A ketogenic diet can cause diabetes

Full version of the 2012 ÖDG guidelines

Viennese

clinical

weekly

The Middle European Journal of Medicine

124th year 2012 Supplement 2 Vienna Klin Wochenschr (2012) 124 [Suppl 2]: 1-128

© Springer-Verlag Vienna 2012

"Diabetes mellitus - instructions for practice"

Revised and expanded version 2012

Guest editor: Austrian Diabetes Society

Coordinator Committee Guidelines: Univ.-Prof. Dr. Martin Clodi

President: Prim. O. Univ.-Prof. Dr. Dr. H. c. Heinz Drexel

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articles of the month articles of the month

Table of Contents

Diabetes mellitus - definition, classification and diagnosis (Michael Roden). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Type 2 Diabetes Mellitus - Screening and Prevention (Marietta Stadler, Rudolf Prager). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4th

Lifestyle: diagnostics and therapy (Raimund Weitgasser, Josef Niebauer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7th

Antihyperglycemic therapy for type 2 diabetes mellitus. Principle statement (Martin Clodi, Heidemarie Abrahamian,

Heinz Drexel, Peter Fasching, Friedrich Hoppichler, Alexandra Kautzky-Willer, Monika Lechleitner, Bernhard Ludvik,

Rudolf Prager, Michael Roden, Christoph Saely, Guntram Schernthaner, Edith Schober, Hermann Toplak, Th omas Wascher,

Raimund Weitgasser). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Insulin therapy for diabetes mellitus (Monika Lechleitner, Michael Roden, Raimund Weitgasser, Bernhard Ludvik,

Peter Fasching, Friedrich Hoppichler, Alexandra Kautzky-Willer, Guntram Schernthaner, Rudolf Prager, Thomas C. Wascher). . . . . . . . 17th

Antihypertensive therapy for diabetes mellitus. Guideline the Austrian Diabetes Society 2012

(Guntram Schernthaner, Heinz Drexel, Alexanthe R. Rosenkranz, Gerit-Holger Schernthaner, Bruno Watschinger). . . . . . . . . . . . . . . . 23

Lipids: Diagnosis and therapy for type 2 diabetes mellitus (Thomas C. Wascher *, Bernhard Paulweber, Hermann Toplak,

Christoph Saely, Heinz Drexel). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Thrombocyte aggregation inhibitors (Thomas Wascher). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Diabetic neuropathy (Monika Lechleitner *, Heidemarie Abrahamian, Mario Francesconi). . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Diabetic foot (Monika Lechleitner, Heidemarie Abrahamian, Mario Francesconi). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Diabetic Nephropathy Update 2012. Position paper the Austrian Diabetes Society and the

Austrian Society for Nephrology with the collaboration of (Martin Auinger, Roland Edlinger, Friedrich Prischl, Alexandra

Kautzky-Willer, Rudolf Prager, Alexanthe R. Rosenkranz, Michael Roden, Marcus Saemann, Martin Clodi, Guntram Schernthaner). . . . 42

Diagnosis, therapy and follow-up the diabetic eye disease (Michael Stur, Stefan Egger, Anton Haas,

Gerhard Kieselbach, Stefan Mennel, Reinhard Michl, Michael Roden *, Ulrike Stolba, Andreas Wedrich). . . . . . . . . . . . . . . . . . . . . . 50

Gestational diabetes (GDM) (Alexandra Kautzky-Willer, Dagmar Bancher-Todesca, Arnold Pollak, Andreas Repa, Monika

Lechleitner, Raimund Weitgasser). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Pregnancy with pre-existing diabetes for the Guidelines for practice (AG Diabetes and Pregnancy theÖDG)

(Alexandra Kautzky-Willer, Raimund Weitgasser, Monika Lechleitner). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Diabetes mellitus in childhood and adolescence (Birgit Rami-Merhar, Elke Fröhlich-Reiterer, Sabine Hofer, Edith Schober). . . . . . . . . . 70

