Based on the recommendations of the World Health Organization, which are rooted in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, gestational diabetes mellitus (GDM) is characterized by fasting venous plasma glucose readings of 92 mg/dL or higher, or a 1-hour post-load reading of 180 mg/dL or more, or a 2-hour post-load reading of 153 mg/dL or more, according to the international standards. A mandatory requirement for metabolic control arises when a pathological value is observed. Post-bariatric surgery, an oral glucose tolerance test (OGTT) is contraindicated due to the possibility of postprandial hypoglycemia. Nutritional counseling, blood glucose self-monitoring instruction, and motivation for moderate-intensity physical activity, if not contraindicated, are essential for all women with gestational diabetes mellitus (GDM) (Evidence Level A). If blood glucose levels persistently remain outside the therapeutic range – defined as fasting glucose below 95 mg/dL and one hour postprandial glucose levels below 140 mg/dL (evidence level B) – then insulin therapy should be initiated as the first-line treatment (evidence level A). Maternal and fetal monitoring is indispensable for reducing maternal and fetal/neonatal morbidity and perinatal mortality risks. Regular obstetric examinations, inclusive of ultrasound scans, are a recommended procedure (Evidence Level A). After birth, newborns of mothers with GDM at high risk of hypoglycemia necessitate neonatal care that includes blood glucose measurements and, if required, suitable intervention. The overall family should concentrate on monitoring the development of children and recommending healthy lifestyles. Following delivery, women previously diagnosed with gestational diabetes mellitus (GDM) must have their glucose tolerance re-evaluated 4-12 weeks later using a 75g oral glucose tolerance test (OGTT) in accordance with WHO standards. Normal glucose tolerance warrants glucose parameter assessments (fasting glucose, random glucose, HbA1c, or an optimal oral glucose tolerance test) every two to three years. At follow-up appointments, all women should receive instruction regarding their heightened risk of type 2 diabetes and cardiovascular disease. Addressing preventive measures, notably lifestyle changes like weight control and a heightened physical activity level, is critical (evidence level A).
While adults experience different diabetes prevalence, type 1 diabetes mellitus (T1D) is the most common type in childhood and adolescence, with a prevalence exceeding 90%. Specialized pediatric units, proficient in pediatric diabetology, are the optimal setting for managing children and adolescents after a Type 1 Diabetes diagnosis. Insulin administration for a lifetime comprises the foundation of treatment, demanding tailored strategies that take into account both the patient's age and the family's routine. Glucose sensors, insulin pumps, and the more recent hybrid closed-loop systems, amongst diabetes technologies, are recommended for this age cohort. Implementing optimal metabolic control at the very start of therapy is frequently linked to improved long-term prospects. To effectively manage diabetes in patients and their families, education is critical and must be delivered through a multidisciplinary team, including a pediatric diabetologist, diabetes educator, dietitian, psychologist, and social worker. APEDO and ISPAD, the Austrian Pediatric Endocrinology and Diabetes Working Group and the International Society for Pediatric and Adolescent Diabetes, respectively, jointly suggest an HbA1c metabolic goal of 70% (IFCC standard) for all pediatric age ranges, barring cases of severe hypoglycemia. The cornerstone of diabetes treatment in all pediatric age groups is ensuring high quality of life through the advancement of age-related physical, cognitive, and psychosocial development, screening for associated diseases, preventing acute complications (like severe hypoglycemia and diabetic ketoacidosis), and mitigating the long-term effects of diabetes.
Evaluating body fat content in individuals using the body mass index (BMI) is a very basic approach. A normal weight does not preclude the possibility of excess body fat in cases of diminished muscle mass (sarcopenia). This highlights the importance of complementary measurements of waist circumference and body fat levels, such as. Employing bioimpedance analysis (BIA) is a recommended practice. Implementing lifestyle modifications, including adjustments to nutrition and increased physical activity, is significant for both the prevention and the treatment of diabetes. When treating type 2 diabetes, doctors are increasingly focusing on body weight as an auxiliary goal. Body weight is a growing factor in the selection of anti-diabetic treatments and complementary therapies. The efficacy of modern GLP-1 agonists and dual GLP-1/GIP agonists in treating obesity and type 2 diabetes contributes significantly to their increasing importance. CRCD2 Bariatric surgery, currently indicated for those with a BMI above 35 kg/m^2, coupled with conditions like diabetes, often results in a degree of diabetes remission. However, integration into a suitable ongoing care plan is essential.
