In view of experimental and clinical findings, it was predicted (Dörner, 1973 and 1976; Dörner and Mohnike, 1973 and 1977) that a preventive therapy of diabetes mellitus may be possible by preventing hyperinsulinism in perinatal life by means of prevention of hyperglycaemia in pregnant women and overnutrition in newborns. Meanwhile, this prediction appears to have been realized. Thus, the prevalences of diabetes mellitus in children, who were born in Berlin/GDR over the past decade, were found to be significantly decreased as compared to those born between 1962 and 1972. On the other hand, the children born in Berlin/GDR between 1962 and 1972 displayed a significantly higher prevalence of diabetes mellitus as compared to those born between 1957 and 1961. The decreasing prevalence of childhood-onset diabetes over the past decade has been apparently achieved by systematic prevention of hyperglycaemia and impaired glucose tolerance in pregnant women and overnutrition in newborns. These findings suggest that a preventive therapy of diabetes mellitus--even of insulin-dependent childhood-onset diabetes--is possible by preventing hyperinsulinism in the foetus and newborn during differentiation and maturation of the neuroendocrine central nervous-pancreatic system.
1. Men who were born in war and post-war periods with shortage of food supply showed a markedly low prevalence of insulin-treated diabetes mellitus (ITDM), but not of non-insulin-treated diabetes mellitus (NITDM) in later life. 2. A significant increase (+ 54%) of ITDM prevalence was observed between 1976 and 1982 for subjects at 26-31 years of age, who were born in a post-war period (1945-50) with shortage and a peace period (1951-56) without shortage of food supply, respectively. By contrast, there was not found an increase --but even a slight decrease (-14%) -of ITDM prevalence between 1976 and 1982 for subjects at 38-43 years of age, who were born in a peace period (1933-38) without shortage and a war period with shortage of food supply, respectively. A similar clear dependence of diabetes prevalence on food supply in perinatal life could not be observed for NITDM. On the other hand, the prevalence of NITDM appeared to be significantly dependent -in contrast to ITDM -on food supply in adulthood.
In order to investigate the possible influence of pre- and/or early postnatal nutrition on the development of diabetes mellitus in later life, diabetes prevalences were ascertained in subjects of similar ages who were born in different periods with or without shortage of food supply. Between 1974 and 1982 the total prevalence of diabetes mellitus increased in Berlin/GDR by 26%. A significantly higher increase of diabetes prevalence (approximately 90%) was found between 1974 and 1982 for subjects at 26-33 years of age, whose years of birth changed from a "hypocaloric war and post-war period (1941-1948)" to a "relatively hypercaloric peace period (1949-1956)". By contrast, there was not found any significant increase of diabetes prevalence between 1974 and 1982 for subjects at 34-41 years of age, whose years of birth changed from a "relatively hypercaloric period (1933-1940)" to a "hypocaloric period (1941-1948)". These findings give further evidence for the dependence of diabetes prevalence in later life on nutrition in perinatal life.
The proportion of secondarily insulin-dependent diabetics among all insulin-dependent diabetics and the incidence of secondary failures among all those receiving sulphonylurea preparations was determined for a defined region of Berlin (DDR). Among all diabetics receiving insulin, 40% were type I diabetics on primary insulin treatment. But the remaining 60% were secondary failures who had been on diet alone or in combination with oral antidiabetics. Among 3071 diabetics on glibenclamide secondary failures occurred in 5% per year. The ratio of primary to secondary insulin-receiving diabetics, between 1:5 and 1:6, defined the number of new insulin-dependent patients per year. The findings indicate that insulin-receiving diabetics constitute an epidemiologically heterogeneous patient group.
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