34^th European Diabetes Congress

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion, leading to hyperglycemia. This condition is influenced by a combination of genetic, environmental, and lifestyle factors. The development of T2DM involves a complex interplay between insulin resistance in peripheral tissues (such as muscle, liver, and fat) and beta-cell dysfunction in the pancreas. Initially, the body compensates for insulin resistance by increasing insulin production. However, over time, the beta cells cannot sustain this increased demand, resulting in insufficient insulin levels and chronic hyperglycemia. Factors such as obesity, physical inactivity, and poor diet significantly contribute to the onset and progression of insulin resistance and beta-cell dysfunction. The management of T2DM has evolved from a one-size-fits-all approach to a more personalized strategy that considers the individual’s unique characteristics, including genetic background, comorbidities, lifestyle, and treatment preferences. Tailoring nutritional plans to reduce carbohydrate intake, promote weight loss, and improve blood glucose control. Encouraging regular physical activity to enhance insulin sensitivity and overall metabolic health.

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy, typically in the second or third trimester. It is characterized by glucose intolerance and elevated blood sugar levels. Proper management of GDM is crucial for the health of both the mother and the fetu. GDM risk is higher in women with obesity, a family history of diabetes, advanced maternal age, a previous history of GDM, or polycystic ovary syndrome (PCOS). Universal screening is usually conducted between 24 and 28 weeks of gestation using an oral glucose tolerance test (OGTT). A balanced diet with controlled carbohydrate intake and regular physical activity are the first-line treatments. Regular monitoring of blood sugar levels helps ensure they remain within target ranges. Women with GDM are at an increased risk of developing preeclampsia, a condition characterized by high blood pressure and potential organ damage. Infants should be monitored for hypoglycemia and other potential complications shortly after birth. Breastfeeding is encouraged as it may help regulate the infant's blood sugar levels. By understanding and managing gestational diabetes, healthcare providers can significantly improve outcomes for both mothers and their babies, ensuring a healthier pregnancy and reducing the risk of long-term complications.

Diabetic complications are significant health issues resulting from prolonged high blood sugar levels, impacting various organs and systems within the body. Effective prevention and management strategies are essential for improving outcomes and quality of life for individuals with diabetes. Diabetes is one of the most common chronic conditions worldwide, affecting approximately 425 million individuals. In the United States, about 9.4% of the adult population is affected by diabetes mellitus, with even higher prevalence rates among racial and ethnic minorities. One in four individuals does not know they have the disease. Due to a significant delay in the diagnosis of diabetes in many cases and suboptimal control of the disease in most patients, diabetes-related complications are extremely common.  Prevention and Management of Diabetes Complications is a distinctive four-day educational opportunity for clinicians who want to design feasible, comprehensive, diabetes-related complications prevention and treatment strategies based on the latest scientific information. This live-virtual course provides a state-of-the-art update on managing and preventing diabetes-related complications to a spectrum of health care providers. Through diligent prevention and proactive management, the impact of diabetic complications can be significantly reduced, enabling individuals with diabetes to lead healthier, more active lives.

Diabetes and metabolic syndrome are closely related health conditions that significantly impact an individual's risk for cardiovascular diseases and other serious health issues. Understanding the connection between these conditions is essential for effective prevention and management. Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes. A common feature of metabolic syndrome and a precursor to type 2 diabetes, insulin resistance occurs when cells in the body become less responsive to insulin, leading to elevated blood sugar levels. Central obesity is a key component of metabolic syndrome and a major risk factor for developing type 2 diabetes. Chronic low-grade inflammation, often seen in individuals with metabolic syndrome, contributes to the development of insulin resistance and diabetes. Adopting a healthy lifestyle is crucial in managing both diabetes and metabolic syndrome. Frequent monitoring of blood sugar, blood pressure, and lipid levels to manage and prevent complications. Use of medications as prescribed to control blood sugar, blood pressure, and cholesterol levels. Educating patients about the importance of lifestyle changes and adherence to treatment plans. By addressing the components of metabolic syndrome, individuals can significantly reduce their risk of developing type 2 diabetes and its associated complications. Early intervention and comprehensive management are key to improving health outcomes and preventing the progression of these interrelated conditions.

Effective management of diabetes hinges on comprehensive nutrition and lifestyle interventions. These approaches not only help in maintaining optimal blood glucose levels but also reduce the risk of diabetes-related complications. Focus on complex carbohydrates such as whole grains, legumes, fruits, and vegetables, which have a lower glycemic index and cause a slower rise in blood sugar levels. Include lean protein sources such as fish, poultry, beans, and nuts to support muscle mass and overall health. Choose healthy fats from sources like avocados, olive oil, nuts, and seeds while avoiding trans fats and limiting saturated fats. Monitor portion sizes to prevent overeating and maintain a healthy weight. Using smaller plates and being mindful of serving sizes can help. Distribute meals evenly throughout the day to avoid large fluctuations in blood sugar levels. Smaller, more frequent meals can help maintain steady glucose levels. Increase dietary fiber intake from whole grains, fruits, vegetables, and legumes to improve blood sugar control and support digestive health. Avoid foods and drinks high in added sugars, such as sodas, candies, and desserts, which can cause rapid spikes in blood sugar levels.  

