effective in reaching good metabolic control during pregnancy. All women should be experienced in the management of their therapy and on stable glycemic control prior to the conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded before pregnancy or treated adequately in order to decrease the risk for a progression of complications during pregnancy as well as for maternal and fetal morbidity.

Das Positionspapier reprasentiert die Empfehlungen der ODG zur diagnostischen und therapeutischen Anwendung der kontinuierlichen Glukosemessung bei Erwachsenen und Kindern mit Diabetes mellitus, basierend auf der zurzeit zur Verfugung stehenden Evidenz.

Hyperglycemia significantly contributes to micro- and macrovascular complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets in regard of optimal therapeutic efficacy and high therapeutic safety is of great importance. In this guideline we present the best and most current evidence-based clinical practice data for healthcare professionals.

Metabolic diseases dramatically affect life of men and women from infancy up to old age and are a major challenge for clinicians. Health professionals are confronted with different needs of women and men. This article aims at an increase of gender awareness and the implementation of current knowledge of gender medicine in daily clinical practice with regard to pre-diabetes and diabetes. Sex and gender affect screening and diagnosis of metabolic diseases as well as treatment strategies and outcome. Impaired glucose and lipid metabolism, regulation of energy balance and body fat distribution are related to steroid hormones and therefore impose their influence on cardiovascular health in both men and women. Furthermore, education, income and psychosocial factors relate to development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at younger age and at lower BMI compared to women, but women feature a dramatic increase of their cardiometabolic risk after menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with higher increase of vascular death in women, but higher increase of cancer death in men. In women pre-diabetes or diabetes are more distinctly associated with a higher number of vascular risk factors, such as inflammatory parameters, unfavourable changes of coagulation and blood pressure. Pre-diabetic and diabetic women are at much higher relative risk for vascular disease. Women are more often obese and less physically active, but may even have greater benefit from increased physical activity than males. Whereas men predominantly feature impaired fasting glucose, women often show impaired glucose tolerance. A history of gestational diabetes or the presence of a PCOS or increased androgen levels in women, on the other hand the presence of erectile dysfunction (ED) or decreased testosterone levels in men are sex specific risk factors for diabetes development. ED is a common feature of obese men with the Metabolic Syndrome and an important predictor of cardiovascular disease. Diabetic women also feature sexual dysfunctions much more frequently than non-diabetic women which should be addressed in clinical care. Several studies showed that diabetic women reach their targets of metabolic control (HbA1c), blood pressure and LDL-cholesterol less often than their male counterparts, although the reasons for worse treatment outcome in diabetic females are not clear. Furthermore, sex differences in action, pharmacokinetics, and side effects of pharmacological therapy have to be taken into account.

Lifestyle in general (nutrition, exercise, smoking habits), besides the genetic predisposition, is known to be a strong predictor for the development of diabetes. Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

Exocrine pancreatic insufficiency (EPI) in diabetic patients is frequent. Studies based on fecal elastase-1 measurement give prevalence rates of 10‒30 % of severe and 22‒56 % of moderate EPI in type 1 and rates of 5‒46 % in type 2 diabetic patients. Nevertheless, not all patients report typical symptoms like diarrhea, steatorrhea and weight loss. For noninvasive testing the determination of fecal elastase-1 has the highest sensitivity and specificity. This test should be performed at least in all symptomatic patients. As differential diagnosis celiac disease (with a prevalence of about 3-5 % of type 1 diabetic patients), autonomic neuropathy, but also diseases like irritable bowel syndrome and gastrointestinal tumors have to be taken into account. Patients with symptoms and a fecal elastase-1

Diabetes education and self management has gained a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and treatment modification, as well as integration of diabetes in patients' daily life to achieve changes in lifestyle accordingly.Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes in everyday life and stress physical activity besides healthy eating as a main component of lifestyle therapy and use interactive methods in order to increase the acceptance of personal responsibility.

