Abstract Background To benefit from real-time continuous glucose monitoring (rtCGM), users need practical skills and in-depth knowledge to analyze the glucose data appropriately and adapt insulin therapy accordingly. To assess the user’s knowledge about rtCGM, a psychometric knowledge test was developed and evaluated. Method Experts on the use of rtCGM systems defined central knowledge contents in a Delphi process and developed a knowledge test comprising 40 multiple-choice items. For test-statistical review, people with insulin-treated diabetes and members of diabetes teams answered the knowledge test. Results The 122 diabetes team members (age 46 (11) years; mean (SD)) and the 111 people with insulin-treated diabetes (age 42 (14) years, diabetes duration 20 (14) years, users of insulin pumps 64 %, previous usage of rtCGM 38 %, HbA1c 8.0 % [95 % CI 7.7–8.3] (64 mmol/mol [60–67]) had different levels of experiences using rtCGM systems. The internal consistency (Cronbach’s alpha) of the knowledge test was 0.92 for the whole sample, for people with diabetes 0.94, and for diabetes team members 0.84. Item difficulty ranged between 0.12 and 0.88 in people with diabetes and between 0.27 and 0.97 among diabetes team members. On average, people with diabetes answered 24.1 (9.9) items correctly, diabetes team members 29.2 (5.2) (p < 0.001); people with diabetes and previous rtCGM-experience had a higher knowledge compared to people without previous experience (29.2 (6.2) vs. 21.0 (10.4) (p = 0.001)). The quality of glucose control (measured by HbA1c) of the people with diabetes was significantly associated with the sum-score of the questionnaire (rho = –0.48, p < 0.001). Conclusion The “rtCGM-Profi-Check” knowledge test provides high internal consistency, high selectivity, and content validity. It is suitable for objective, reliable, and valid assessment of the indispensable knowledge of people with diabetes to use different rtCGM systems successfully. The questionnaire is manufacturer-independent and is suitable to evaluate the needs and success of rtCGM education among persons with diabetes.

AbstractSuccessful diabetes treatment requires a high degree of therapy-related competence and everyday coping from the patients. The necessary knowledge and skills are developed in diabetes education programs together with the diabetes health care team. This article presents history, structural components and methodological-didactic aspects, gives an up-to-date overview of existing programs in Germany and an outlook on future diabetes education in view of technological progress.

AbstractDepressive disorders are highly prevalent in patients with diabetes. While depressive disorders themselves require therapy, they also contribute negatively to diabetes-related medical, social and psychological outcomes, and therefore need to be addressed. Disease burden is very high for both diabetes and depression, even more so in case of comorbidity. Comorbid depressive symptoms in patients with diabetes are associated with a reduced quality of life and adherence to treatment regimes, impaired coping abilities, as well as increased morbidity and mortality rates, diabetes-related distress, and economic burden.The interactions between diabetes and depression are bidirectional. Both diseases appear to have a variety of shared bio-psychosocial, as well as biological risk factors. Recent research implies that the interaction between diabetes and depression cannot be understood as a simple cause-effect relationship but might rather be explained by being part of a disturbed homeostasis of biological and psychological circuits.Regular depression screenings should be applied to identify depressive symptoms in patients with diabetes. To verify positive screening results, treating physicians have a key role in targeting depression by actively asking patients for depressive symptoms within the last 14 days. If symptoms are present, further diagnostics, and the exploration of psychosocial problems are necessary. In case of a depressive disorder, varieties of effective antidepressant treatments (psychotherapy, psychopharmacological medications) are available. Physical activation and diabetes education programs can be offered additionally. The current paper offers insights on epidemiology, symptoms, interactions, diagnostics, treatments as well as the relationship between physician and patient.

AbstractThe frequency of diabetic retinopathy increases and is a leading cause of blindness in the working population. Recommended exams are testing of the visual acuity, ophthalmoscopy with dilated pupils, fundus fluorescein angiography and optical coherence tomography (OCT). By OCT the diagnosis and monitoring of diabetic macular edema has vastly improved. By intravitreal medications such as intravitreal anti-VEGF or intravitreal steroids macular edema can be treated successfully. Panretinal laser photocoagulation is the gold-standard in the therapy of proliferative diabetic retinopathy. Patients benefit from good co-working of general practitioner and ophthalmologist concerning screening and treatment.

AbstractPolycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women of childbearing age. Due to hyperandrogenism and chronic anovulation affected women may suffer from hirsutism, androgenetic alopecia, acne, menstrual disturbance and sub-/infertility. Furthermore underlying insulin resistance promotes hyperandrogenemia, overweight and risk for diabetes. Therefore, routine evaluation of glycemic status is recommended. Treatment strategies are based on therapeutic lifestyle changes and focus on patient-important complaints. First line pharmacologic treatment for infertility in women with PCOS is letrozole. Clomiphene and metformin can be used alternatively with lower success rates. Women seeking medical advice for hyperandrogenism can be offered oral contraceptive pills with the lowest effective estrogen dose without any preference of a certain gestagen. Risk for deep vein thrombosis should be taken into account when choosing estrogen dose and type of gestagen. Antiandrogen substances such as spironolactone should only be prescribed in combination with safe contraception due to their risk of fetal undervirilisation. Additionally, substance specific risks should be considered. Baseline treatment of overweight or metabolic issues includes behaviour modification, weight reduction and physical activity. Additional benefit can be reached by combination of lifestyle changes with metformin. Studies indicate a positive effect of inositol and antidiabetic substances like liraglutide and empagliflozin but should be regarded as experimental therapies.

