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Ein Schwangerschaftsdiabetes erhoht das Risiko, spater im Leben an einem Typ-2-Diabetes zu erkranken. Jede zweite Frau mit Gestationsdiabetes mellitus (GDM) entwickelt innerhalb von 10 Jahren nach der Entbindung einen Typ-2-Diabetes, obwohl sich ihr Blutzuckerspiegel nach der Schwangerschaft zunachst wieder normalisiert. Zahlreiche Risikofaktoren, wie z. B. Insulintherapie wahrend der Schwangerschaft und Adipositas in der fruhen Schwangerschaft, werden mit der Entwicklung eines Typ-2-Diabetes postpartum in Verbindung gebracht. Wissenschaftler vom Institut fur Diabetesforschung, Helmholtz Zentrum Munchen, haben nun einen Risiko-Score entwickelt, der eine gute Abschatzung des Typ-2-Diabetes Risikos postpartum anhand weniger, leicht erfassbarer klinischer Variablen ermoglicht. Eine Risikoabschatzung ist essenziell fur die adaquate Planung von Kontrolluntersuchungen beim betreuenden Arzt.

The incidence of type 1 diabetes is increasing rapidly. Detecting the mechanisms underlying the autoimmune disease is a main goal of research. Studies investigating the pathogenesis of type 1 diabetes are working on the identification and characterization of exogenous, endogenous and genetic factors which induce or modify autoimmunity. Islet cell autoimmunity can be detected through screening for islet cell autoantibodies. This quantitative analysis allows the stratification of the individual risk for the development of type 1 diabetes. Prospective observational studies are most suitable to assess persons at risk, either because of the occurrence of type 1 diabetes in the family or because of a genotype associated with increased risk. Age-related factors which are analysed in observational studies include nutrition, increase in height and weight, childhood diseases and vaccinations as well as psychosocial aspects. Identification and characterization of these risk factors will serve as a basis for working on new approaches to prevent or to cure type 1 diabetes. Aim of this article is to provide an overview of the most relevant observational studies.

Immunomodulatory strategies in the management of type 1 diabetes mellitus (T1DM) have as their primary target the prevention of initiating islet autoimmunity (primary-), the secondary one is the progression to diabetes (secondary-) in non-diabetic persons at risk, and the decline of beta-cell function in new-onset patients (tertiary-prevention). This article reviews four recent immunointervention trials in patients with T1DM. (1) The Pre-POINT study is a primary prevention trial that will test whether vaccination with oral or nasal insulin can prevent the progression of islet autoimmunity and of T1DM in autoantibody-negative children who are genetically at high diabetes risk. (2) The Cord Blood study is a tertiary immunointervention trial that will test whether administration of autologous umbilical cord blood to children with T1DM can lead to regeneration of pancreatic islet insulin-producing beta-cells and improved blood glucose control. (3) The GAD Vaccination study will test whether vaccination with alum-formulated rhGAD65 (recombinant human glutamic acid decarboxylate) can preserve beta-cell function in 320 children with newly diagnosed T1DM, as has been suggested in a recent phase II study. (4) The AIDA study will test the beta-cell protective effect of interleukin-1-receptor antagonist Anakinra in 80 patients with T1DM, which has recently been shown to improve beta-cell function in patients with type 2 diabetes.

Infant diet affects health and development. The aim of our study was to investigate WHO infant feeding compliance in children who have a first degree family history of type 1 diabetes (T1D). One hundred and fifty children who were first degree relatives of patients with T1D were intensively followed from birth in the BABYDIET intervention study. Infant feeding, infections, and medication were recorded daily by participating families. Weight and length of children were obtained from paediatric records. Only 5% of the families followed the WHO recommendations for infant feeding that include full breastfeeding for at least 6 months (18.8% of children) and introduction of complementary foods under continued breastfeeding thereafter (22.2% of children). Maternal age in the first quartile (29 years; p0.0001), and maternal smoking (p0.0001) were associated with an earlier introduction of solid food and reduced breastfeeding. Full breastfeedingor =6 months was associated with reduced frequency of gastrointestinal infections (12 vs. 38%, p=0.02) and antibiotic treatment (24 vs. 48%, p=0.04). Our findings indicate that WHO infant feeding recommendations were poorly followed by families with a family history of T1D. Action to improve levels of infant feeding behaviour is essential, especially among young mothers with T1D.

