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.

These guidelines represent the recommendations of the Austrian Diabetes Society (ÖDG) on the use of diabetes technology (continuous glucose monitoring, CGM; insulin pump therapy; automated insulin delivery systems, AID, connected insulin pens, diabetes apps) and the access to these technological innovations for people with diabetes mellitus. The guidelines were based on current scientific evidence.

The increased availability and use of automated insulin delivery (AID) systems in recent years have shown that individuals using AID systems can more easily and consistently achieve glycemic targets and that this is associated with improvements in quality of life. Alongside this technological progress, regular physical activity and exercise remain cornerstones of diabetes management for individuals with type 1 diabetes, owing to the numerous well-documented health benefits of an active lifestyle. Despite the clear evidence supporting the positive effects of physical activity and exercise, glucose fluctuations frequently occur around physical activity and exercise, posing challenges for AID systems and simultaneously deterring people with type 1 diabetes from maintaining a physically active lifestyle. Given the growing number of clinical trials and reviews on AID systems in the context of physical activity and exercise, there is a clear need to consolidate this knowledge and develop joint guidelines by the German Diabetes Association (DDG) and the Austrian Diabetes Association (ÖDG). This German-language guideline is based on the current position statements of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). They summarize the evidence on AID systems and provide practical recommendations for the management of physical activity and exercise in children, adolescents and adults with type 1 diabetes using AID systems. Within the guidelines we detail each AID system available in Germany and Austria and give specific guidance for their use around physical activity and exercise. Furthermore, we discuss glycemic responses to physical activity and exercise and outline therapeutic strategies to maintain glycemia within target ranges.

Continuous glucose monitoring (CGM) is now central to diabetes management, yet variation in how respective medical products are evaluated limits meaningful comparison between CGM systems. Three barriers currently constrain reliable interpretation of glucose-derived measures. The first is limited transparency: in several regulatory settings, particularly those using Conformité Européenne marking, clinical-study reports, reference-method information and analytical documentation required for market authorisation are not publicly accessible. The second barrier is heterogeneity in study procedures. Existing evaluations use different reference-glucose methods, sampling strategies, glucose-manipulation protocols and participant characteristics, leading to accuracy estimates that cannot be interpreted consistently across systems. The third barrier is calibration alignment. Even with full transparency and aligned procedures, CGM systems may differ because their calibration algorithms are trained on distinct reference-glucose datasets, influencing reported glucose ranges, automated insulin-delivery behaviour and interpretation during device transitions. A modified Delphi process involving clinicians, laboratory scientists, and researchers identified these issues as the principal determinants of comparability. During this process, the International Federation of Clinical Chemistry and Laboratory Medicine released a validated framework for performance evaluation of CGM systems, providing a unified approach to reference-method selection, dynamic in-clinic testing, and structured reporting. Adoption would reduce procedural variability but does not resolve calibration-alignment differences. This international clinical opinion proposes a pathway towards internationally interpretable CGM evaluation: immediate transparency of clinical evidence, routine declaration of calibration alignment, and progressive adoption of validated standardised procedures. These steps provide a foundation for reliable interpretation and globally comparable assessment of CGM technologies.

Diese Leitlinie repräsentiert die Empfehlungen der Österreichischen Diabetes Gesellschaft (ÖDG) zur Nutzung von Diabetes-Technologie (kontinuierliche Glukosemesssysteme [CGM], Insulinpumpentherapie, Automated-Insulin-Delivery-Systeme [AID], „connected insulin pens“, Diabetes-Apps) und den Zugang zu diesen technologischen Innovationen für Menschen mit Diabetes mellitus. Die Leitlinie wurde basierend auf aktueller wissenschaftlicher Evidenz erstellt.

BACKGROUND:Cystic fibrosis-related diabetes (CFRD) is a common comorbidity in cystic fibrosis (CF), significantly impacting morbidity and mortality. Recent advancements in therapy and diabetes technology have transformed the management of CF and diabetes. This study aims to assess the evolution of CFRD and its treatment over the past few decades in a large cohort receiving routine care. METHODS:Longitudinal data of 1039 persons with CFRD (median age at CFRD onset (Q1;Q3): 15.7 (13.2-19.9) years; 57.2% females) from the Diabetes Prospective Follow-up (DPV) database between 2000 and 2023 were analyzed. Changes in demographics, anthropometrics and diabetes therapy were studied using adjusted linear and logistic regression models. RESULTS:BMI-SDS at CFRD diagnosis increased from -0.62 (-1.78;+0.12) in 2000 to -0.45 (-0.81; +0.36) in 2023 (p = 0.002), while age at CFRD diagnosis decreased from 14.8 (13.4;19.1) years in 2000 to 12.5 (11.3;14.7) years in 2023 (p = 0.033). Pharmacological CFRD treatment has changed over the past years. Insulin monotherapy increased from 65.1% to 78.7% (p = 0.044), while OAD/GLP-1 RA-only use decreased (16.9% to 0.7%, p < 0.001). Insulin pump therapy was documented in 26.2% of people with CFRD (PwCFRD) in 2023. The use of CGM increased continuously since 2015, with 76.7% of participants using CGM in 2023 (p < 0.001). Proportion with underweight dropped from 34.3% in 2000 to 14.2% in 2023 (p < 0.001), while overweight increased during this period from 1.5% to 6% (p = 0.011). CONCLUSIONS:Insulin monotherapy and in particular diabetes technology is used more frequently. Improvements in CF therapy are reflected in increasing BMI-SDS and a decrease in the proportion of underweight people with CFRD.