Continuous Glucose Monitoring (CGM) is a cutting-edge technology that allows for real-time tracking of glucose levels throughout the day and night. This technology provides valuable insights into glucose trends and patterns, enabling more precise diabetes management. CGMs provide continuous data on glucose levels, typically updated every 5 minutes. Early warnings help prevent severe hypoglycemia by alerting users before levels drop too low. Many CGM systems integrate with smartphones, smart watches, and insulin pumps, providing comprehensive diabetes management. Insulin pumps are small, computerized devices that deliver continuous subcutaneous insulin infusion (CSII). They provide both basal (background) insulin and bolus (mealtime) insulin doses Smart pens record insulin doses, helping users and healthcare providers monitor and adjust therapy Users receive reminders for missed doses and alerts for potential dosing errors. Many smart pens can sync with smartphone apps to provide detailed reports and trends. Also known as artificial pancreas systems, hybrid closed-loop systems combine CGMs and insulin pumps to automate insulin delivery. By leveraging the advancements in CGM and insulin delivery technologies, individuals with diabetes can achieve better glycemic control, reduce complications, and improve their overall quality of life. These technologies represent a significant step forward in the journey towards more effective and personalized diabetes care.

The psychosocial aspects of diabetes care encompass the psychological, social, and emotional well-being of individuals living with diabetes. Managing diabetes is not only a physical challenge but also a mental and emotional one. Understanding and addressing these aspects is crucial for comprehensive diabetes management and improving patients' quality of life. Living with diabetes can cause significant stress and anxiety, impacting blood sugar control and overall health. Patients often worry about managing their condition, potential complications, and lifestyle changes. People with diabetes are at a higher risk of developing depression. Depression can negatively affect diabetes management, leading to poor adherence to treatment plans and worsening health outcomes. A specific emotional burden related to diabetes management, including feelings of frustration, burnout, and helplessness due to the constant demands of managing the condition. Psychological factors significantly influence patients' adherence to medication, diet, and exercise regimens. Motivation, self-efficacy, and coping strategies play critical roles in maintaining adherence. Adapting to a diabetes-friendly lifestyle involves significant behavioral changes. Support and education are essential to help patients make and sustain these changes. The support system of family and friends is vital in diabetes management. Encouragement and assistance from loved ones can help patients adhere to their treatment plans and maintain a positive outlook .

Diabetes education and self-management are essential components of diabetes care. They empower individuals with diabetes to understand their condition, make informed decisions about their health, and effectively manage their diabetes on a day-to-day basis. Education and self-management play a crucial role in preventing complications, improving quality of life, and achieving optimal health outcomes for people with diabetes. Understanding how diabetes affects the body, including insulin production, glucose metabolism, and the role of hormones like insulin and glucagon. Differentiating between type 1, type 2, gestational, and other forms of diabetes, including their causes, risk factors, and management strategies. Learning about the potential complications of diabetes, such as cardiovascular disease, neuropathy, retinopathy, and nephropathy, and how to prevent or manage them. Learning to use a blood glucose meter to monitor blood sugar levels regularly and understanding the target range for blood glucose levels. Understanding how factors such as food, physical activity, medications, and stress can affect blood sugar levels and how to interpret glucose monitoring results. Learning about the different types of diabetes medications, including insulin, oral medications, and injectables, and how they work to manage blood sugar levels. Understanding the importance of taking medications as prescribed and managing side effects or complications. Learning stress management techniques such as mindfulness, meditation, yoga, or relaxation exercises to cope with the emotional challenges of living with diabetes. Understanding the importance of regular check-ups with healthcare providers to monitor diabetes control, screen for complications, and adjust treatment plans as needed. 

Diabetes prevention and public health initiatives are critical in addressing the growing global burden of diabetes. By focusing on lifestyle modifications, community interventions, and policy changes, it is possible to reduce the incidence of type 2 diabetes and improve the overall health of populations. Implementing public health campaigns to raise awareness about diabetes risk factors, prevention strategies, and the importance of healthy lifestyles. Engaging with communities to provide education on healthy eating, physical activity, and weight management. Implementing health education programs in schools to promote healthy lifestyles and prevent childhood obesity, a risk factor for type 2 diabetes. Encouraging the adoption of a healthy diet rich in fruits, vegetables, whole grains, and lean proteins, while limiting sugary beverages and processed foods. Promoting regular physical activity, such as walking, cycling, or sports, to help maintain a healthy weight and improve insulin sensitivity. Identifying individuals at high risk of developing diabetes through screening tests, such as blood glucose tests or A1C tests.

