Diabetes education and self-management play a critical role in diabetes care. Individualized patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification, while enabling those affected to integrate diabetes management into their daily routine and adapt it to their lifestyle situation. Diabetes education must be accessible to all patients. Preventive measures in the prediabetic status are of additional value. In order to be able to provide a structured and validated education program, adequate personnel, rooms/facilities, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease, it has been shown that structured diabetes education is able to improve diabetes outcome as measured by parameters such as blood glucose, time in glucose range, HbA1c, lipids, blood pressure, and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity and mental health, and also healthy eating as important components of lifestyle therapy and use interactive methods to increase the acceptance of personal responsibility. Specific situations (e.g., start of injectable medication, pregnancy, illness, travel), the occurrence of diabetic complications, and the use of technical devices such as glucose sensor systems (continuous glucose monitoring [CGM]), intelligent smartpen systems, insulin pumps (mostly sensor-augmented pumps [SAPs]), as well as automated insulin delivery (AID), hybrid closed loop (HCL), and open source AID systems require additional educational measures supported by adequate electronic tools (diabetes apps and diabetes web portals). New data have demonstrated the effect of telemedicine and internet-based services for diabetes prevention and management. In addition, social status, education, age, language, and cultural background must be taken into account to support personalized empowerment to achieve adequate health competence and treatment adherence.

Dieses Positionspapier beinhaltet die Empfehlungen der Österreichischen Diabetes Gesellschaft zum Management von Patient*innen mit Diabetes mellitus während stationärer Aufenthalte und im perioperativen Setting, basierend auf aktueller Evidenz zu Glukosezielbereichen, Insulintherapie und Therapie mit oralen/injizierbaren Antidiabetika. Zusätzlich werden Spezialsituationen wie intravenöse Insulintherapie, begleitende Glukokortikoidtherapie sowie die Anwendung von Diabetestechnologie im stationären und perioperativen Bereich diskutiert.

Adipositas ist eine chronische Erkrankung mit einer Vielzahl an metabolischen, mechanischen und psychosozialen Komplikationen und einem hohen Risiko, an Prädiabetes bzw. in weiterer Folge an Diabetes mellitus Typ 2 zu erkranken. Sowohl die Wahl der antidiabetischen Therapie als auch der Begleittherapien nimmt vermehrt auf das Vorliegen der Adipositas Rücksicht. Die modernen GLP-1-Analoga sowie der kombinierte GIP/GLP-1-Agonist Tirzepatid nehmen einen wichtigen Stellenwert in der gemeinsamen Behandlung von Adipositas und Diabetes mellitus Typ 2 ein. Die metabolische Chirurgie ist derzeit bei an Diabetes mellitus Typ 2 erkrankten Menschen mit einem BMI > 30 kg/m2 indiziert, kann zur Diabetesremission beitragen, muss jedoch in ein entsprechendes, lebenslanges Betreuungskonzept eingebunden sein. Die Lebensstilmodifikation ist die Grundlage jeder Adipositastherapie. Aufgrund der Vielzahl an neuen Medikamenten sowie der vielen neuen Studien, bei denen versucht wurde, die relevantesten zu zitieren, erfolgten große Änderungen in diesem Kapitel im Vergleich zu 2023. Auch die Indikationen für eine metabolische Therapie wurden angepasst.

Die Leitlinie nimmt Bezug auf die Diagnostik einschließlich begleitender Autoimmunerkrankungen bei Typ-1-Diabetes mellitus, die Insulintherapie und die glykämischen Zielwerte.

INTRODUCTION:Sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce cardiovascular events across a wide range of kidney function, including advanced stages of chronic kidney disease, but evidence for their efficacy in patients with kidney failure on haemodialysis is lacking. The underlying mechanisms remain incompletely understood, and whether cardiovascular benefits depend on residual kidney function is unknown. STUDY DESIGN:The Dapagliflozin in Hemodialysis (DAPA-HD) trial (NCT05179668) is an academic, multicentre, randomized, double-blind, placebo-controlled trial designed to assess the cardiovascular effects of dapagliflozin in 220 patients with kidney failure receiving haemodialysis. Stratified block randomization was based on patient-reported residual urine volume. The primary endpoint is the change in left ventricular mass indexed to body surface area using echocardiography after 6 months of treatment. A prespecified subgroup analysis will compare treatment effects between patients with residual urine output >200 ml/24 h versus ≤200 ml/24 h. Secondary endpoints include additional echocardiographic assessments, changes in biomarker concentrations, quality of life, and clinical events. DISCUSSION:The DAPA-HD trial is the first trial specifically evaluating the cardiovascular and haemodynamic effects of dapagliflozin in patients with kidney failure receiving maintenance haemodialysis with and without residual urine outputs.