The incidence of diabetes and its complications is significantly heightened by smoking and exposure to secondhand smoke. Quitting smoking, even with the potential for weight gain and a greater chance of diabetes, still lowers cardiovascular and total mortality rates. Initial diagnostic measures, such as the Fagerstrom Test and exhaled CO levels, are crucial to effective smoking cessation. Varenicline, Nicotine Replacement Therapy, and Bupropion are among the supporting medications. Important influences on smoking habits and quitting smoking include social and psychological factors, as well as socio-economic considerations. Heated tobacco products, exemplified by electronic cigarettes, are not a healthy substitute for conventional cigarettes and are correlated with higher rates of illness and death. Studies' vulnerability to selection bias and underreporting could skew the results towards an overly optimistic interpretation. Alternatively, the detrimental effects of alcohol on excess morbidity and disability-adjusted life years are dose-dependent, specifically with regard to cancer, liver disease, and infectious illnesses.
A healthy lifestyle, encompassing regular physical activity, is demonstrably important in the prevention and management of type 2 diabetes. Furthermore, sedentary behaviors should be recognized as detrimental to health, and prolonged sitting should be avoided. Training's positive effect is directly proportional to the improvement in fitness, which remains effective only so long as the fitness level is consistently maintained. The effectiveness of exercise training is consistent across various age groups and genders. Adults often find standardized, regionally-based, supervised exercise classes engaging and beneficial to achieve health-enhancing physical activity. The Austrian Diabetes Associations, building on the extensive evidence of exercise referral and prescription, plans to incorporate the role of a physical activity advisor into its multidisciplinary diabetes care provision. Sadly, the project has failed to include the key components of booth-local exercise classes and advisors.
A personalized approach to nutritional guidance is crucial for diabetes management in all patients. Lifestyle and diabetes type factors necessitate that the patient's needs take priority in dietary therapy. The patient's diet needs specific metabolic targets alongside recommendations, to lessen the development of the disease and avoid long-term health consequences. For this reason, practical advice regarding portion sizes and meal planning should form the core of diabetes management, per national and international standards. Consultations provide support in managing health conditions, particularly in choosing appropriate food and beverages to improve health outcomes. These practical recommendations are a summary of the most current literature on nutritional approaches to diabetes.
The current scientific evidence forms the basis for the Austrian Diabetes Association (ODG)'s recommendations in this guideline regarding the utilization and access to diabetes technology (insulin pumps, CGM, HCL systems, diabetes apps) for people with diabetes mellitus.
The presence of hyperglycemia in patients with diabetes mellitus significantly impacts the occurrence of complications. While fundamental to disease prevention and management, lifestyle interventions are often insufficient for glycemic control in most type 2 diabetes patients, eventually requiring pharmaceutical therapy. Determining specific patient targets concerning optimal therapeutic efficacy, safety, and cardiovascular implications is essential. Healthcare professionals are presented with the most current, evidence-based, and best clinical practice data in this guideline.
A heterogeneous group of diabetes cases, arising from factors beyond the standard ones, involves alterations in glucose metabolism resulting from other endocrine disorders, such as acromegaly or hypercortisolism, or diabetes induced by medications (e.g.). Immunosuppressive agents, antipsychotic medications, glucocorticoids, highly active antiretroviral therapy (HAART), and checkpoint inhibitors, as well as genetic forms of diabetes (e.g.,) Diabetes presenting early in life, including MODY (Maturity-onset diabetes of the young), neonatal diabetes, alongside genetic disorders like Down syndrome, Klinefelter syndrome, and Turner syndrome, and pancreatogenic diabetes (including instances of .) Following surgery, conditions like pancreatitis, pancreatic cancer, haemochromatosis, and cystic fibrosis, along with some rare autoimmune or infectious forms of diabetes, can emerge. CRCD2 Diagnostic considerations of specific diabetes types play a role in the choice of treatment options. CRCD2 Exocrine pancreatic insufficiency, a condition not solely confined to pancreatogenic diabetes, is also a prevalent feature in both type 1 and longstanding type 2 diabetes.
The heterogeneous conditions encompassed by diabetes mellitus are united by a shared elevation of blood glucose concentrations.