Zusammenfassung Dieses Positionspapier zur Anwendung der subkutanen Insulinpumpentherapie (CSII) bei Diabetes mellitus basiert auf aktueller Evidenz zu Sicherheit und Vor-und Nachteile der CSII, insbesondere im Hinblick auf glykämische Kontrolle, Hypoglykämie, ketoazidotische Entgleisung, Lebensqualität und Anwendung in der Schwangerschaft. Dieser Artikel beinhaltet die Empfehlungen der Österreichischen Diabetesgesellschaft für die klinische Anwendung der Insulinpumpentherapie bei Kindern, Jugendlichen und Erwachsenen.

BACKGROUND: Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown.METHODS: To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function.RESULTS: Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1).CONCLUSIONS: The 16 diabetic kidney disease-associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.

Diabetic kidney disease (DKD) is a heritable but poorly understood complication of diabetes. To identify genetic variants predisposing to DKD, we performed genome-wide association analyses in 19,406 individuals with type 1 diabetes (T1D) using a spectrum of DKD definitions basedon albuminuria and renal function. We identified 16 genome-wide significant loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain(COL4A3)gene, which encodes a major structural component of the glomerular basement membrane (GBM) implicated in heritable nephropathies. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of DKD, including albuminuria and end-stage renal disease. Three other loci are in or near genes with known or suggestive involvement in DKD(BMP7)or renal biology (COLEC11andDDR1). The 16 DKD-associated loci provide novel insights into the pathogenesis of DKD, identifying potential biological targets for prevention and treatment.

Background and Aims: Apolipoprotein C3 (ApoC3) is a key regulator of triglyceride metabolism via its inhibitory effects on lipolysis and hepatic remnant uptake. Emerging evidence indicate that ApoC3 is an independent risk factor for cardiovascular events. The fact that glucose and insulin regulates ApoC3 expression raises the role of ApoC3 and cardiovascular risk in diabetes. We, therefore, investigated ApoC3 and its association with cardiovascular disease (CVD) in patients with and without diabetic nephropathy. Methods: This cross-sectional and prospective analysis was part of the prospective, ongoing Finnish Diabetic Nephropathy (FinnDiane) Study. Between 1994 and 2015 data were obtained from 3926 type 1 diabetes (T1D) patients at more than 80 hospitals or health centers across Finland. ApoC3 levels were explored by groups of albuminuria, CKD stages, presence of CVD as well as prediction of CVD and death. Survival curves were calculated by Cox regression analysis. Results: At baseline, normo-, micro- and macroalbuminuria were present in 71.7%, 13.8% and 14.5% of the population (n=3926, females 48%, age 37.8±12.2 years, diabetes duration 23.2±13 years, HbA1c 8.4±1.5%). CKD stage 3-5 was diagnosed in 14.3%. Coronary heart disease or stroke (CVD) were present in 5.5% at baseline, while 16.3% developed CVD during 15-year follow-up. Compared to normoalbuminuria ApoC3 was elevated in the presence of micro- (p=0.013) or macroalbumiuria (p Conclusions: Baseline ApoC3 levels were elevated in T1D patients with micro- and macroalbuminuria, with impaired renal function, and with CVD. ApoC3 also predicted the development of CVD and death during follow-up. Disclosure L. Stechemesser: None. C. Forsblom: None. R. Weitgasser: None. P. Groop: Other Relationship; Self; AstraZeneca, AbbVie Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medscape, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi.

Aims:Estimate the costs associated with flash glucose monitoring as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) using intensive insulin, from a UK National Health Service (NHS) perspective.Methods:The base-case cost calculation used the frequency of SMBG and healthcare resource use observed in the REPLACE trial. Scenario analyses considered SMBG at the flash monitoring frequencies observed in the REPLACE trial (8.3 tests per day) and a real-world analysis (16 tests per day).Results:Compared with 3 SMBG tests per day, flash monitoring would cost an additional £585 per patient per year, offset by a £776 reduction in healthcare resource use, based on reductions in emergency room visits (41%), ambulance call-outs (66%) and hospital admissions (77%) observed in the REPLACE trial. Per patient, the estimated total annual cost for flash monitoring was £191 (13.4%) lower than for SMBG. In the scenarios based on acquisition cost alone, flash monitoring was cost-neutral versus 8.3 SMBG tests per day (5% decrease) and cost-saving at higher testing frequencies.Conclusion:From a UK NHS perspective, for patients with T2DM using intensive insulin, flash monitoring is potentially cost-saving compared with routine SMBG irrespective of testing frequency. Keywords