Geriatric aspects of diabetes mellitus (Joakim Huber, Michael Smeikal, Monika Lechleitner, Peter Fasching). . . . . . . . . . . . . . . 74

Dietary recommendations for diabetes mellitus (Karin Schindler, Bernhard Ludvik). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Self-monitoring of blood sugar levels (Thomas C. Wascher *). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Diabetes education for adults with diabetes (Raimund Weitgasser, Martin Clodi, Gertrud Kacerovsky-Bielesz,

Peter Grafi nger, Monika Lechleitner, Kinga Howorka, Bernhard Ludvik). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Gender-specific aspects for clinical practice in prediabetes and diabetes mellitus (Alexandra Kautzky-Willer,

Raimund Weitgasser, Peter Fasching, Fritz Hoppichler, Monika Lechleitner). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Migration and Diabetes (Kadriye Aydinkoc, Karin Schindler, Alexandra Kautzky-Willer, Bernhard Ludvik, Peter Fasching). . . . . . . . . 97

Position paper: Exocrine pancreatic insufficiency and diabetes mellitus (Raimund Weitgasser, Heidemarie Abrahamian,

Martin Clodi, Werner Fortunat, Heinz Hammer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Position paper theÖDG: Therapy the Hyperglycaemia in adult, critically ill patients (Martin Clodi,

Michael Resl, Heidemarie Abrahamian, Bernhard Föger, Raimund Weitgasser). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Position paper: Mental illnesses and diabetes mellitus (Heidemarie Abrahamian, Alexandra Kautzky-Willer,

Angelika Rießland-Seifert, Peter Fasching, Christoph Ebenbichler, Peter Hofmann, Hermann Toplak). . . . . . . . . . . . . . . . . . . . . . . . . . 107

Position paper: Operation and diabetes mellitus (Peter Fasching, Joakim Huber, Martin Clodi, Heidemarie Abrahamian,

Bernhard Ludvik). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Position paper of the insulin pump committee the OEDG for continuous glucose measurement (CGM - Continuous

Glucose Monitoring) (Ingrid Schütz-Fuhrmann, Edith Schober, Birgit Rami-Merhar, Marietta Stadler, Martin Bischof,

Sandra Fortunat, Markus Laimer, Raimund Weitgasser, Rudolf Prager). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Guidelines Insulin pump therapy in kinthen and adults (For the Insulin Pump Therapy Committee the

Austrian Diabetes Society) (Marietta Stadler, Sandra Zlamal-Fortunat, Ingrid Schütz-Fuhrmann,

Birgit Rami-Merhar, Edith Schober, Alexandra Kautzky-Willer, Raimund Weitgasser, Rudolf Prager, Martin Bischof). . . . . . . . . . . . . . . 123

S 2 © Springer-Verlag Vienna Suppl 2 /2012 wkw


FOREWORD to the practical instructions 2012

In 2009 the Guidelinesthe Austrian Diabetes Society (ÖDG) for the comprehensive care of diabetics

last revised. The goal of this Guidelines, on which a large number of diabetologists in Austria worked

has is to provide an informed guide to improvement the Quality of diabetes care based on current scientific

Enable insights. All key topics were revised and some new ones introduced.

In these practical guides, we have tried to incorporate all useful and available evidence from current studies

allow. Next Guidelines position papers are also included in this issue. The evidence grades were

Inserted in analogy to the American and European Diabetes Society in the corresponding chapters.

We hope with these Guidelines and position papers on further improvement the Diabetic care in

Austria to contribute and to offer you practical help in making therapy decisions. We will the

Guidelines regularly revise and on in the future the Homepage theÖDG Publish relevant updates. It is planned,

the next published Guidelines To be published in 2015.