Clinical and experimental studies have delineated a link between dietary cow milk protein and the development of insulin-dependent diabetes mellitus (IDDM), and bovine serum albumin (BSA) was proposed as one candidate mediator of this effect. The demonstration of anti-BSA antibodies in new onset type 1-diabetic children from Finland initiated a controversial debate on the utility of BSA antibodies as a disease marker and on the role of BSA in IDDM. Here we analyzed BSA antibodies in newly diagnosed type 1-diabetic patients and their first degree relatives, patients with other autoimmune diseases, and children with Down's syndrome from Germany. Blinded serum samples (n = 308) were screened for IgG anti-BSA antibodies by particle concentration fluoroimmunoassay (PCFIA). The prevalence of elevated BSA antibodies in newly diagnosed type 1-diabetic patients was low (11%), although mean BSA antibody levels were significantly increased in diabetic patients as compared to controls (1.94 +/- 1.51 vs. 0.97 +/- 0.93 kFU, p < 0.0007). Mean BSA antibody levels were also increased in ICA+ and/or IAA+ first degree relatives (1.32 +/- 0.43, p < 0.002) and in children with Down's syndrome (3.01 +/- 1.93, p < 0.0007), but not in the other autoimmune disorders tested. The low prevalence of elevated anti-BSA levels in IDDM patients limits the clinical usefulness of this immune marker. We conclude that current anti-BSA assays do not substantially contribute to the prediction and diagnosis of IDDM.

Mucosal administration of autoantigen, if efficacious, is an attractive therapeutic approach for prevention of type 1 diabetes. It can prevent or delay autoimmune diabetes in animal models, but although shown to be safe has not yet been proven effective in human studies. Efficacy may depend upon the dose and route at which antigen is administered, the stage in type 1 diabetes pathogenesis at which treatment is initiated, and the study cohort that is treated. Here we address these issues and propose a clinical translation possibility for mucosal insulin administration in genetically at risk individuals.

Insulin autoantibody (IAA) and islet cell antibody (ICA) titres were measured in 108 newly diagnosed type I diabetics (49 male, 59 female, mean age 20 [1-38] years) and 103 non-diabetic controls (41 male, 62 female, mean age 23 [16-46] years). IAA titres in the controls were normally distributed, with a mean of 5 +/- 11 nU/ml. The upper limit of normal was established as 49 nU/ml (mean + 4 standard deviations). Raised IAA and ICA titres were present in 45% and 44% of type I diabetics, respectively, with 59% positive for either IAA or ICA or both. IAA were markedly age-dependent, being positive in 70% (26 out of 37) of diabetics under the age of 15 years, and in 32% (23 out of 71) at the age of 15 years or more (P = 0.0004). There was a less marked difference for ICA titres (positive in 62% of patients less than 15 years, and in 35% of those of 15 years of older; P less than 0.01). IAA were significantly more common in HLA DR4 positive patients than in HLA DR4 negative patients (56% vs 11%; Pc less than 0.00015). With regard to age a significant association between IAA and HLA DR phenotype was present only in homozygous (Pc less than 0.03) and heterozygous (P less than 0.0003) patients aged 15 years or older. By contrast, ICA was not significantly correlated with HLA phenotype. These data suggest a genetic predisposition for the development of IAA.