AbstractDiabetes in old age is one of the most common chronical diseases by a prevalence of up to 25 % of the 70-year and older patients. Elderly with diabetes often suffer from functional or cognitive deficits that must be realized for therapeutic issues. These would include special geriatric syndromes like frailty, falls, immobility or higher vulnerability for drug interactions. Therefore the German Diabetes Association recommends to adjust therapeutic goals not only to patients’ goals but also to their individual functional status. Simple therapy regimens should be preferred to avoid polypharmacia and to preserve the patients’ independence as long as possible.

AbstractBreathlessness or dyspnea is a frequent symptom in patients with diabetes and the first disease which has to be excluded is the coronary heart disease. However, previous epidemiological studies have shown that patients with diabetes mellitus have an increased risk for fibrotic pulmonary diseases, such as the idiopathic pulmonary fibrosis (IPF). Recent studies were able to show that patients with newly diagnosed type 2 diabetes have impaired pulmonary oxygen consumption and over 26 % of patients with long-term type 2 diabetes showed restrictive lung function with fibrotic interstitial lung diseases. Especially patients with type 2 diabetes and nephropathy had an 8-fold higher risk for lung diseases. This is not surprising since the pathomechanisms of pulmonary fibrosis and diabetic complications have much in common: reactive oxygen species induce DNA-damage with consecutive activation of inflammatory cytokines which induce fibrotic remodeling of the tissue. This leads us to the suggestion that patients with diabetes, albuminuria and breathlessness should be examined for interstitial lung disease on regular basis. However, data regarding the natural course of diabetic pneumopathy and therapeutic approaches are still missing. Small intervention studies with IPF-patients could show that sports and physical activity were able to stabilize the disease progression.

AbstractThe article provides an overview on Shared Decision Making (SDM), which is considered as the ideal form of physician-patient-interaction by many stakeholders of the health care system. SDM is distinguished from other models of physician-patient-interaction such as the paternalistic model and the information model. Besides the degree of acceptance of SDM in the general population and among physicians, barriers for its implementation will be reported. Indications for SDM as well as strategies and support material for its use in individual consultations will be discussed and illustrated by an oncological case study. Effects of SDM for patients as well as for clinicians will be highlighted. After background information on origins of SDM, its significance with regard to health policy in Germany is discussed.

AbstractDiabetes mellitus is a very important comorbidity in patients with heart failure, as the common presence of both diseases significantly worsens the prognosis of patients. In order to improve the outcome of these patients, it is essential to diagnose both diseases at an early stage and to treat them in accordance with guidelines. In particular, a differentiated medication plays a crucial role. The therapy of heart failure does not differ in patients with diabetes and patients without diabetes. In the treatment of diabetes mellitus, however, it is very important to choose substances that have a positive effect on the cardiovascular outcome of patients. First-line treatment of diabetes in patients with cardiovascular diseases should be metformin, followed by a SGLT-2 inhibitor or GLP-1 receptor agonist with proven cardiac benefit. A rigorous adjustment of risk factors according to current guidelines reduces cardiovascular mortality and hospitalization rates. Glitazones and saxagliptin are associated with increased hospitalization rates and should be avoided in heart failure.

Bei Diabetes mellitus sind auch im hohen Lebensalter eine moderate korperliche Bewegung (soweit diese funktionell moglich ist) und eine Ernahrung mit ausgewogener Mischkost zur Optimierung der Stoffwechseleinstellung vorteilhaft. Der anzustrebende Body-Mass-Index liegt bei uber 65-Jahrigen zwischen 24 und 29 kg/m2, denn Gewichtsverlust geht bei alteren Menschen mit und ohne Diabetes mit einer erhohten Sterblichkeit einher. Ist eine Insulineinstellung indiziert, mussen psychologische Barrieren der Insulintherapie alterer Menschen berucksichtigt werden, wie z. B. die Injektionsangst oder die Furcht vor Stigmatisierung durch die Insulintherapie. Geriatrietypische Begleiterkrankungen wie z. B. kognitive Storungen und Depressionen sind haufige Komorbiditaten neben dem Diabetes und mussen entsprechend behandelt werden. Dabei ist die Einbeziehung von Angehorigen und/oder Pflegekraften meist vorteilhaft. Auch Besonderheiten bei kardiovaskularen und zerebralen Akutereignissen im hoheren Lebensalter werden im vorliegenden Beitrag dargestellt.