Evidence Graduation System (analogous to the American Diabetes Association, ADA)

Evidence level Description

DIABETES CARE, VOLUME 34, SUPPLEMENT 1, JANUARY 2011, S12

With best regards

Univ.-Prof. Dr. Martin Clodi

Chairthe of the committee GuidelinestheÖDG

A Clear evidence from well-conducted studies, applicable in principle, RCTs with sufficientthe Power:

- Evidence from well-executed, multicenter studies

- Evidence of meta-analyzes, which quality analyzes the included studies

Supporting evidence from well-conducted, radomised studies with sufficientthe power

- Evidence from well-conducted studies in an othe several centers

- Evidence of meta-analyzes which include quality analyzes

B Supporting evidence from well-conducted cohort studies

- Evidence from well-conducted prospective cohort studies etc.the Registers

- Evidence from meta-analyzes based on cohort studies

Supporting evidence from a well-conducted case-control study

C Supporting evidence from poorly controlled or similarthe uncontrolled studies

- Evidence from randomized controlled trials with an othe several coarse othe three othe

several, minor methodological weaknesses

- Evidence from observational studies with a high risk of bias

- Evidence from case series etc.the Case reports

WitheExtensive data with data that support the recommendation

E Expert consensus or similarthe clinical experience

wkw Suppl 2 /2012 © Springer-Verlag Vienna S 3

a


Diabetes Mellitus - Instructions for Practice

Published by the Austrian Diabetes Society

The committee Guidelines*:

Abrahamian Heidemarie

Clodi Martin (chair and coordination)

Drexel Heinz

Mardi Gras Peter

Hoppichler Friedrich

Kautzky-Willer Alexandra

Lechleitner Monika

Ludvik Bernhard

Prague Rudolf

Roden Michael

Säly Christoph

Schernthaner Guntram

Schober Edith

Toplak Hermann

Washer Thomas C.

Weitgasser Raimund

With the cooperation of *:

Auinger Martin

Aydinkoc-Tuzcu Kadriye

Bancher death ca Dagmar

Bishop Martin

Ebenbichler Christoph

Edlinger Roland

Egger Stefan

Föger Bernhard

Fortunat Werner

Francesconi Mario

Fröhlich-Reiterer Elke

* In alphabetic order.

Grafinger Peter

Haas Anton

Hammer Heinz

Hofer Sabine

Hofmann Peter

Howorka Kinga

Huber Joakim

Kacerovsky-Bielesz Gertrud

Kieselbach Gerhard

Laimer Marcus

Mennel Stefan

Michl Reinhard

Niebauer Josef

Paul weaver Bernhard

Pollak Arnold

Prischl Friedrich

Rami-Merhar Birgit

Repa Andreas

Resl Michael

Riessland-Seifert Angelika

Rosary Alexanthe R.

Saemann Marcus

Schernthaner Gerit-Holger

Schindler Karin

Contactor carter Ingrid

Smeikal Michael

Stadler Marietta

Stolba Ulrike

Stubborn Michael

Watschinger Bruno

Wedrich Andreas

Zlamal-Fortunat Sandra

S 4 © Springer-Verlag Vienna Suppl 2 /2012 wkw


Vienna Klin Wochenschr (2012) 124 [Suppl 2]: 1-3

DOI 10.1007 / s00508-012-0269-z

Diabetes mellitus - definition, classification

and diagnosis

Michael Roden

Published online: December 19th 2012

© Springer-Verlag Vienna 2012

Diabetes mellitus: definition, classification

and diagnosis

Summary Diabetes mellitus comprises of a group of

heterogeneous disorthes, which have an increase in

blood glucose concentrations in common. The current

classifications for diabetes mellitus type 1–4 are described

and the main features of type 1 and type 2 diabetes

are compared to allow for better discrimination

between these diabetes types. Furthermore, the criteria

for the correct biochemical diagnosis during fasting

and oral glucose tolerance tests as well as the use of

hemoglobin A1c (HbA1c) are summarized. These data

form the basis of the recommendations of the Austrian

Diabetes Association for the Clinical Practice of Diabetes

treatment.

Summary Diabetes mellitus is one

Group of heterogeneous diseases, theen common

Find the increase the Blood glucose is.