Die Hyperglykämie ist wesentlich an der Entstehung der Folgeerkrankungen bei Menschen mit Diabetes mellitus Typ 2 beteiligt. Während Lebensstilmaßnahmen die Eckpfeiler jeder Diabetestherapie bleiben, benötigen die meisten Menschen mit Typ-2-Diabetes im Verlauf eine medikamentöse Therapie. Bei der Definition individueller Behandlungsziele stellen die Therapiesicherheit, die Effektivität sowie substanzspezifische, organprotektive Effekte der Therapie die wichtigsten Faktoren dar. Diese nationale Leitlinie fasst die Evidenz aus der aktuellen Datenlage für die klinische Praxis zusammen.

Introduction and Objective: In the ESSENCE trial (NCT04822181), semaglutide 2.4 mg improved HbA1c regardless of baseline glycemia level. We explored dynamic changes in HbA1c, other cardiometabolic risk factors (CMRFs), and liver health parameters across different glycemia-level subgroups. Methods: Post hoc analysis of the first 800 participants randomized to semaglutide or placebo. Groups: nondiabetes, prediabetes, type 2 diabetes. CMRFs (HbA1c, body weight [BW], waist-to-height ratio [WtHR], systolic and diastolic blood pressure [BP], triglycerides, non-HDL cholesterol, hsCRP) and liver health parameters (ALT, controlled attenuation parameter, Enhanced Liver Fibrosis, FibroScan-AST, liver stiffness measurement) were assessed up to week 72. Results: Regarding semaglutide treatment up to week 72 and across all glycemia-level subgroups, BW and WtHR steadily decreased. HbA1c, BP, triglycerides, non-HDL, and hsCRP improved (Figure). By contrast, shifts in these CMRFs were negligible with placebo. All liver health parameters improved with semaglutide treatment; changes were minimal with placebo (Figure). Conclusion: Semaglutide resulted in progressive and consistent improvement in CMRFs and liver health parameters versus placebo regardless of baseline glycemia level in people with MASH and liver fibrosis. Disclosure M. Rinella: Consultant; Current; 89bio, Inc., Lilly, Novo Nordisk, Madrigal Pharmaceuticals, Inc., Regeneron Pharmaceuticals Inc., GlaxoSmithKline plc., Boehringer Ingelheim International GmbH, Altimmune, Akero Therapeutics, Inc. Other - this is an error. cannot remove. Also could not add Akero and Echosens to disclosures; Current; Gan & Lee Pharmaceuticals. M. Arias-Loste: Consultant; Ended; Novo Nordisk, Merck Sharp & Dohme Corp. Speaker's Bureau; Ended; Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk. E. Bugianesi: None. L. Castera: Advisory Panel; Current; Boehringer Ingelheim International GmbH, Boston Therapeutics, Inc. Advisory Panel; Ended; Gilead Sciences, Inc. Advisory Panel; Current; Echosens, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk. Advisory Panel; Ended; Pfizer Inc. Advisory Panel; Current; Siemens, GSK. Speaker's Bureau; Current; AstraZeneca, Boehringer Ingelheim International GmbH, Echosens, Madrigal Pharmaceuticals, Inc., Novo Nordisk. Advisory Panel; Current; Sagimet. N.M. Eklöf: Employee; Current; Novo Nordisk A/S. W. Kim: None. N.M. Krarup: Employee; Current; Novo Nordisk. B. Ludvik: Advisory Panel; Current; Novo Nordisk. Research Support; Current; Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Advisory Panel; Current; Boehringer Ingelheim International GmbH. Research Support; Current; Boehringer Ingelheim International GmbH. Speaker's Bureau; Current; Boehringer Ingelheim International GmbH. Advisory Panel; Current; Eli Lilly and Company. Research Support; Current; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Research Support; Current; Amgen Inc. P.N. Newsome: Speaker's Bureau; Current; Novo Nordisk, Ipsen Biopharmaceuticals, Inc. Consultant; Current; Akero Therapeutics, Inc. Speaker's Bureau; Current; Echosens. Consultant; Current; Aligos, Boehringer Ingelheim International GmbH, Forth Therapeutics, Inventiva Pharma, Sagimet, Madrigal Pharmaceuticals, Inc., Novo Nordisk, 89bio, Inc., UCB, Inc. V. Ratziu: Consultant; Current; Novo Nordisk, Boehringer Ingelheim International GmbH, GlaxoSmithKline plc., Akero Therapeutics, Inc., 89bio, Inc. A. Sanyal: Consultant; Current; Eli Lilly and Company, Abbott, GENFIT, Corcept Therapeutics, Arrowhead Pharmaceuticals, Inc., Alnylam Pharmaceuticals, Inc., Boehringer Ingelheim International GmbH, Genentech, Inc., Gilead Sciences, Inc., Gilead Sciences, Inc., Lipocine Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., GlaxoSmithKline plc., Novartis AG, Novo Nordisk, Pfizer Inc., Salix Pharmaceuticals, Sequana Medical NV, Takeda Pharmaceutical Company Limited. Other - Institution has received grant support; Current; AstraZeneca. Consultant; Current; AstraZeneca. Other - Institution has received grant support; Current; Bristol-Myers Squibb Company. Consultant; Current; Bristol-Myers Squibb Company. Other - Institution has received grant support; Current; Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Novartis AG. Other - Royalties; Current; Elsevier, UpToDate. Stock/Shareholder; Current; DURECT Corporation. A. Trifan: Consultant; Ended; Lilly Global Health Partnership, Novo Nordisk Foundation. Research Support; Ended; AbbVie Inc., Gilead Sciences, Inc. T. Vestergaard: Employee; Current; Novo Nordisk. M. Roden: Advisory Panel; Current; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly, Madrigal Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Echosens.