Aims:To characterize youth with monogenic diabetes worldwide in the SWEET database and define trends in clinical care and outcomes. Methods:Youth with monogenic diabetes between the ages of 0 and 21 years from 44 worldwide centers in the SWEET registry divided into global regions were studied in this retrospective analysis. This included 690 youth with data at diabetes diagnosis and/or follow-up at 1 year and 214 patients with data at both time points. Demographics, comorbidities, and treatments were evaluated. Results:Globally, mean age and hemoglobin A1c (HbA1c) at diagnosis were 10.1 years (SD 4.57 years) and 6.9% (52 mmol/mol) (SD 1.7%, 18 mmol/mol), respectively. At 1-year follow-up, mean HbA1c decreased by 0.4%. Average body mass index (BMI) at diabetes diagnosis was in the normal range (World Health Organization BMI SD score 0.31). At diabetes diagnosis, 3.6% presented in diabetic ketoacidosis (DKA). Seven percent were treated with oral antidiabetes medications or glucagon-like peptide-1 receptor agonists at diabetes diagnosis, increasing to 15.3% at follow-up. Overall, treatment with insulin increased by 10% at follow-up. Conclusion:Worldwide, patients with monogenic diabetes typically present during late childhood/early adolescence with mild elevation in HbA1c, normal BMI, and lack of DKA. Regional differences in demographics and treatment modalities highlight heterogeneity in presentation and management of monogenic diabetes, impacting clinical care.

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.

In den letzten Jahren hat die bessere Verfügbarkeit und Nutzung automatisierter Insulinabgabesysteme (AID) gezeigt, dass Menschen mit AID-Behandlung in höherem Ausmaß glykämische Therapieziele erreichen und dass dies mit einer Verbesserung der Lebensqualität einhergeht. Regelmäßige physische Aktivität und Sport sind grundlegende Bestandteile der Diabetesbehandlung bei Menschen mit Diabetes mellitus Typ 1 und verbessern neben der glykämischen Einstellung und der allgemeinen Gesundheit auch die Lebensqualität. Trotz der klaren Evidenz für die positiven Effekte von physischer Aktivität und Sport stellen Glukoseschwankungen während dieser Aktivitäten eine Herausforderung für Menschen mit Diabetes und ihre Therapie dar. Die Zunahme an Evidenz über die letzten Jahre mit vermehrt klinischen Studien und Übersichtsarbeiten zu verschiedenen AID-Systemen bei physischer Aktivität und Sport führte zur Erstellung eines gemeinsamen Positionspapiers zweier großer Diabetesgesellschaften, der Europäischen Diabetes Gesellschaft (EASD) und der Internationalen Gesellschaft für pädiatrischen und adoleszenten Diabetes (ISPAD). Dieses Positionspapier fasst die aktuelle Evidenz zu AID-Systemen zusammen und bietet praxisnahe Empfehlungen für das Management von physischer Aktivität und Sport bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus Typ 1 unter Nutzung von AID-Systemen. Diese Arbeit bietet die Grundlage für die hier vorliegende deutschsprachige gemeinsame Leitlinie der Deutschen Diabetes Gesellschaft (DDG) und der Österreichischen Diabetes Gesellschaft (ÖDG) zum Thema AID, physische Aktivität und Sport bei Diabetes mellitus Typ 1. In dieser Leitlinie werden alle in Deutschland und Österreich verfügbaren AID-Systeme vorgestellt und systemspezifische Empfehlungen für deren Anwendung bei physischer Aktivität und Sport gegeben. Darüber hinaus werden unterschiedliche Glukosereaktionen für physische Aktivität und Sport besprochen und differenzierte Therapieoptionen aufgezeigt, um Glukoseschwankungen zu vermeiden und den gewünschten Glukosezielbereich zu erreichen.