The current classifications of diabetes mellitus

Types 1-4 are described and the main ones

Characteristics of type 1 and type 2 diabetes are used

better differentiation between these types of diabetes.

In addition, the criteria for

the correct biochemical diagnosis under fasting

Conditions and in the oral glucose tolerance test as well

the application of hemoglobin A1c (HbA1c) summarized.

These data form the basis the recommendations

the Austrian Diabetes Society

for clinical practice the Diabetes treatment.

For the committee Guidelines

M. Roden ()

Institute for Clinical Diabetology, German Diabetes

Center, Leibniz Center for Diabetes Research,

Department of Metabolic Diseases, Heinrich-Heine University,

Dusseldorf, Germany

Email: [email protected]

1 3

definition

guidelines for practice

Viennese clinical weekly

The Central European Journal of Medicine

Diabetes mellitus describes a group of metabolic diseases

theen common finding the

Increase in blood glucose levels, the hyperglycaemia,

is. Severe hyperglycemia results from classic symptoms

like polyuria, polydipsiathes inexplicable

Weight loss through visual disturbances and susceptibility to infections

up to ketoacidosis etc.the non-ketoacidotic

hyperosmolar syndrome with risk of coma. Chronic

Hyperglycemia leads to disorders the secretion

and / othe Effects of insulin and associated with long-term damage

and malfunctions of various

Tissues and organs (eyes, kidneys, nerves, heart and

Blood vessels).

classification

Insulin dependence (e.g .: insulin (in) dependent diabetes

mellitus, IDDM, NIDDM) does not constitute a classification

The classification of diabetes mellitus takes place in 4

Types [1, 2]:

1. Type 1 diabetes: disorder the Insulin secretion through

predominantly immunologically mediated destruction

the pancreatic β-cells with mostly absolute insulin deficiency.

LADA (latent autoimmune diabetes

the Adult) is due to occurrence in adulthood

and the slower loss the Insulin secretion

marked.

2. Type 2 diabetes: disorder the Insulin effect (insulin resistance)

with initially mostly relative insulin deficiency

(typically disorder the Glucose-dependent

Insulin secretion). The malfunctions are

long before the clinical manifestation of the

Diabetes alone or similarthe as part of a metabolic

Syndrome at increased risk for macrovascular

Episodes present. Table 1 lists notes on clinical

Differential diagnosis to type 1 diabetes.

Diabetes mellitus - definition, classification and diagnosis 1


guidelines for practice

Table 1. Differential diagnostic considerations (10 criteria)

Criterion Type 1 Diabetes Type 2 Diabetes

Frequency Rarely, < 10="" %="">the

Diabetes cases

Age of manifestation Mostly younger,

< 40="" a="">

LADA)

Body weight Mostly normal weight

3. Tothee specific forms of diabetes: causes such as

Diseases of the exocrine pancreas (e.g .: pancreatitis,

Traumas, operations, tumors, hemochromatosis,

cystic fibrosis), endocrine organs (e.g .:

Cushing's syndrome, acromegaly), drug-chemically

(e.g .: glucocorticoids, α-interferon), genetic

Defects the Insulin secretion (e.g .: forms of

Maturity Onset Diabetes of the Young, MODY) and

the Insulin action (e.g .: lipoatrophic diabetes)thee

genetic syndromes (e.g .: Down, Klinefelter,

Turner syndrome), infections (e.g .: congenital rubella)

and rare forms of autoimmune-mediated

Diabetes (e.g .: "Stiff-man" syndrome).