The guidelines summarize the diagnostics of type 1 diabetes mellitus, including accompanying autoimmune diseases, insulin therapy regimens and glycemic target values.

Introduction and Objective: Bariatric surgery (BS) can substantially reduce the increased cardiovascular (CV) risk of people with morbid obesity. Atherogenic lipoproteins, particularly triglyceride-rich lipoproteins (TRL), contribute to CV risk and are closely associated with obesity. The aim of this study was to characterize changes in lipids, with a specific focus on TRLs, and to assess their relationship with glycaemic status in a large cohort before and after BS. Methods: We conducted a retrospective, cross-sectional analysis of 1.637 individuals with MO (76% female, BMI 45±7kg/m2, age 39±12 years) and a longitudinal analysis in 442 individuals before and after BS. Patients were stratified according to their preop glycaemic status into following groups: normoglycaemia (NG), HbA1c <5.7%; prediabetes (pD), HbA1c 5.7-6.4%; and diabetes mellitus (DM), HbA1c >6.4%. Statistical analyses were performed using SPSS. Results: In the cross-sectional analysis, there was a significant increase in TRL concentrations according to glycemic status (NG 25±12mg/dl vs. pD 29±15mg/dl vs. DM 35±19mg/dl; between-group differences p<0.001). Postoperatively, there was a favorable change in the overall lipid profile with a significant reduction in TRL (28±15mg/dL vs 18±18mg/dL, p<0.001), LDL-C, nonHDL-C and TG (each p<0.001).A correlation analysis revealed a significant association between Δ(pre vs post-op)HbA1c and ΔTRL (p<0.001), but no correlation between ΔTRL and ΔBMI (p=0.62). Following stratification by glycaemic status, a highly significant association with ΔTRL was observed in the DM group (p<0.001), whereas no such associations were found in the NG or pD groups. Conclusion: BSinduced weight loss significantly reduces TRL levels. The absence of a correlation between ΔTRL and ΔBMI, together with a significant association with ΔHbA1c, indicates that the CV benefits of metabolic surgery—particularly in individuals with DM—extend beyond weight loss alone. Disclosure F. Höllerl: None. B. Ludvik: Advisory Panel; Current; Novo Nordisk. Research Support; Current; Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Advisory Panel; Current; Boehringer Ingelheim International GmbH. Research Support; Current; Boehringer Ingelheim International GmbH. Speaker's Bureau; Current; Boehringer Ingelheim International GmbH. Advisory Panel; Current; Eli Lilly and Company. Research Support; Current; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Research Support; Current; Amgen Inc. J.M. Brix: Advisory Panel; Current; Abbott Diabetes, Boehringer Ingelheim International GmbH. Speaker's Bureau; Current; AstraZeneca. Speaker's Bureau; Ended; Dexcom, Inc. Speaker's Bureau; Current; Bayer AG. Advisory Panel; Current; Eli Lilly and Company, Merck Sharp & Dohme Corp. Speaker's Bureau; Ended; Medtronic. Advisory Panel; Current; Novo Nordisk.