Background Type 2 diabetes is a chronic disease associated with poorer health outcomes and decreased health related quality of life (HRQoL). The aim of this analysis was to explore the impact of a disease management programme (DMP) in type 2 diabetes on HRQoL. A multilevel model was used to explain the variation in EQ-VAS. Methods A cluster-randomized controlled trial—analysis of the secondary endpoint HRQoL. Our study population were general practitioners and patients in the province of Salzburg. The DMP “Therapie-Aktiv” was implemented in the intervention group, and controls received usual care. Outcome measure was a change in EQ-VAS after 12 months. For comparison of rates, we used Fisher’s Exact test; for continuous variables the independent T test or Welch test were used. In the multilevel modeling, we examined various models, continuously adding variables to explain the variation in the dependent variable, starting with an empty model, including only the random intercept. We analysed random effects parameters in order to disentangle variation of the final EQ-VAS. Results The EQ-VAS significantly increased within the intervention group (mean difference 2.19, p = 0.005). There was no significant difference in EQ-VAS between groups (mean difference 1.00, p = 0.339). In the intervention group the improvement was more distinct in women (2.46, p = 0.036) compared to men (1.92, p = 0.063). In multilevel modeling, sex, age, family and work circumstances, any macrovascular diabetic complication, duration of diabetes, baseline body mass index and baseline EQ-VAS significantly influence final EQ-VAS, while DMP does not. The final model explains 28.9% (EQ-VAS) of the total variance. Most of the unexplained variance was found on patient-level (95%) and less on GP-level (5%). Conclusion DMP “Therapie-Aktiv” has no significant impact on final EQ-VAS. The impact of DMPs in type 2 diabetes on HRQoL is still unclear and future programmes should focus on patient specific needs and predictors in order to improve HRQoL. Trial registration Current Controlled trials Ltd., ISRCTN27414162

Background: Imprecise carbohydrate counting as a measure to guide the treatment of diabetes may be a source of errors resulting in problems in glycemic control. Exact measurements can be tedious, leading most patients to estimate their carbohydrate intake. In the presented pilot study a smartphone application (BEAR), that guides the estimation of the amounts of carbohydrates, was used by a group of diabetic patients. Methods: Eight adult patients with diabetes mellitus type 1 were recruited for the study. At the beginning of the study patients were introduced to BEAR in sessions lasting 45 minutes per patient. Patients redraw the real food in 3D on the smartphone screen. Based on a selected food type and the 3D form created using BEAR an estimation of carbohydrate content is calculated. Patients were supplied with the application on their personal smartphone or a loaner device and were instructed to use the application in real-world context during the study period. For evaluation purpose a test measuring carbohydrate estimation quality was designed and performed at the beginning and the end of the study. Results: In 44% of the estimations performed at the end of the study the error reduced by at least 6 grams of carbohydrate. This improvement occurred albeit several problems with the usage of BEAR were reported. Conclusions: Despite user interaction problems in this group of patients the provided intervention resulted in a reduction in the absolute error of carbohydrate estimation. Intervention with smartphone applications to assist carbohydrate counting apparently results in more accurate estimations.

Die Hyperglykamie ist ein haufiges Phanomen bei kritisch kranken Patienten, welches zu Komplikationen wie einer erhohten kardiovaskularen Ereignisrate bzw. einem gesteigerten Infektrisiko fuhrt. Basierend auf der aktuell verfugbaren Datenlage sollte eine blutzuckersenkende Therapie mittels intravenosem Insulin ab einem Blutzuckerwert von 180 mg/dl eingeleitet werden. Der Blutzuckerspiegel sollte zwischen 140 und 180 mg/dl gehalten werden. Bei chirurgischen Patienten sind niedrigere BZ-Werte zwischen 110 und 140 mg/dl anzustreben. Nach der Transferierung auf eine „Normal-Station“ sollte eine formelle Glukosediagnostik betrieben werden.

