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. Mandatory metabolic control is crucial in cases of a pathological value. Oral glucose tolerance tests (OGTTs) are not recommended post-bariatric surgery, given the risk of developing postprandial hypoglycemia. For those women diagnosed with gestational diabetes mellitus, nutritional counseling, blood glucose monitoring, and encouragement to increase moderate-intensity physical activity should be prioritized, if not contraindicated by their health condition (Evidence Level A). Maintaining blood glucose within the therapeutic parameters (fasting glucose below 95 mg/dL and one hour after meals below 140 mg/dL, evidence level B) necessitates the initiation of insulin therapy as the preferred initial treatment (evidence level A). Maternal and fetal monitoring is indispensable for reducing maternal and fetal/neonatal morbidity and perinatal mortality risks. Ultrasound examinations, along with routine obstetric checkups, are advised (Evidence Level A). Neonatal care for GDM infants at risk for hypoglycemia involves assessing blood glucose levels after birth and implementing suitable interventions where required. A healthy lifestyle for children and the monitoring of their development are key concerns for every member of the family. Following childbirth, all women diagnosed with gestational diabetes mellitus (GDM) require a reevaluation of their glucose tolerance using a 75g oral glucose tolerance test (OGTT) according to WHO criteria, performed 4 to 12 weeks after delivery. Glucose parameter assessments (fasting glucose, random glucose, HbA1c, or optimally, an oral glucose tolerance test) are advised every two to three years for individuals with normal glucose tolerance. Instruction on the elevated risk of type 2 diabetes and cardiovascular disease should be given to all women during their follow-up visits. Weight management and maintaining/increasing physical activity, as part of preventative lifestyle changes, should be addressed (evidence level A).
In contrast to adult diabetes, type 1 diabetes mellitus (T1D) emerges as the most frequent form of diabetes in the childhood and adolescent population, comprising over 90% of cases. After diagnosis, children and adolescents with Type 1 Diabetes need the care of pediatric units specializing in pediatric diabetology for optimal management. A fundamental aspect of treatment for lifelong insulin dependency involves customized approaches that accommodate the patient's age and the family's established routines. This age group should consider the use of diabetes technologies, specifically glucose sensors, insulin pumps, and the recently developed hybrid closed-loop systems. The initial establishment of optimal metabolic control in therapy is indicative of an enhanced long-term outcome. 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. The International Society for Pediatric and Adolescent Diabetes (ISPAD) and the Austrian working group for pediatric endocrinology and diabetes (APEDO) recommend an HbA1c metabolic target of 70% (IFCC 70%), applicable to all pediatric age groups, provided there are no signs of severe hypoglycemia. Treatment goals for diabetes in all pediatric age groups encompass age-related physical, cognitive, and psychosocial growth, detecting related diseases, preventing acute complications (like severe hypoglycemia and diabetic ketoacidosis), and avoiding long-term consequences to guarantee a high standard of living.
A person's body fatness is represented in a very rough manner by the body mass index (BMI). Normal-weight individuals can still have substantial body fat if their muscle density is low (sarcopenia), thus emphasizing the importance of assessing additional metrics like waist circumference and body fat content. The recommended procedure for analysis often involves bioimpedance (BIA). The prevention and treatment of diabetes hinges on adopting a comprehensive lifestyle strategy that includes dietary modifications and increased physical activity. Type 2 diabetes management often now incorporates body weight as a secondary factor for evaluation. Weight is a crucial factor with an increasing influence on the selection of anti-diabetic treatment plans and concurrent therapies. The rising significance of modern GLP-1 agonists and dual GLP-1/GIP agonists stems from their ability to address both obesity and type 2 diabetes. learn more Bariatric surgery is currently suggested for those with a BMI above 35 kg/m^2 and additional health issues like diabetes, and potentially achieves at least partial remission of diabetes. However, its use must be part of an encompassing long-term care regime.
The incidence of diabetes and its complications is significantly heightened by smoking and exposure to secondhand smoke. While smoking cessation might result in weight gain and an elevated risk of diabetes, it significantly reduces cardiovascular and overall mortality. For successful smoking cessation, a fundamental diagnostic approach, encompassing the Fagerstrom Test and exhaled CO levels, is required. Varenicline, Nicotine Replacement Therapy, and Bupropion are among the supporting medications. Smoking behavior and its cessation are greatly impacted by a confluence of socio-economic and psychological variables. Electronic cigarettes and similar heated tobacco products do not provide a healthy alternative to cigarettes, and their use has been linked to higher rates of illness and death. The presence of selection bias and underreporting in studies likely leads to an overly optimistic perception. 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.
Physical activity, especially consistent exercise, plays a significant role in managing and preventing type 2 diabetes as part of a healthy lifestyle. Furthermore, the adverse effects of inactivity on health require recognition, and extended periods of sitting should be curtailed. The positive effects of training are directly related to the amount of fitness gained, but these effects persist only while the fitness level is preserved. Exercise interventions show effectiveness in both men and women of all ages. Reproducibility and reversibility are inherent characteristics of the process. 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. Unfortunately, a crucial element is lacking: the implementation of booth-local exercise classes and advisors.
Individualized nutritional consultations are required for every patient with diabetes, handled by professionals. Dietary therapy should center on the needs of the patient, taking into account their lifestyle and the kind of diabetes they have. Dietary guidance for the patient should be supplemented by specific metabolic targets to limit disease progression and prevent potential long-term health issues. Consequently, practical guidelines, including portion control and meal planning strategies, should receive paramount attention. Consultations provide support in managing health conditions, including dietary selection to improve health status. These practical recommendations encapsulate the key findings of current literature on nutrition and diabetes treatment.
This document, representing the Austrian Diabetes Association (ODG)'s recommendations, details the appropriate use and access to diabetes technology (insulin pumps, CGM, HCL systems, diabetes apps) for individuals with diabetes mellitus, underpinned by current scientific evidence.
Hyperglycemia is a major factor in the array of complications experienced by those with diabetes mellitus. Although lifestyle modifications are foundational for disease prevention and management, a considerable number of type 2 diabetes patients will, ultimately, necessitate pharmaceutical interventions for appropriate glycemic control. Characterizing individual targets for optimal therapeutic outcome, safety, and cardiovascular benefits holds significant clinical importance. Healthcare professionals are presented with the most current, evidence-based, and best clinical practice data in this guideline.
Diabetes originating from diverse sources besides the primary causes includes disruptions in glucose homeostasis caused by other endocrine dysfunctions such as acromegaly or hypercortisolism, and diabetes induced by drugs (e.g.). Checkpoint inhibitors, glucocorticoids, antipsychotic medications, immunosuppressive agents, highly active antiretroviral therapy (HAART), and genetic forms of diabetes, including specific examples (e.g.), comprise a spectrum of therapeutic approaches. MODY (Maturity-onset diabetes of the young), neonatal diabetes, diabetes linked to genetic conditions including Down syndrome, Klinefelter syndrome, and Turner syndrome, and pancreatogenic diabetes (including examples of .) Postoperative complications, including diabetes in its rare autoimmune or infectious forms, can include diseases such as pancreatitis, pancreatic cancer, haemochromatosis, and cystic fibrosis. learn more Specific diabetes type diagnoses can potentially alter the approach to therapy. learn more Beyond its presence in pancreatogenic diabetes, exocrine pancreatic insufficiency is frequently diagnosed in type 1 and long-term type 2 diabetes patients.
The heterogeneous conditions encompassed by diabetes mellitus are united by a shared elevation of blood glucose concentrations.