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<p>In this article, advances in the treatment of diabetes are presented. The prevalence of diabetes is increasing significantly worldwide, with obesity remaining the number one risk factor. The benefits of type&#xa0;2 diabetes remission are evident even when remission is only temporary rather than sustained. Early and effective diabetes management as well as dietary and lifestyle interventions initiated at the stage of impaired glucose tolerance can delay or prevent microvascular and, in the long term, macrovascular complications. In other words, each year without diabetes has a positive impact on the patient’s health. In this context, it should be noted that, contrary to earlier assumptions, sugar substitutes are not without cardiovascular risk. The new European Society of Cardiology (ESC) guideline on chronic coronary syndrome (CCS, stable coronary artery disease) introduces a new diagnostic algorithm in which invasive coronary assessment has lost significance. Performing oral glucose tolerance tests in older individuals with prediabetes is not justified; in those over 75 years of age, the burden of hyperglycemia can be adequately assessed using the HbA<sub>1c</sub> (glycohemoglobin) value. With regard to the treatment of diabetes and its comorbidities, the following are important: tirzepatide is effective in resolving metabolic dysfunction-associated steatohepatitis (MASH) with moderate or severe fibrosis of the liver. Sodium–glucose cotransporter&#xa0;2 inhibitors (SGLT-2) inhibitors are also beneficial for patients with severe chronic kidney disease. In individuals with diabetes mellitus and CCS, both a glucagon-like peptide‑1 receptor agonist (GLP‑1 RA) and an SGLT‑2 inhibitor are recommended, while in those with CCS without diabetes but with obesity, semaglutide is recommended to reduce cardiovascular events. Dapagliflozin improves heart failure and frailty in type&#xa0;2 diabetes. Depression and psychological factors must be considered in the treatment concept. GLP‑1 RA reduce substance use disorders and may potentially be indicated for addictive or impulsive psychiatric disorders. The potent statins rosuvastatin or atorvastatin should ideally be used as first-line agents and combined early with ezetimibe, as this approach lowers low-density lipoprotein cholesterol more rapidly and effectively.</p>

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Diabetes Update 2025 – viel Neues

  • 期刊论文

  • 发表日期：

    2025年7月14日

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  • Werner Alfons Scherbaum

摘要

In this article, advances in the treatment of diabetes are presented. The prevalence of diabetes is increasing significantly worldwide, with obesity remaining the number one risk factor. The benefits of type 2 diabetes remission are evident even when remission is only temporary rather than sustained. Early and effective diabetes management as well as dietary and lifestyle interventions initiated at the stage of impaired glucose tolerance can delay or prevent microvascular and, in the long term, macrovascular complications. In other words, each year without diabetes has a positive impact on the patient’s health. In this context, it should be noted that, contrary to earlier assumptions, sugar substitutes are not without cardiovascular risk. The new European Society of Cardiology (ESC) guideline on chronic coronary syndrome (CCS, stable coronary artery disease) introduces a new diagnostic algorithm in which invasive coronary assessment has lost significance. Performing oral glucose tolerance tests in older individuals with prediabetes is not justified; in those over 75 years of age, the burden of hyperglycemia can be adequately assessed using the HbA1c (glycohemoglobin) value. With regard to the treatment of diabetes and its comorbidities, the following are important: tirzepatide is effective in resolving metabolic dysfunction-associated steatohepatitis (MASH) with moderate or severe fibrosis of the liver. Sodium–glucose cotransporter 2 inhibitors (SGLT-2) inhibitors are also beneficial for patients with severe chronic kidney disease. In individuals with diabetes mellitus and CCS, both a glucagon-like peptide‑1 receptor agonist (GLP‑1 RA) and an SGLT‑2 inhibitor are recommended, while in those with CCS without diabetes but with obesity, semaglutide is recommended to reduce cardiovascular events. Dapagliflozin improves heart failure and frailty in type 2 diabetes. Depression and psychological factors must be considered in the treatment concept. GLP‑1 RA reduce substance use disorders and may potentially be indicated for addictive or impulsive psychiatric disorders. The potent statins rosuvastatin or atorvastatin should ideally be used as first-line agents and combined early with ezetimibe, as this approach lowers low-density lipoprotein cholesterol more rapidly and effectively.