4. Gestational diabetes (GDM): first time during the

Pregnancy occurred / diagnosed glucose tolerance disorder,

which is the first manifestation of a type

1, type 2 diabetes or similarthe attheit includes types of diabetes

(please refer ÖDG-GuidelinesGestational diabetes).

diagnosis

Often, - 90% the Diabetes cases

Mostly older people> 40 years old, increasing

previous manifestation

Mostly overweight, obese

Symptoms Often less common

Tendency towards ketoacidosis Pronounced Absent or similarthe only slightly

Family accumulation Low Typical

Plasma C-peptide Mostly low to

missing

Usually normal to elevated

Islet cell antibodies 85–95% + (GAD,

ICA, IA-2, IAA)


HLA association + (HLA-DR / DQ) -

Insulin therapy required immediatelytheLich often only after a long time

course

The diagnosis of diabetes is based on fasting glucose,

oral glucose tolerance test (OGTT) or similarthe

Hemoglobin A1c (HbA1c). The hyperglycemia develops

and the disturbances of fasting

and postprandial glycemia exhibit different

Timelines on. The established limit values ​​are therefore

not in complete agreement in the identification

of patients with diabetes, are further subject

all tests of a variability, so that testlikethefetch

Othe Confirmation of a test result by antheen

Test - unless there are classic clinical symptoms

- always expltheis lich.

2 Diabetes mellitus - definition, classification and diagnosis

Tab. 2. Standard diagnostics of diabetes mellitus and of

increased risk of diabetes

Manifest diabetes Increased risk of diabetes

mellitus

a

Not sober

("Random

Glucose")

Sober-

Glucose (venous

Plasma)

2-h glucose

after 75 g

OGTT (venous

Plasma)

≥ 200 mg / dl + classic

Symptomec OR

≥ 200 mg / dl on 2 days, ≥ 126 mg / dl on 2

Days b ≥ 200 mg / dl on 2

Days b

HbA1c ≥ 6.5% (48 mmol / mol)

in 2 days b

Fasting Glucose and OGTT

The diagnosis is made regardless of age and gender

by measuring multiple increased blood glucose levels

asked on at least two different days

(Tab. 2). In the event of clinical suspicion and witheproverbial

The diagnosis is made using OGTT.

To be considered "normal" thefasting glucose values

in the venous plasma of < 100="" mg/dl="">< 5,6="">

although lower values ​​indicate the presence of glucose metabolism disorder

and do not rule out consequential damage.

Basis for choice the Limits is in the mostly

continuous relationship between higher

Blood glucose values ​​(on an empty stomach and 2 hours after

oral glucose load) and the Increase in risk

for consequential damage.

The prerequisites for determining glucose are:

• Exclusive use of quality-assured measures

Othe Testing;

• preferably determination in venous plasma (add

of lithium heparin or similarthe better EDTA + sodium fluoride).

Serum samples are only to be used

when a glycolysis inhibitor has been added;

• no determination with blood glucose meters that

used for self-control

become;

• "Sober" means time of ≥ 8 hours without calorie

admission;

• At the Implementation is on the possible falsification

the Diagnosis by intercurrent illness


≥ 100 mg / dl, but ≤ 125 mg /

dl (abnormal fasting glucose,

"Impaired fasting glucose",

IFG)

Glucose ≥ 140 mg / dl, but

≤ 199 mg / dl (impaired glucose tolerance,

"Impaired glucose

tolerance ", IGT)

≥ 5.7% (39 mmol / mol), but

≤ 6.4% (46 mmol / mol) d

a An increased risk of diabetes can occur even without evidence of disorders the

Glycemia exist and can be ascertained using defined risk tests

(see ÖDG-Guidelines Prevention)

bIf 2 different tests are positive, the diagnosis is diabetes,

so on the test liketheretrieval can be dispensed with. Surrender

different tests then have different results the Test with

increased earnings to liketheto fetch

cIf hyperglycaemia and classic symptoms are present, the diagnosis is

without test likethefetch given, since z. E.g .: at the first manifestation of the

Type 1 diabetes HbA1c may be normal

d Further diagnostics using fasting glucose or similarthe OGTT is requiredthelich

1 3


genes (e.g .: infections, dehydration, gastrointestinal

Diseases) othe Taking medication

(e.g .: glucocorticoids) to pay attention to;

• For the diagnosis of the GDM apply tothee than the in

Table 2 listed criteria (see ÖDG-Guidelines

to gestational diabetes).