Background: Cardiovascular–kidney–metabolic (CKM) syndrome refers to a multi-systemic condition with established pathophysiological connections between obesity, diabetes mellitus, chronic kidney disease (CKD), and cardiovascular disease (CVD). Chronic low-grade inflammation has been recognized as a common pathophysiological theme linking metabolic dysfunction to multisystem damage of the heart, kidneys, and vasculature. The aim of this narrative review is to summarize the major pharmacologic strategies that target inflammatory pathways in obesity and across the cardiovascular–kidney–metabolic (CKM) disease spectrum, including metabolic therapies with indirect anti-inflammatory effects and targeted immunomodulatory agents. Summary: New therapies have markedly changed the obesity and the CKM treatment paradigm, with evidence that currently available metabolic medications confer cardiovascular and renal benefits in addition to glycemic control or weight improvement. Nutrient-Stimulated Hormone (NuSH) therapies, and sodium–glucose cotransporter‐2 inhibitors (SGLT2i), work synergistically to positively modulate systemic inflammation while maintaining cardiovascular health and cardiometabolic function throughout therapy. Additionally, emerging clinical data for direct anti-inflammatory treatments, such as interleukin‐1β/interleukin‐6 inhibition and low‐dose colchicine, have established inflammation as a modifiable cardiovascular risk factor. Furthermore, therapies that target the liver such as resmetirom, fibroblast growth factor-21 (FGF21) analogues, and peroxisome proliferator-activated receptors (pan-PPAR) agonists, have highlighted the role of the liver–adipose axis in metabolic inflammation and CKM progression. Together, both metabolic and direct anti-inflammatory therapies represent the most recent evolution of a combined approach to treating metabolic dysfunction and inflammation. This type of approach has the potential to revolutionize the prevention and treatment of CKM across the spectrum of diseases and usher in personalized medicine for obesity-related cardiometabolic diseases. However, further studies are needed to determine when these therapies should be initiated, which patients are most likely to benefit, and whether combination approaches can alter disease progression beyond the current standard of care.

All people with diabetes should receive an individualized nutritional medical consultation and education provided by qualified professionals, depending on the type of diabetes and treatment. The focus is still on a patient-centered and personalized counselling, tailored to the specific needs, lifestyle and type of diabetes. The aim is to support the implementation of a balanced diet while jointly defining realistic metabolic and weight goals to positively influence the disease progression and prevent long-term complications. Particular emphasis should be placed on practical, food-based recommendations that take personal food preferences into account and include tools for planning appropriate portion sizes and a balanced meal composition. In accordance with current international and national standards, people with diabetes should have access to ongoing nutrition counselling and education. During the consultation they should be supported in self-management of their health condition and learn to be able to make a better estimation of the postprandial reaction to food and drinks and to positively influence this by an appropriate selection of foods and beverages. These practical recommendations summarize the most recent literature on nutritional aspects of diabetes.

The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. ClinicalTrials.gov Identifier: NCT03574597