INTRODUCTION:Automated insulin delivery (AID) systems offer superior glycaemic control compared to non-AID in children with type 1 diabetes, yet their performance during real-life challenges, such as summer camps with physical activity, remains underexplored. This study evaluated AID efficacy based on time range (70-180 mg/dL), comparing AID systems against sensor-augmented pump therapy (SAP) during a summer camp in children with type 1 diabetes. METHODS:Data were collected from a 14-day diabetes camp (July 2024) involving 26 children (mean + SD age 10 ± 1.3 years), using Medtronic MiniMed 780G (n = 13), mylife CamAPS FX (n = 7), or SAP (n = 6). Continuous glucose monitoring (CGM)-derived metrics for the two AID systems and SAP were compared by means of t tests or Mann-Whitney U tests (p ≤ 0.05). RESULTS:Both AID systems showed a similar time in range over the camp (primary endpoint, 75.5 ± 7.5% for MiniMed 780G vs. 71.1 ± 11.16% for CamAPS FX; p = 0.30). No significant differences were found for other glycaemic metrics or insulin dosage. Overnight, MiniMed 780G had less time below 54 mg/dL (0.0% [IQR: 0.0; 0.0%]) than CamAPS FX (0.4% [IQR: 0.0; 0.7%]; p = 0.024). SAP had significantly lower time in range than both AID systems (75.0% [IQR: 70.0; 81.0%] vs. 56.0% [IQR: 55.0; 66.0%]; p = 0.006). A positive correlation was found between coefficient of variation and the total number of steps (r = 0.39; p = 0.0459). CONCLUSIONS:Despite the camp's challenges, both AID systems were safe and effective, meeting recommended CGM-derived treatment targets. Furthermore, AID systems showed superior glycaemic control compared to SAP.

Background The effect of closed-loop insulin delivery on the risk of acute diabetes complications in people with type 1 diabetes is unclear. We investigated whether the rates of severe hypoglycaemia and diabetic ketoacidosis are lower with hybrid closed-loop insulin therapy compared with sensor-augmented (open-loop) pump therapy in a large cohort of young people. Methods In this population-based cohort study, we evaluated young people with type 1 diabetes from 250 diabetes centres in Germany, Austria, Switzerland, and Luxembourg participating in the Diabetes Prospective Follow-up (DPV) initiative. Included participants were aged 2-20 years, with diabetes duration of more than 1 year, and were treated between Jan 1, 2021, and Dec 31, 2023. The primary outcomes were the rates of severe hypoglycaemia and ketoacidosis in people using closed-loop therapy versus open-loop therapy. Key secondary outcomes were differences in HbA1c levels, percentage of time in glucose range of 39-100 mmol/L, and glycaemic variability. To account for relevant confounders, we applied propensity score inverse probability of treatment weighting considering several baseline characteristics. Findings 13 922 young people (median age 132 years [IQR 100 to 160]; 51% male) in the DPV database met inclusion criteria and were included in the analysis. 7088 used closed-loop therapy and 6834 used open-loop therapy, with a median observation time of 16 years [IQR 11 to 24]. Individuals using closed-loop therapy had a higher rate of ketoacidosis (174 per 100 patient-years) than those using open-loop therapy (096 per 100 patient-years; incidence rate ratio 181 [137 to 240], p<00001) and there was no significant difference between groups in the rate of severe hypoglycaemia (559 per 100 patient-years vs 663 per 100 patient-years; incidence rate ratio 084 [95% CI 069 to 103], p=0089). Individuals using closed-loop therapy had a lower rate of hypoglycaemic coma (062 per 100 patient-years) compared with individuals using open-loop therapy (091 per 100 patient-years; incidence rate ratio 068 [95% CI 048 to 097], p=0034). Those in the closed-loop therapy group also had a lower HbA1c level (734% vs 750%; difference -016% [95% CI -020 to -013], p=00007), higher percentage of time in target glucose range of 39-100 mmol/L (64% vs 52%, difference 12% [10 to 14], p<00001), and less glycaemic variability (coefficient of variation 354% vs 383%; difference -29% [-33 to -25], p<00001) than those in the open-loop therapy group. The rate of ketoacidosis was particularly high in young people with HbA1c of 85% or higher in the closed-loop therapy group (525 per 100 patient- years) compared with the open-loop therapy group (153 per 100 patient-years; incidence rate ratio 343 [95% CI 169 to 697], p<00001). Interpretation Hybrid closed-loop insulin delivery has no significant effect on the rate of severe hypoglycaemia, and is associated with an increased risk of diabetic ketoacidosis, but is associated with a reduced risk of hypoglycaemic coma and improved glycaemia. These findings indicate the need for additional educational measures for the use of closed- loop insulin delivery.