Aims To estimate the costs associated with a flash glucose monitoring system as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes mellitus (T1DM) using intensive insulin, from a UK National Health Service (NHS) perspective. Methods The base-case cost calculation was created using the maximum frequency of glucose monitoring recommended by the 2015 National Institute for Health and Care Excellence guidelines (4–10 tests per day). Scenario analyses considered SMBG at the frequency observed in the IMPACT clinical trial (5.6 tests per day) and at the frequency of flash monitoring observed in a real-world analysis (16 tests per day). A further scenario included potential costs associated with severe hypoglycaemia. Results In the base case, the annual cost per patient using flash monitoring was £234 (19%) lower compared with routine SMBG (10 tests per day). In scenario analyses, the annual cost per patient of flash monitoring compared with 5.6 and 16 SMBG tests per day was £296 higher and £957 lower, respectively. The annual cost of severe hypoglycaemia for flash monitoring users was estimated to be £221 per patient, compared with £428 for routine SMBG users (based on 5.6 tests/day), corresponding to a reduction in costs of £207. Conclusions The flash monitoring system has a modest impact on glucose monitoring costs for the UK NHS for patients with T1DM using intensive insulin. For people requiring frequent tests, flash monitoring may be cost saving, especially when taking into account potential reductions in the rate of severe hypoglycaemia.

Doel Onderzoek naar het voorkomen en de impact van niet-ernstige hypoglycemieen bij mensen met type 1 diabetes (T1D) en met insuline behandelde type 2 diabetes (T2D) in Nederland. Deze studie is onderdeel van de internationale HIT-studie die is uitgevoerd in zeven Europese landen.

Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing.Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance.Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia.Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection.NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.

Aims Hypoglycaemia presents a barrier to optimum diabetes management but data are limited on the frequency of hypoglycaemia incidents outside of clinical trials. The present study investigated the rates of self-reported non-severe hypoglycaemic events, hypoglycaemia awareness and physician discussion of events in people with Type 1 diabetes mellitus or insulin-treated Type 2 diabetes mellitus. Methods People in seven European countries aged >15 years with Type 1 diabetes or insulin–treated Type 2 diabetes (basal-only, basal-bolus and other insulin regimens) were recruited via consumer panels, nurses, telephone recruitment and family referrals. Respondents completed four online questionnaires. The first questionnaire collected background information on demographics and hypoglycaemia-related behaviour, whilst all four questionnaires collected data on non-severe hypoglycaemic events in the preceding 7 days. Results Analysis was based on 11 440 respondent-weeks from 3827 respondents. All participants completed the first questionnaire and 57% completed all four. The mean number of events/respondent–week was 1.8 (Type 1 diabetes) and 0.4–0.7 (Type 2 diabetes, with different insulin treatments) corresponding to annual event rates of 94 and 21–36, respectively. A total of 63% of respondents with Type 1 diabetes and 49–64% of respondents with Type 2 diabetes, treated with different insulin regimens, who experienced hypoglycaemic events, reported impaired hypoglycaemia awareness or unawareness. A high proportion of respondents rarely or never informed their general practitioner/specialist about hypoglycaemia: 65% (Type 1 diabetes) and 50–59% (Type 2 diabetes). Overall, 16% of respondents with Type 1 diabetes and 26% of respondents with Type 2 diabetes reported not being asked about hypoglycaemia during routine appointments. Conclusion Non-severe hypoglycaemic events are common amongst people with Type 1 diabetes and insulin–treated Type 2 diabetes in real-world settings. Many rarely or never inform their general practitioner/specialist about their hypoglycaemia and the real burden of hypoglycaemia may be underestimated.

