This is the third set of Guidelines produced by the ESC in collabora- tion with the EASD, designed to provide guidance on the manage- ment and prevention of cardiovascular (CV) disease (CVD) in subjects with, and at risk of developing, diabetes mellitus (DM). The last Guidelines on this subject were published in the European Heart Journal in 2013. The interval between preparing the previous

. Guidelines and the current document has been relatively short, but it . has been a period in which we have seen an unprecedented increase . in the evidence base available for practicing healthcare professionals . to refer to in their daily consultations. This has been characterized by . the presentation and publication of a number of CV safety trials for . type 2 DM (T2DM) treatments, the results of which, to the casual . observer, must seem both exciting and bewildering. Exciting, because . while all the recent studies have reported CV safety, several have . also reported, for the first time, clear evidence of CV benefit. . Bewildering, because these trials continue to be dogged by various . side effects that dull the clarity of decision-making. It is one of our . aims to guide the reader through this important data set.

. In other ways, and on a global scale, little has changed. The preva- . lence of DM worldwide continues to increase, rising to 10% of the . population in countries such as China and India, which are now . embracing western lifestyles. In 2017, ?60 million adult Europeans . were thought to have T2DM—half undiagnosed—and the effects of . this condition on the CV health of the individual and their offspring . create further public health challenges that agencies are attempting . to address globally.

. These massive numbers led to the prediction that >600 million . individuals would develop T2DM worldwide by 2045, with around . the same number developing pre-DM.1 These figures pose serious . questions to developing economies, where the very individuals who . support economic growth are those most likely to develop T2DM . and to die of premature CVD. Awareness of specific issues associated . with age at onset, sex, and race—particularly the effects of T2DM in . women (including epigenetics and in utero influences on non- . communicable diseases)—remains of major importance, although . there is still much work to be done. Finally, the effects of advancing . age and comorbidities indicate the need to manage risk in an individu- . alized manner, empowering the patient to take a major role in the . management of his or her condition.

. The emphasis in these Guidelines is to provide information on the . current state of the art in how to prevent and manage the effects of . DM on the heart and vasculature. Our aim has been to focus mostly . on the new information made available over the past 5?6 years, and . to develop a shorter, concise document to this end. The need for . more detailed analysis of specific issues discussed in the present . Guidelines may be met by referring to the plethora of specialist . Guidelines from organizations such as the ESC and the American . Diabetes Association (ADA).

. It has been a privilege for us to have been trusted with the oppor- . tunity to guide the development of these Guidelines and to work . alongside acknowledged experts in this field. We want to extend our . thanks to all members of the Task Force who gave freely of their time . and expertise, to the referees who contributed a great deal to the . final manuscript, and to the ESC and EASD committees that oversaw . this project. Finally, we express our thanks to the Guidelines team at . the European Heart House, in particular Veronica Dean, Nathalie . Cameron, Catherine Despres, and Laetitia Flouret for their support . in making this process run smoothly.