Diabetes affects a diverse range of populations, each with unique challenges and considerations for management and treatment. Understanding these special populations is crucial for providing tailored care and improving outcomes. There are special populations where features, management and outcome may differ from the usual patient with diabetes. Data on management of DKA in such special populations such as chronic kidney disease and pregnancy are sparse and recommendations are based mainly on small case series and expert opinion. Clinicians need to recognize and manage euglycaemic DKA in patients prescribed sodium-glucose cotransporter inhibitors. DKA is particularly a major health concern due to high rates of hospital admissions and mortality in resource-limited settings due to financial constraints, limiting the adequate provision of insulin and access to health care systems, and dysfunctional health systems. We review the challenges of diagnosis and management of DKA in these specific groups and provide recommendations on optimal patient care. Predominantly seen in this group, requiring insulin therapy, frequent blood sugar monitoring, and education on lifestyle management. Increasingly prevalent due to rising obesity rates, necessitating early intervention and lifestyle modifications. 

Diabetic retinopathy is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). The condition can develop in anyone who has type 1 or type 2 diabetes and is a leading cause of blindness in adults. Chronic high blood sugar levels can cause damage to the blood vessels in the retina. The blood vessels may swell and leak, or abnormal new blood vessels may grow on the surface of the retina, leading to vision problems. Early stage where small areas of swelling occur in the retina's blood vessels. Many more blood vessels are blocked, depriving the retina of its blood supply, leading to the growth of new blood vessels. Advanced stage where new, abnormal blood vessels proliferate, which can lead to severe vision loss or blindness. Annual comprehensive eye exams can detect retinopathy early. Maintaining good control of blood sugar, blood pressure, and cholesterol levels can help prevent or delay the onset of diabetic retinopathy. Adopting a healthy diet, regular exercise, and avoiding smoking can contribute to overall eye health. Diabetic retinopathy is a serious complication of diabetes that can lead to vision loss if not detected and managed early. 

Physical activity guidelines provide recommendations on the amount and type of physical activity needed for health benefits. These guidelines are typically developed by health authorities or organizations and are based on scientific evidence. Here is an overview of general physical activity guidelines for adults Adults should aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, or a combination of both. Aerobic activities include brisk walking, jogging, cycling, swimming, or dancing. Adults should do muscle-strengthening activities on two or more days a week. These activities should work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms). Include flexibility and balance exercises in your routine, especially for older adults. These exercises can help improve balance, prevent falls, and maintain flexibility. Reduce sedentary time and break up long periods of sitting. Stand up, stretch, or walk around periodically, especially if you have been sitting for a long time.

Epidemiology and mechanisms refer to the study of the patterns, causes, and effects of health and disease conditions in defined populations. In the context of diabetic retinopathy (DR), which is a complication of diabetes affecting the eyes, epidemiology focuses on the prevalence, incidence, and risk factors associated with the condition. Understanding the epidemiology and mechanisms of DR is crucial for developing effective prevention and management strategies. DR is the most common microvascular complication of diabetes and a leading cause of vision loss in working-age adults. The prevalence of DR increases with the duration of diabetes, affecting approximately one-third of people with diabetes aged 40 years and older in the United States. DR is more common in individuals with type 1 diabetes, but it also affects a significant proportion of those with type 2 diabetes. Hyperglycemia: Chronic high blood sugar levels can damage the blood vessels in the retina, leading to DR. Oxidative stress: Increased production of reactive oxygen species (ROS) in response to high blood sugar levels can cause damage to retinal cells. Chronic low-grade inflammation is believed to play a role in the development and progression of DR. These are formed when sugar molecules attach to proteins in the blood vessels, contributing to damage. Epidemiological studies help identify populations at risk for DR, while understanding the underlying mechanisms provides insights into the development and progression of the disease. This knowledge is essential for developing targeted interventions and improving outcomes for individuals with diabetic retinopathy.

Diabetes and mental health are closely interconnected, as managing a chronic condition like diabetes can significantly impact a person's mental and emotional well-being. Conversely, mental health conditions can affect diabetes management and outcomes. Managing diabetes involves constant monitoring of blood sugar levels, dietary restrictions, and medication adherence, which can cause significant stress. Fear of complications, needle phobia, or worries about blood sugar fluctuations can lead to anxiety. People with diabetes are at a higher risk of developing depression due to the chronic nature of the disease and the lifestyle adjustments required. Mental health conditions like depression can reduce motivation and energy, making it difficult for individuals to adhere to their diabetes treatment plans. Anxiety and depression can lead to unhealthy lifestyle choices such as poor diet, lack of exercise, and substance abuse, which can worsen diabetes control. Stress and mental health issues can cause hormonal changes that affect blood sugar levels, leading to poorer glycemic control. Collaborative care models that involve both diabetes specialists and mental health professionals can provide comprehensive support. 