Background: This study aimed to explore if group-based peer support as an additional component to a disease management programme (DMP) in type 2 diabetes can reduce the number of prescribed drugs; hospital admissions; and length of hospital stay and therefore be a cost-effective model. Methods: Controlled study based on a secondary data analysis of a cluster randomized trial. Our study population was general practitioners and patients in the province of Salzburg. The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters. The groups exercised together, discussed diabetes related topics, and received support by professionals. Data was anonymously collected on clusters through the statutory health insurance. Results: Data were available of 118 (82.5%,17 clusters of the patients in the original randomized trial) participants in the intervention and 143 (77.3%,19 clusters) in the control groups. The length of hospital stay was shorter in the intervention groups compared with controls. The mean difference during the 24-month study period was −40.13 days (95% CI − 78.54 to − 1.71, P = 0.041) in favour of the intervention groups. No differences were seen in the number of prescribed drugs and hospital admission. Estimated yearly savings by reducing the length of hospital stay was €1660.60 per patient. Conclusion: A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care. Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model.

Summary Background Tight control of blood glucose in type 1 diabetes delays onset of macrovascular and microvascular diabetic complications; however, glucose levels need to be closely monitored to prevent hypoglycaemia. We aimed to assess whether a factory-calibrated, sensor-based, flash glucose-monitoring system compared with self-monitored glucose testing reduced exposure to hypoglycaemia in patients with type 1 diabetes. Method In this multicentre, prospective, non-masked, randomised controlled trial, we enrolled adult patients with well controlled type 1 diabetes (HbA 1c ≤58 mmol/mol [7·5%]) from 23 European diabetes centres. After 2 weeks of all participants wearing the blinded sensor, those with readings for at least 50% of the period were randomly assigned (1:1) to flash sensor-based glucose monitoring (intervention group) or to self-monitoring of blood glucose with capillary strips (control group). Randomisation was done centrally using the biased-coin minimisation method dependent on study centre and type of insulin administration. Participants, investigators, and study staff were not masked to group allocation. The primary outcome was change in time in hypoglycaemia ( Findings Between Sept 4, 2014, and Feb 12, 2015, we enrolled 328 participants. After the screening and baseline phase, 120 participants were randomly assigned to the intervention group and 121 to the control group, with outcomes being evaluated in 119 and 120, respectively. Mean time in hypoglycaemia changed from 3·38 h/day at baseline to 2·03 h/day at 6 months (baseline adjusted mean change −1·39) in the intervention group, and from 3·44 h/day to 3·27 h/day in the control group (−0·14); with the between-group difference of −1·24 (SE 0·239; p Interpretation Novel flash glucose testing reduced the time adults with well controlled type 1 diabetes spent in hypoglycaemia. Future studies are needed to assess the effectiveness of this technology in patients with less well controlled diabetes and in younger age groups. Funding Abbott Diabetes Care.

Die exokrine Pankreasinsuffizienz bei Diabetes-Patienten ist haufig. Auf Basis der fakalen Elastase-1 erhobene Studiendaten beschreiben Pravalenzen von etwa 50 % bei Patienten mit Typ 1 Diabetes und 33 % bei Typ 2 Diabetes. Allerdings berichten nicht alle Patienten uber die klassischen Symptome mit Durchfallen, Steatorrhoe und Gewichtsabnahme. Die invasive Diagnostik ist der Goldstandard, unter den indirekten Tests weist die Bestimmung der Elastase-1 im Stuhl die hochste Sensitivitat und Spezifitat auf. Die Testung auf fakale Elastase-1 sollte zumindest bei allen symptomatischen Patienten durchgefuhrt werden. Differentialdiagnostisch sind unter anderem Erkrankungen wie Zoliakie (betrifft ca. 3–5 % aller Patienten mit Typ 1 Diabetes) und autonome Neuropathien des Magen-Darm-Traktes, aber auch Diabetes-unabhangige Erkrankungen wie das Reizdarmsyndrom und gastrointestinale Karzinome zu berucksichtigen. Symptomatische Patienten mit einer fakalen Elastase-1

Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting > 126 mg/dl, spontaneous > 200 mg/dl or HbA1c > 6.5 % before 20 weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit (Evidence level B) is recommended in women at increased risk using standard diagnostic criteria (high risk: history of GDM or pre-diabetes (impaired fasting glucose or impaired glucose tolerance); malformation, stillbirth, successive abortions or birth weight > 4,500 g in previous pregnancies; obesity, metabolic syndrome, age > 45 years, vascular disease; clinical symptoms of diabetes (e. g. glucosuria)). Performance of the OGTT (120 min; 75 g glucose) may already be indicated in the first trimester in some women but is mandatory between 24 and 28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (Evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study GDM is defined, if fasting venous plasma glucose exceeds 92 mg/dl or 1 h 180 mg/dl or 2 h 153 mg/dl after glucose loading (OGTT; international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. This diagnostic approach was recently also recommended by the WHO. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring and to increase physical activity to moderate intensity levels- if not contraindicated. If blood glucose levels cannot be maintained in the normal range (fasting

Die Hyperglykamie ist wesentlich an der Entstehung mikro- als auch makrovaskularer Spatkomplikationen bei an Diabetes mellitus Typ 2 erkrankten Patienten beteiligt. Wahrend Lebensstilmasnahmen die Eckpfeiler jeder Diabetestherapie bleiben, benotigen im Verlauf die meisten PatientInnen mit Typ 2 Diabetes eine medikamentose Therapie. Bei der Definition individueller Behandlungsziele stellen die Therapiesicherheit bzw. die Effektivitat der Therapie die wichtigsten Faktoren dar. In dieser Leitlinie haben wir die rezenten evidenzbasierten Daten fur die klinische Praxis zusammengestellt.

Bereits vor uber 25 Jahren forderte die St. Vincent Deklaration, dass diabetische Schwangere vergleichbare Schwangerschaftsergebnisse wie nicht-diabetischen Frauen erreichen sollen. Dennoch belegen aktuelle Erhebungen, dass Frauen mit bereits prakonzeptionell entwickeltem manifestem Diabetes nach wie vor hohere Komplikationsraten und eine hohere perinatale Morbiditat und Mortalitat aufweisen. Das ist grosteils auf eine fehlende oder zumindest unzureichende Schwangerschaftsplanung und prakonzeptionelle Betreuung mit Optimierung der Stoffwechsellage vor Konzeption zuruckzufuhren. Weltweit steigende Adipositaspravalenz fuhrt zusatzlich zu einem Anstieg von Muttern mit Typ 2 Diabetes. Dieser Trend ist auch bei Typ 1 Diabetikerinnen zu beobachten und aggraviert die Metabolik und die perinatalen Ergebnisse. Die diabetische Embryopathie und diabetische Fetopathie sind eng mit der mutterlichen Stoffwechselkontrolle zu Schwangerschaftsbeginn assoziiert (Ziel: Normoglykamie und normales HbA1c, falls dies ohne Risiko fur Hypoglykamien moglich ist). Das Hypoglykamierisiko ist in der Fruhschwangerschaft deutlich erhoht, nimmt aber mit den hormonellen Veranderungen und der Zunahme der Insulinresistenz im Schwangerschaftsverlauf deutlich ab. Eine funktionelle, intensivierte Insulintherapie mit multiplen taglichen Insulininjektionen oder eine Insulinpumpentherapie sind gleich effektiv im Erreichen einer guten mutterlichen Stoffwechselkontrolle wahrend der Schwangerschaft. Alle Diabetikerinnen sollen im Selbstmanagement der Insulintherapie mit Anpassungen der Insulindosis geschult sein und eine stabile Stoffwechsellage vor Schwangerschaftsbeginn aufweisen. Auserdem mussen eine Schilddrusendysfunktion, eine Hypertonie oder diabetische Komplikationen vor der Konzeption ausgeschlossen bzw. adaquat behandelt sein, um eine mogliche Progression der Komplikationen und Begleiterkrankungen sowie insgesamt die mutterlichen und fetalen Risiken zu minimieren.