Diabetesschulung und Selbstmanagement nehmen eine zentrale Rolle in der Diabetesbetreuung ein. Das dabei angestrebte individualisierte Patienten-Empowerment zielt auf die aktive Beeinflussung des Diabetesverlaufs durch Selbstwirksamkeit und eigenständige Therapieanpassung sowie die Befähigung der Betroffenen, den Diabetes in ihren Alltag zu integrieren und an ihre Lebensumstände entsprechend anzupassen. Eine Diabetesschulung ist allen Personen mit Diabetes zugänglich zu machen. Präventive Maßnahmen im prädiabetischen Stadium sind zudem anzustreben. Um ein strukturiertes und validiertes Schulungsprogramm anbieten zu können, sind adäquate personelle, räumliche, organisatorische und finanzielle Voraussetzungen nötig. Neben dem Zuwachs an Wissen über die Erkrankung konnte gezeigt werden, dass eine strukturierte Diabetesschulung ergebnisorientiert Parameter wie Blutzucker, TIR (Zeit im Zielbereich), HbA1c, Blutfette, Blutdruck und Körpergewicht positiv beeinflussen kann. Neuere Schulungsmodelle betonen neben der Ernährung die körperliche Bewegung und mentale Gesundheit als wichtigen Bestandteil der Lebensstil-Therapie und bedienen sich interaktiver Methoden, um die persönliche Verantwortung herauszuarbeiten. Spezifische Situationen (z. B. Beginn einer parenteralen Therapie, Schwangerschaft, Krankheit, Reisen), das Auftreten diabetischer Folgeerkrankungen und der Einsatz technischer Geräte, wie Glukosesensoren zur kontinuierlichen Glukosemessung („continuous glucose monitoring“ [CGM]), intelligente Smartpen-Systeme, Insulinpumpen (meist „sensor-augmented pump“ [SAP]) sowie AID („automated insulin delivery“)-, HCL („hybrid closed loop“)- und open source AID-Systeme bedürfen zusätzlicher Schulungsmaßnahmen, unterstützt durch adäquate elektronische Hilfsmittel (Diabetes-Apps, Diabetes-Web-Portale). Neue Erkenntnisse belegen den Nutzen telemedizinischer oder internetbasierter Dienste für die Diabetesprävention und das Diabetesmanagement. Ferner ist auf die Berücksichtigung von sozialem Status, Bildungsniveau, Alter, sowie sprachlichem und kulturellem Hintergrund zu achten, um durch personalisiertes Empowerment Gesundheitskompetenz und Therapieadhärenz zu erreichen.

This position statement presents the recommendations of the Austrian Diabetes Association for the management of patients with diabetes during inpatient stay and in the perioperative setting. These recommendations are based on current evidence with respect to glucose targets, insulin therapy and treatment with oral/injectable antihyperglycemic agents during hospitalization and in perioperative setting. Additionally, it discusses special situations such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization and the perioperative setting.

Hyperglycemia is substantially involved in the occurrence of complications in people with type 2 diabetes mellitus. While lifestyle interventions remain the cornerstones of diabetes treatment, most people with type 2 diabetes will eventually require pharmacotherapy for improved glycemic management. The definition of individual treatment targets regarding optimal therapeutic efficacy and safety as well as organ-protective effects are the most important factors. These national guidelines summarize the most current evidence-based recommendations for the clinical practice.

Je nach Diabetesform und -therapie sollen alle Menschen mit Diabetes eine individuelle ernährungsmedizinische Beratung und Schulung durch Fachpersonal erhalten. Im Vordergrund steht weiterhin eine patient:innenzentrierte, individualisierte Beratung, angepasst an die jeweiligen Bedürfnisse und Lebensumstände der Menschen mit Diabetes. Ziel ist es, neben der Unterstützung zur Umsetzung einer ausgewogenen Ernährung gemeinsam realistische Stoffwechsel- und Gewichtsziele zu definieren, um den Krankheitsverlauf positiv zu beeinflussen und Spätfolgen zu vermeiden. Dabei sollten vor allem praxisbezogene Empfehlungen ausgesprochen werden, die persönliche Nahrungsmittelpräferenzen berücksichtigen und Hilfsmittel zur Planung von geeigneten Portionsgrößen sowie ausgewogener Mahlzeitenzusammenstellung einbeziehen. Entsprechend aktueller internationaler und nationaler Standards sollen Menschen mit Diabetes im Diabetesselbstmanagement unterstützt werden (DSMES) und erlernen, die postprandiale Reaktion auf Speisen und Getränke besser einschätzen und durch die geeignete Lebensmittel- und Getränkeauswahl positiv beeinflussen zu können. Alle Menschen mit Diabetes sollten regelmäßig, je nach individuellem Bedarf, die Möglichkeit haben, eine ernährungstherapeutische Beratung oder Schulung in Anspruch nehmen zu können. Diese Praxisempfehlung stellt eine Zusammenfassung der aktuellen Literatur zu ernährungsrelevanten Aspekten bei Diabetes dar.