There are indications that the effect of environmental factors on the risk of type 1 diabetes mellitus (T1DM) is increasing over time. This can be documented by the rapid increase of T1DM incidence in genetically stable populations. Our aim was to study an association of T1DM with the variable factors of the perinatal period and of early infancy, using data from children born over a period of changing exposure to some of the studied factors. A case-control dataset was analysed, consisting of 868 diabetic children and 1,466 anonymous controls, mostly schoolmates of the children with T1DM. The data were collected using structured questionnaires completed by parents. After performing univariate analyses, the associations were analysed using multiple logistic regression adjusted for potential confounders, including the year of birth. The risk of T1DM decreased with increasing duration of breast-feeding, while no breast-feeding was associated with an increased T1DM risk, OR=1.93 [95% CI: 1.33-2.80], breast-feeding for more than 12 months was protective, OR=0.42 [95% CI: 0.22-0.81], both being relative to the reference category of breast-feeding for 1-3 months. A short duration of day-care attendance (none or less than 1 year) was weakly associated with the risk of T1DM, OR=1.65 [95% CI: 1.05-2.62]. No association was detected between T1DM and signs of prenatal infections, perinatal stress factors, birth size and weight, indicators of crowding or the presence of a domestic pet in the household. Short breast-feeding period and short attendance to day care is associated with the risk of T1DM in Czech children.

No abstract

The 3.8% frequency of coeliac disease found in siblings of diabetic children is close to the 4.3% found previously in Czech children with type 1 diabetes mellitus and is substantially higher than the rate in the healthy children population.

Six models of a new type of insulin pen (MADI) were developed comprising models for insulin U‐40, U‐80 and U‐100 with a single dose of either one or two units of insulin in each of them1−4. Every model may be easily adapted to be used either as a ‘needle pen’ or a ‘catheter pen’. In the needle pen, a sliding cover prevents the contamination of the needle. A syringe‐like interchangeable plastic reservoir (3ml) is filled (and can be refilled up to 100 times) by the patient from the insulin vials, with any kind of soluble insulin. Actual insulin administration occurs by twisting the cap. A clinical trial with 365 adult patients and 46 children (1991‐93) showed good patient satisfaction in 95%. There were 17 MADI pen failures requiring technical assistance in the 12 months of the clinical trial. The preference for a catheter pen was assessed separately in a group of 35 carefully‐trained patients. There was a marginal preference for the needle pen (54% of the patient days) compared with the catheter pen (46% of the patient days). In 345 patients without special training, the catheter pen was only preferred by one patient (0.3%). MADI pen may be recommended as an insulin delivery device of choice. In particular, patients on any form of animal insulin and/or U‐40 and/or U‐80 insulin may benefit from this pen.