HbA1c

Those already in the ÖDG-Guidelines 2009 mentioned possibility

increased HbA1c levels to diagnose diabetes

Using mellitus is now in agreement

with the appropriate recommendationsthehe

Professional societies in the standard diagnostic criteria

adopted [3, 4]. Accordingly, diabetes mellitus

based the HbA1c limit values ​​≥6.5% diagnosed

(Tab. 2). The basis for this is the increase in

Risk of diabetic retinopathy from HbA1c values

of> 6.5%. For HbA1c values ​​from 5.7% up to and including

6.4% an increased risk of diabetes is to be assumed,

so that a clarification using fasting glucose and

OGTT is recommended. However, diabetes is at risk

mellitus not even with lower HbA1c values

to exclude. Furthermore, the HbA1c can be due to

the limited informative value under the following

May not be used to diagnose diabetes mellitus

can be used:

• Hemoglobinopathies: e.g. E.g .: HbS, HbE, HbF, HbC,

HbD

• changetheung the Erythrocyte lifespan: e.g. B: hemolytic

and iron deficiency anemia, anemia treatment,

Liver and kidney diseases, age)

• Modification of the Hb: z. E.g .: uremia (carbamylated

Hb), acetylsalicylic acid (acetylated Hb)

• Inhibition the Glycation: e.g. B .: long-term therapy with

Vitamin C othe Vitamin E.

• pregnancy

For better comparability the Methods for

Determination of the HbA1c is recommended by the Austrian

Society for Laboratory Medicine and Clinical Chemistry

(ÖGLMKC) and the ÖDG, from 01.01.2012 exclusively

Methods to use according to the new standard

the International Fetheation of Clinical Chemistry

(IFCC) are referenced [5]. These values ​​are intended to avoid confusion

to avoid following the IFCC standard in

mmol / mol can be output. The conversion to

HbA1c value in percent according to the National Glycohemoglobin

Standardization Program (NGSP) or according to the

DCCT is as follows:

HbA1c in percent = (0.09148 * HbA1c in mmol / mol) +2.152

A DCCT-HbA1c value of 6.5% therefore corresponds to a

IFCC-HbA1c of 48 mmol / mol.

1 3

guidelines for practice

Performing the oral glucose tolerance test

(OGTT) according to WHO guidelines

Indications: risk groups (see ÖDG-Guidelines-

Screening and prevention), elderly patients (but

abnormal fasting glucose

Implementation: ≥ 3 days carbohydrate-rich (≥ 150 g /

Day) nutrition

10–16 hours of food and alcohol abstinence before

test

Performed in the morning lying down / sitting (no smoking

before / during the test)

Glucose determination (time 0 min)

Drinking 75 g of glucose (or similar)the equivalent amount of starch)

in 250-350 ml of water (kinthe: 1.75 g / kg to a maximum

75 g glucose) within 5 min

Glucose determination (time 60 min after glucose uptake):

only when diagnosing gestational diabetes

Glucose determination (point in time 120 min after glucose

recording)

Contraindications: intercurrent diseases, St.

p. Gastrointestinal resection, resorption disorders,

proven diabetes mellitus.

Influencing factors: prolonged fasting, carbohydrate malnutrition

can also be pathological in healthy people

Glucose tolerance can result. A row of

Drugs such as B. glucocorticoids, adrenaline

(Epinephrine), phenytoin, and furosemide can die

Worsen glucose tolerance.

Conflict of interest

M.R. has from the following companies, which also förthende

MembersthetheÖDG are, research supports

and / othe Fees received: Eli Lilli, Novo

Nordisk, sanofi-aventis, Takeda

literature

1. Kerner W, Brückel J. Definition, classification and diagnostics

of diabetes mellitus. Diabetol metabolism. 2011; 6

Suppl 2: 107-10. (Practical recommendations the German Diabetes Society

(DDG)).

2. American Diabetes Association. Position statement. Standards

of Medical Care in Diabetes - 2012. Diabetes Care.

2012; 32 Suppl 1: 11-63.

