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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.

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.

Men who were born in war and post-war periods with shortage of food supply (1943-47) showed a markedly low prevalence of insulin-treated diabetes mellitus (ITDM), but not of non-insulin-treated diabetes mellitus (NITDM) in later life. 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 (1939-44) 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.

Among 163 insulin-dependent (type I) diabetics (average age 43.5 years; average duration of diabetes 17.5 years), 40 (24.5%) died within ten years from the consequences of micro- and (or) macro-angiopathies. The death-rate among hypertensives was twice that among normotensives: 21 of 53 patients (39.6%) with blood pressures above 160/95 mmHg, but 19 of 110 patients (17.3%) with normal pressures. Proliferative retinopathy at the onset of the study was also a predictive marker of a poor prognosis. The death-rate increased threefold for patients with retinopathy if they also had hypertension: 13 of 30 (43.3%) with background retinopathy and hypertension died, compared with 9 of 68 without hypertension (13.2%; P less than 0.01). Independently of hypertension the death-rate for patients with persistent proteinuria (greater than 0.5 g/24 h) was about threefold that among those without it. The highest death-rate (56.7%) was among the 30 patients with proteinuria and hypertension. Stepwise linear regression analysis demonstrated that the correlation between death from micro- and macro-vascular disease and the known risk factors was entirely determined by blood pressure and proteinuria.

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.

At present in Germany, data on the prevalence of diabetes can only be obtained by modelling health insurance data. The National Diabetes Register of the former (East) German Democratic Republic which, between 1960 and 1990, monitored approximately 98% of all diabetic subjects, provides a tool for evaluating epidemiological estimates from other data sources. Therefore, the following data bases were compared for the year 1988: (1) a 5% random-sample (n = 6478) of all subjects insured at a local statutory health insurance company in the city of Dormund; (2) related data from the population-based diabetes register of former East-Berlin and (3) of the former German Democratic Republic. All data were standardized by sex and age according to the 1988 population statistics of the Federal Republic of (West) Germany thus resulting in the apparent diabetes prevalence of the Western part of Germany at that time.total prevalence rates were (1) 4.8%, (2) 4.9%, and (3) 4.4% (p0.05). The percentages of insulin-treated patients were (1) 18%, (2) 19%, and (3) 16%, respectively. 54% (1), 37% (p0.05) (2), and 42% (p0.05) (3), of the patients received oral antidiabetic drugs. It is concluded that the three samples are comparable and that the diabetes prevalence rates as estimated from health insurance data and from the two population-based registers give corresponding conclusions. Sample-based health insurance data may provide a useful and reliable tool for epidemiological studies on diabetes mellitus.

In the Centre of Diabetes and Metabolic Disorders of Berlin, G.D.R., a computer-aided care system has been used since 1974, aiming at relieving physicians and medical staff from routine tasks and rendering possible epidemiological research on an unselected diabetes population of a defined area. The basis of the system is the data bank on diabetics (DB), where at present data from approximately 55,000 patients are stored. DB is used as a diabetes register of Berlin. On the basis of standardised criteria of diagnosis and therapy of diabetes mellitus in our dispensary care system, DB facilitates representative epidemiological analyses of the diabetic population, e.g. prevalence, incidence, duration of diabetes, and modes of treatment. The availability of general data on the population or the selection of specified groups of patients serves the management of the care system. Also, it supports the computer-aided recall of type II diabetics, treated either with diet alone or with diet and oral drugs. In this way, the standardised evaluation of treatment strategies in large populations of diabetics is possible on the basis of uniform metabolic criteria (blood glucose plus urinary glucose). The system consists of a main computer in the data processing unit and of personal computers in the diabetes centre which can be used either individually or as terminals to the main computer. During 14 years of experience, the computer-aided out-patient care of type II diabetics has proved efficient in a big-city area with a large population.

In 20 diabetic inpatients with type IIb, III, IV and V hyperlipoproteinemia (HPL) the triglyceride fatty acid pattern (TFAP) of serum, adipose tissue and liver biopsy specimens before and after one year of clofibrate treatment has been determined by gas-liquid chromatography. Compared to previous results which revealed a correlation between fat droplet size and the TFAP in liver parenchyma cells, remarkable changes were observed after long-term therapy. In adipose tissue, only linoleic acid increased significantly from 8.6 to 11.3%. In serum, myristic and palmitic acid decreased, whereas linoleic, eicosatetraenoic (arachidonic) and eicosapentaenoic acid rose significantly. In liver fat, palmitic acid decreased, whereas linoleic, eicosatrienoic, arachidonic and eicosapentaenoic acid significantly increased. After clofibrate therapy, the TFAP in diabetic subjects with HLP became similar to that of diabetics without HLP. The most pronounced changes were found in the liver, serum having an intermediate position between liver and adipose tissue. The pathophysiological relevance in view of possible relations to prostaglandins has been discussed.