This position statement is based on the cur-rent evidence available on the safety and benefits of continous subcutaneous insulin pump therapy (CSII) in diabetes mellitus with an emphasis on the effects of CSII on glycemic control, hypoglycaemia rates, occur-ance of ketoacidosis, quality of life and the use of insu-lin pump therapy in pregnancy. The current article rep-resents the recommendations of the Austrian Diabetes Association for the clinical praxis of insulin pump treat-ment in children and adults.

We evaluated the disease management programme (DMP) “Therapie Aktiv” for diabetes mellitus type 2 during the first year of implementation in a cluster-randomised controlled trial (RCT), which revealed an improvement of process quality, but only insignificant effects on HbA1c. To further analyse the effects of the DMP we followed up participants of the RCT for another year. After completion of the RCT, the study was continued as an open observational trial. By patient’s choice, three groups were formed. Group 1 (DMP/DMP): interventions of the RCT (DMP), who remained in the DMP; group 2 (Control/DMP): controls of the RCT (usual care), who participated in the DMP during the second year; group 3 (Control/Control): controls of the RCT (usual care), who remained as controls. Primary outcome measure: HbA1c. Secondary outcome measures: BMI, lipids, blood pressure and measures of process quality. Only 801 of 1,489 RCT participants completed the study (53.8 %). Group 1: n = 355; group 2: n = 335; group 3: n = 111. After 2 years, pre-post-analysis revealed a significant reduction of HbA1c (0.37 %, p

Resistance training has become a mainstay of exercise training in type 2 diabetes mellitus (T2DM). However, it remains controversial whether hypertrophy resistance training (HRT) is superior to endurance resistance training (ERT) with regard to its effects on glycaemic control, muscle mass and strength.Thirty-two patients with T2DM (13 men and 19 women; 64.8 ± 7.8 years) were randomly assigned to either eight weeks of HRT (n = 16; 2 sets, 10-12 repetitions, 70% of the one-repetition maximum (1-RM)) or ERT (n = 16; 2 sets, 25-30 repetitions, 40% 1-RM). In addition, all patients participated in aerobic exercise training (AET; 1 hour/day on 2 non-consecutive days/week; cycle ergometer; 70% of heart rate reserve).After eight weeks of intervention, there were time but not group effects for reduced glucose and fructosamine levels, weight, BMI, waist circumference, subcutaneous abdominal fat, resting heart rate, systolic and diastolic blood pressure; muscle mass of the arms and physical exercise capacity increased significantly. Significant time and group effects were documented for maximum strength of the chest, with a greater increase for HRT than ERT (p = 0.01).Specific maximal resistance training of the chest muscles led to superior gain in strength as compared to endurance resistance training. This, however, did not translate into superior values of glycaemic control, weight, waist circumference, muscle mass and physical work capacity, which all improved significantly by a similar magnitude in both groups. Since overall effects of both protocols were comparable, both may be offered to patients according to their personal preference.

Aim. Testing the effectiveness of peer support additionally to a disease management programme (DMP) for type 2 diabetes patients.Methods. Unblinded cluster-randomised controlled trial (RCT) involving 49 general practices, province of Salzburg, Austria. All patients enrolled in the DMP were eligible,n=337participated (intervention: 148 in 19 clusters; control: 189 in 20 clusters). The peer support intervention ran over 24 months and consisted of peer supporter recruitment and training, and group meetings weekly for physical exercise and monthly for discussion of diabetes related topics.Results. At two-year follow-up, adjusted analysis revealed a nonsignificant difference inHbA1cchange of 0.14% (21.97 mmol/mol) in favour of the intervention (95% CI −0.08 to 0.36%,p=0.22). Baseline values were 7.02 ± 1.25% in the intervention and 7.08 ± 1.25 in the control group. None of the secondary outcome measures showed significant differences except for improved quality of life (EQ-5D-VAS) in controls (4.3 points on a scale of 100; 95% CI 0.08 to 8.53,p=0.046) compared to the intervention group.Conclusion. Our peer support intervention as an additional DMP component showed no significant effect onHbA1cand secondary outcome measures. Further RTCs with a longer follow-up are needed to reveal whether peer support will have clinically relevant effects.Trial Registration. This trial has been registered with Current Controlled Trials Ltd. (ISRCTN10291077).