3. The International Expert Committee. International expert

committee report on the role of the A1C assay in the diagnosis

of diabetes. Diabetes Care. 2009; 32: 1327-34.

4. Report of a World Health Organization Consultation. Use of

glycated hemoglobin (HbA1c) in the diagnosis of diabetes

mellitus. Diabetes Res Clin Pract. 2011; 93: 299-309.

5. Hübl W, Haushofer A, Weitgasser R. Joint recommendations

the ÖGLMKC and theÖDG for referencing the

HBA1C determination according to the IFCC standard ÖGLMKC.

ÖDG; 2011. www.oedg.org/1105_recommendation.

Diabetes mellitus - definition, classification and diagnosis 3


guidelines for practice

Vienna Klin Wochenschr (2012) 124 [Suppl 2]: 4-6

DOI 10.1007 / s00508-012-0271-5

Type 2 diabetes mellitus screening

and prevention

Summary The prevalence of diabetes is increasing in

westernized countries. In addition, about half of all patients

suffering from diabetes are not diagnosed. The

current article represents the recommendations of the

Austrian Diabetes Association for the screening and prevention

of type 2 diabetes, based on currently available

evidence.

Keywords: Screening- prevention- type 2 diabetes

Summary The global prevalence of diabetes

increases significantly, with a high number of unreported cases

Patient gives theen diabetes not yet diagnosed

has been. The following article includes the on thetheearly

Evidence-based recommendations the Austrian

Diabetes Society for Screening and

Prevention of type 2 diabetes mellitus.

Keywords: screening, prevention, type 2 diabetes

Epidemiology of Type 2 Diabetes Mellitus

The global prevalence of type 2 diabetes mellitus

(T2DM) in adults was revealed in 2000

Valued at 151 million, an increase of 46%

221 million adopted by 2010 and 300 million by 2025

became [1, 2]. In Austria, according to a

Viennese clinical weekly

The Central European Journal of Medicine

Type 2 Diabetes Mellitus - Screening and Prevention

Marietta Stadler, Rudolf Prager

Published online: December 19th 2012

© Springer-Verlag Vienna 2012

For the committee Guidelines

M. Stadler () · R. Prager

3. Medical department, hospital the City of Vienna-Hietzing,

Vienna, Austria

Email: [email protected]

Karl Landsteiner Institute for Metabolic Diseases

and nephrology, Vienna, Austria

Elevation the Statistics Austria the prevalence of diabetes

estimated at around 6% (Stastik Austia, health survey

2006/2007). Starting from epidemiological

However, studies are about half the Type 2 diabetic

not yet diagnosed as such [3], but have

already increased risk of stroke, heart attack and

peripheral arterial occlusive disease [4, 5]. Given

the impending diabetes pandemic theen health

and socio-economic consequences are

efficient strategies for prevention and early detection

of the T2DM requiredthelich.

Risk factors for T2DM

Causes of T2DM are mainly lifestyle-related

Factors such as sedentary lifestyle and

hypercaloric, high-fat diet as well as a

genetic disposition. The risk,

Developing T2DM increases with age, obesity

and sedentary lifestyle. Offspring othe

Siblings of type 2 diabetics, as well as women

Gestational diabetes, show

also increased T2DM risk on [6].

Patients with metabolic syndrome (insulin resistance syndrome)

with the subcomponents glucose metabolism disorder

(IGT), obesity, dyslipidemia and /

Othe arterial hypertension is the main risk group

for the development of type 2 diabetes, and are

therefore also the primary target group for screening and

Diabetes prevention.