BACKGROUND AND OBJECTIVE: Children born to mothers with gestational diabetes are at an increased risk of developing obesity. Breastfeeding is acknowledged as beneficial for child development and it is suggested that breastfeeding protects against becoming obese. The aim of this study was to document breastfeeding habits of women with gestational diabetes and to identify factors that affect breastfeeding habits. METHODS: Breastfeeding habits (breastfeeding of any duration) were recorded of 257 mothers with gestational diabetes (mean age 31.4 +/- 4.8 years) who participated in a prospective post-partum study between 1989 and 1999 and compared to breastfeeding habits of 527 healthy mothers (mean age 30.3 +/- 4.2 years), all enrolled in the prospective BABYDIAB study between the years 1989 and 2000. Breastfeeding data were prospectively obtained by questionnaire and interview. RESULTS: Compared to children of healthy mothers, fewer children of mothers with gestational diabetes were breastfed (75% vs 86%; P 30 kg/m2 breastfed (65% vs 80%; p=0.01) and for a shorter duration than women with a BMI

BACKGROUND AND OBJECTIVE: Breastfeeding is considered to be a protective factor against obesity in healthy children. But previous studies about the effect of breastfeeding in the offspring of diabetic mothers have provided inconsistent results. It was the aim of this study to assess the effect of breastfeeding on the risk of becoming overweight at two years of age in children of these mothers. METHODS: In a prospective cohort study data on exclusive or partial breastfeeding habits, were obtained from questionnaires given to 816 mothers, aged between 17 and 43 years, with type 1 diabetes. Weight and height of their children was obtained from their pediatric records. Children with a BMI> or = 90th percentile were classified as being overweight. RESULTS: 77.9 % of all mothers started breastfeeding after the child's birth. Six months later 33.1 % were still breast-feeding. 14.5 % of all children were overweight at two years of age. After adjusting for smoking in pregnancy and the child's gender and birth weight, there was a risk reduction for overweight of 60 % (OR=0.405; 95%-CI: 0.211-0.779) for breastfeeding duration of 12 to 25 weeks. A similar positive association was found for predominant breastfeeding for a duration of at least four months (OR=0.500; 95%-CI: 0.282-0.887). Protective effects were already present when the duration of breastfeeding was four weeks or more. CONCLUSIONS: Mothers with type 1 diabetes breastfed less and for a shorter duration than those in the general population. Breastfeeding duration of at least four weeks was associated with a reduced risk for overweight at two years of age. Special needs regarding diabetes management have to be taken into account.

Fragestellung: Die Krankheit Diabetes stellt fur viele Patienten eine besondere Belastung dar und fuhrt zu verandertem Verhalten und Bewaltigen von Alltagssituationen. Wir untersuchten soziale Verhaltensweisen von Muttern und Vatern mit und ohne Typ 1 Diabetes (T1D) wahrend der Schwangerschaft und wahrend der ersten Lebensjahre ihres Kindes im Rahmen einer prospektiven Studie. Methodik: Untersucht wurden Rauchverhalten, Berufstatigkeit der Eltern und Art und Dauer der Kinderbetreuung innerhalb der ersten drei Lebensjahre mittels Fragebogen bei Entbindung und im Alter von 9 Monaten, 2 und 5 Jahren. Befragt wurden 2498 Elternpaare, davon 1439 Mutter mit und 1059 ohne Diabetes, die in den Jahren 1989 bis 2005 ein Kind bekommen hatten. Ergebnisse: Durchschnittlich rauchten 10,7% der Mutter und 31,5% der Vater wahrend der Schwangerschaft, wobei die Raucher von 1989 bis 2005 abnahmen (Mutter: 13,2 vs. 8,9%, p=0,07 / Vater: 32,4 vs. 24,7%, p

In a normotensive 67 year old female patient, transient ischemic attacks occurred in the context of a primary hyperparathyroidism, probably owing to calcium-induced cerebrovascular spasms. Since nimodipine therapy brought about freedom from attacks, prophylactic therapy with calcium antagonists in primary hyperparathyroidism should be considered preoperatively.