The sterol regulatory element-binding protein-1c (SREBP-1c) is a transcription factor involved in the regulation of lipid and glucose metabolism and has been implicated in the pathophysiology of type 2 diabetes mellitus (T2DM). We aimed to confirm associations of the SREBF-1 gene with T2DM in an Austrian population and to study possible associations with diabetes-related quantitative traits. We genotyped a diabetic cohort (n=446) along with a control group (n=1524) for a common C/G variation that is located in exon 18c (rs2297508) and has been associated with obesity and T2DM in French populations. Body mass index (BMI), indices of insulin sensitivity and β-cell function, plasma adiponectin, T2DM and single-nucleotide polymorphism rs2297508. Genotype distributions associated with rs2297508 differed by T2DM status (P=0.0045), but not by BMI. The variant G allele was associated with a modest, but significant, increase in the prevalence of T2DM after adjustment for age, sex and BMI (G/G: odds ratios (OR) (95% confidence intervals)=1.45 (0.99–2.11) and G/C: OR=1.37 (1.04–1.81)). In a cross-sectional population of non-diabetic subjects, associations of rs2297508 genotypes with plasma adiponectin levels adjusted for age, sex and BMI (P=0.0017) were observed in that the risk G/G genotype displayed the lowest adiponectin levels. We observed associations of rs2297508 with T2DM prevalence and plasma adiponectin. SREBP-1c has been implicated in the regulation of adiponectin gene expression. Our results therefore raise the possibility that sequence variations at the SREBF-1 gene locus might contribute to T2DM risk, at least in part, by altering circulating adiponectin levels.

The cholesteryl ester transfer protein (CETP) is responsible for the exchange of triglycerides and cholesteryl esters between lipoprotein particles leading to an increased hepatic clearance of HDL-cholesteryl esters. A high CETP activity reduces serum HDL levels, whereas persons without CETP activity have high HDL levels. We investigated the association of the TaqIB CETP polymorphism and various parameters of the insulin resistance syndrome in a cross sectional population based study. We included 1029 persons without known cardiovascular disease or diabetes mellitus consecutively enrolled in our SAPHIR program (Salzburg Atherosclerosis Prevention program in persons with a High Infarction Risk). Numerous clinical and laboratory data were accomplished. Insulin sensitivity was measured by a short insulin tolerance test. The TaqIB CETP polymorphism was determined by PCR, TaqI restriction and electrophoresis. 35.2% were homozygous for the prevalence (B1B1), 46.7% were heterozygous (B1B2), and 18.1% homozygous for the absence (B2B2) of the restriction site. HDL cholesterol and apolipoprotein A1 were lower and small dense low-density lipoproteins (sdLDL) higher in B1B1 compared to B2B1 and B2B2 persons. In women, we found a significant interaction effect between CETP genotype and adiposity for HDL cholesterol. B1B1 women with a BMI and a waist circumference above the median had 9.7 mg/dl lower HDL than B1B2 and 9.1 mg/dl lower HDL than B2B2 women (P0.001). In men, no interaction effect but a marked genotype to HDL correlation was found. There was a high CETP effect on sdLDL detected in men (P = 0.001). B1B1 men had sdLDL in 36%, B1B2 in 24.6%, and B2B2 in only 14.5%. Men with adiposity and insulin resistance had twice as many sdLDL as insulin sensitive men. We found a significant sex specific effect of the TaqIB CETP polymorphism on the insulin resistance parameters HDL-cholesterol and sdLDL in an Austrian population based study.