T2DM screening and prevention - current

recommendations

Systematic screening for T2DM

Individuals at increased risk of diabetes should be identified

and systematically for the presence of T2DM, etc.the

Prediabetes (impaired glucose tolerance; IGT and / othe

4 Type 2 Diabetes Mellitus - Screening and Prevention 1 3


Table 1. Criteria for diabetes screening in asymptomatic patients

Adults (aged ≥ 45 years). (Adapted from

[6])

Regardless of age, if you are overweight (BMI ≥ 25 kg / m²) and an othe

several additional risk factors

Physical inactivity

First degree relatives with diabetes

Arterial hypertension (≥ 140/90 mmHg othe antihypertensive therapy)

HDL cholesterol men < 35="" mg/dl="">the Triglycerides> 250 mg / dl

Polycystic Ovarian Syndrome, birth of a child weighing> 4.5 kg

Body weight, etc.the previous gestational diabetes

IFG othe Earlier time point IGT, HbA1c ≥ 5.7

Cardio- othe cerebrovascular disease

High-risk population (Asian, African, Latin American

Origin)

Acanthosis nigricans

BMI body mass index, IFG impaired fasting glucose, IGT impaired glucose tolerance

disturbed fasting glucose; IFG) (recommendation grade

B).

Fasting plasma glucose (alternatively HbA1c or similar)the

oral glucose tolerance test) should be used from the age of

Checked every 45 years at 3-year intervals (E).

If there is also a the further listed in Tab. 1

Risk factors present should be more common and also in younger ones

People are screened [6]. With a fasting blood sugar

An oral glucose tolerance test should be> 100 mg / dl

be carried out [6] (recommendation grade B).

Lifestyle modification

Lifestyle modification with Gesunthe Diet, weight loss

and physical activity cannot just arise

by T2DMthenothe delay, sonthen works

overall beneficial to cardiovascular risk and

the quality of life. The Diabetes Prevention Study

(DPS) [7] and the Diabetes Prevention Program (DPP) [8]

document a 58% relative ratio in patients with IGT

Risk reduction for the occurrence of T2DM through

Lifestyle modification.

It is therefore important that people with increased T2DM

Risk - even if there is no manifest glucose metabolism disorder

present - awareness of the importance

of weight loss and regular physical

Creating activity. Additional cardiovascular risk factors

(e.g. smoking, hypertension, and dyslipidemia)

should be recognized and treated in good time.

If screening determines prediabetes, it should

a lifestyle intervention in the form of structured

Advice on diet and exercise and regular

Follow-ups are made to help keep body weight loss

of approx. 7% and 150 min / week

to achieve physical activity (recommendation grade B).

At specialthes high risk of diabetes (IFG, IGT, etc.)the

1 3

guidelines for practice

an HbA1c> 5.7%, in particularthee those with obesity

> 35 kg / m 2, age < 60="" jahrem="">the with previous

Gestational diabetes) can also be the gift of

Metformin should be considered [6], (recommendation grade A).

nutrition

Basically, the diet should be based on a healthy one

Mixed diets are made that are low in fat, low in carbohydrates and

is high in fiber. Less than 30% of the daily energy requirement

should be through fat, less than 10% through saturated

Fatty acids are covered. Obese should

Weight reduction of approx. 5–10% of the body weight

through a reduced-calorie diet and physical activity

to reach. In arterial hypertension, the food should

Low in salt, in hyperlipidaemia low in cholesterol and fat

and be low in purine in hyperuricemia [6].

Physical activity

According to the recommendations the American Diabetes Society

(ADA) should be people with elevated

Risk of diabetes, as well as prediabetes patients

Othe manifestem T2DM, to regular motheater physical

Activity (30 min / day or 150 min / week)

be motivated [6].

Finally, the importance of screening is enormous

and prevention in T2DM, a disease with

rise rapidlythe Incidence, highlighted. Lifestyle modification

with diet and physical activity is that

most effective measure to prevent T2DM.

Conflict of interest

M.S. has from the following companies, which also förthende

MembersthetheÖDG are, research supports

and / othe Received Fees: Medtronic, Novo

Nordisk, Roche, sanofi-aventis.

R.P. has from the following companies, which also förthende

MembersthetheÖDG are, research supports

and / othe Fees received: Abbott, Astra

Zeneca, Bristol-Myers Squibb, Johnson & Johnson Medical,

Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk,

Roche, sanofi-aventis, Takeda.