Dialysis and transplantation are critical medical treatments used to manage and treat end-stage renal disease (ESRD) and severe kidney failure. These therapies help maintain the patient's health by either replacing the function of the failed kidneys or by providing a new, functioning kidney. Dialysis is a medical procedure that replicates the kidney's essential functions, such as removing waste products and excess fluid from the blood. Blood is removed from the body, filtered through a dialyzer (an artificial kidney), and then returned to the body. This process removes waste products, extra chemicals, and fluid. Requires vascular access, usually through an arteriovenous (AV) fistula, AV graft, or a central venous catheter. Uses the lining of the abdomen (peritoneum) as the filter. A cleansing fluid (dialysate) is introduced into the abdominal cavity through a catheter, where it absorbs waste products and excess fluids from blood vessels in the peritoneum. The fluid is then drained and replaced. Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). Requires a sterile environment to prevent infections; less effective for some patients compared to hemodialysis. Kidney transplantation involves surgically placing a healthy kidney from a donor into a patient with ESRD. It is considered the most effective treatment for kidney failure. A kidney from a living person, often a family member or close friend. Offers better survival rates and longevity. Both treatments require lifestyle adjustments. Dialysis impacts daily schedules and requires diet and fluid restrictions.

Biomarkers and diagnostic tools are crucial in the early detection, diagnosis, monitoring, and management of various diseases. They provide valuable insights into the physiological and pathological processes occurring in the body, allowing for more precise and personalized medical care. Biomarkers are biological molecules found in blood, other body fluids, or tissues that are indicative of a normal or abnormal process, or of a condition or disease. They can be proteins, nucleic acids, lipids, metabolites, or other types of molecules. Detect Disease, Diagnose Disease, Predict Disease Progression, Monitor Treatment Response, Personalize Treatment. Diagnostic tools are technologies and methods used to detect and measure biomarkers. They include a wide range of techniques and instruments designed to provide accurate and reliable results. MRI (Magnetic Resonance Imaging), CT (Computed Tomography) Scans, Biomarkers and diagnostic tools play a vital role in modern medicine, enabling early detection, accurate diagnosis, effective monitoring, and personalized treatment of various diseases. Advances in technology and ongoing research continue to enhance their capabilities, paving the way for improved patient outcomes and more efficient healthcare systems.

Cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality worldwide. Prevention strategies are essential to reduce the incidence and impact of these diseases. Effective prevention requires a multifaceted approach, involving lifestyle modifications, medical interventions, and public health initiatives. Emphasize the consumption of fruits, vegetables, whole grains, lean proteins, and healthy fats (e.g., olive oil, nuts, and avocados). Reduce intake of saturated and trans fats, which are found in processed and fried foods, as well as red and processed meats. Excessive sodium can increase blood pressure. Aim for less than 2,300 mg per day, or even lower if recommended by a healthcare provider. If you drink alcohol, do so in moderation. This typically means up to one drink per day for women and up to two drinks per day for men. Engage in at least 150 minutes of moderate-intensity aerobic exercise (e.g., brisk walking) or 75 minutes of vigorous-intensity exercise (e.g., running) per week. Quit smoking and avoid secondhand smoke. Smoking cessation programs and medications can assist in quitting. 

Mobile health applications, often referred to as mHealth apps, have become an essential tool in modern healthcare, particularly for chronic conditions like diabetes. These apps offer a variety of functionalities that help patients manage their health more effectively, providing tools for monitoring, education, and communication with healthcare providers. Users can log their blood glucose levels manually or sync data from continuous glucose monitors (CGMs) and blood glucose meters. Many apps allow users to record their insulin doses and other medications, helping to ensure proper management and avoid missed doses. Many apps allow users to record their insulin doses and other medications, helping to ensure proper management and avoid missed doses. Apps can integrate with fitness trackers to monitor physical activity, providing insights into how exercise affects blood glucose levels. Apps often provide educational content on managing diabetes, including tips on diet, exercise, and medication adherence. Some apps offer healthy recipes and meal planning tools tailored to the dietary needs of individuals with diabetes. Apps analyse logged data to identify patterns and trends, helping users and their healthcare providers make informed decisions. Many apps allow for virtual consultations with healthcare providers, enabling remote monitoring and advice. Some apps offer forums or social features where users can connect with others managing similar health conditions, providing peer support. AI algorithms provide tailored advice on insulin dosing, diet, and lifestyle changes based on individual data. Machine learning models predict blood glucose fluctuations and potential complications.