From 1956 to 1970, 15,638 diabetics died in East Berlin; 5,462 were men and 10,176 women; 3,254 of these patients (1,107 men and 2,147 women) were submitted to post mortem in order to establish the cause of death and the complications. Average age at onset of overt diabetes in cases undergoing post mortem was 63.4 years, average age at death, 70.7 years. The most frequent chief cause of death was myocardial infarction accounting for 21%. Diabetic coma was responsible for the fatal outcome in 1.7%, kidney disease in 5.4% and malignant tumors in 6% of the cases. The correlation of causes of death to age at death and duration of diabetes was also examined. Further indications on the prevalence of complications were obtained from the evaluation of all post mortem findings, including those of minor importance. Coronary changes occupied the first place with a frequency of 66%. The correlation of post mortem findings to age at death and duration of diabetes was equally studied.

In 30 diabetic inpatients the fatty acid pattern of triglycerides in parenchymal liver cells was studied by gas-liquid chromatography. With increasing size of fat droplets, a significant increase in the proportion of palmitic and oleic acid was observed as well as a significant fall of arachidonic (C 20: 4) and eicosapentaenoic acid (C 20: 5).

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.

In 36 unselected insulin-depending type I diabetics the reliability and practicability of the blood glucose self-control was investigated by means of the glucosignal test strip in the course of 12 weeks under everyday ambulatory conditions. In these cases the quality of the manual handling and of the visual evaluation of 896 test strips was judged in three series of application by special personnel in the laboratory by means of photometric evaluation. 7.5% of the test strips of all series were incorrectly handled and could not be evaluated photometrically. The correlation coefficients between the blood glucose concentrations which were visually valuated by the patient and measured photometrically in the laboratory were in the three investigation series 0.962, 0.964, and 0.950, i.e. the patients obtained a great reliability in the visual valuation of the test strips. Altogether 75-90% of all test strips were correctly judged by the patients. Deviations appeared in every case only by one concentration region, whereby there was an unequivocal tendency to underestimation, particularly in higher regions of blood glucose concentration. Prerequisite for a reliable handling of Glucosignal test strip by the patient is a thorough individual training.

In 40 diabetic inpatients the fatty acid pattern of triglycerides in liver fat and in subcutaneous adipose tissue was determined by gas liquid chromatography. With rising size of fat droplets in liver parenchymal cells there was a significant increase of palmitic acid (C∶16), oleic acid (C 18∶1) and linoleic acid (C 18∶2) as well as a decrease of myristoleic acid (C 14∶1), arachidonic (C 20∶4) and eicosapentaenoic acid (C 20∶5) in liver triglycerides, resulting in a fatty acid composition in big droplets similar to that of adipose tissue. Fatty acid pattern of subcutaneous depot fat was strikingly constant.

Among 163 insulin-dependent (type I) diabetics (average age 43.5 years; average duration of diabetes 17.5 years), 40 (24.5%) died within ten years from the consequences of micro- and (or) macro-angiopathies. The death-rate among hypertensives was twice that among normotensives: 21 of 53 patients (39.6%) with blood pressures above 160/95 mmHg, but 19 of 110 patients (17.3%) with normal pressures. Proliferative retinopathy at the onset of the study was also a predictive marker of a poor prognosis. The death-rate increased threefold for patients with retinopathy if they also had hypertension: 13 of 30 (43.3%) with background retinopathy and hypertension died, compared with 9 of 68 without hypertension (13.2%; P less than 0.01). Independently of hypertension the death-rate for patients with persistent proteinuria (greater than 0.5 g/24 h) was about threefold that among those without it. The highest death-rate (56.7%) was among the 30 patients with proteinuria and hypertension. Stepwise linear regression analysis demonstrated that the correlation between death from micro- and macro-vascular disease and the known risk factors was entirely determined by blood pressure and proteinuria.