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In CME/CPD, a significant part of research is about effectiveness. Attention to the development process can be vital to understand how it impacts progress and results. This study aims to explore an innovative process of applying a combined approach using design-based research, collaborative innovation, and program theory to develop CPD about type 2 diabetes for GPs and clinic nurses with a group of interprofessional stakeholders. In particular, the development process of the combined approach and how it impacts the progress and the activities. We applied two qualitative methods. First, we analysed 159 documents from the development process, and second, eight semi-structured key informant interviews. Data were deductively analysed using 15 predefined elements derived from the combined approach combined with open coding analyses. The analysis showed how the combined approach structured the process. And the interviews broadened our understanding of the relationship between the process and the activities. Four additional themes were constructed from the open coding, including surrender to the process. Surrendering was a central part of the interviewees' participation in the process. The combined approach facilitated this unfamiliar experience of surrender. By supporting participants to surrender, the combined approach enabled an expansion of interprofessional collaboration and the development of innovative activities and learning methods in CPD on type 2 diabetes.

Background and Aim: In today’s digital world, people with type 1 and 2 diabetes turn to peers on social media to exchange information and support. However, little is known about what the online sharing of diabetes-related information implies for the clinical encounter. This study examines how information that stems from social media is discussed in clinical encounters between healthcare professionals (HCPs) and people with diabetes (PWD) . Methods: We conducted semi-structured interviews with 25 PWD aged 22-76 (type 1: n= 17, type 2: n=8) and HCPs (nurses n=9, medical doctors n=7, dieticians n=3) . The participants were recruited from the diabetes outpatient care setting in Denmark. Two researchers independently developed a thematic coding framework that was compared, revised, and then applied to analyze each interview. Subsequently, overarching themes were identified across the whole data set. Results: The first theme suggests that HCPs tend to have a ‘blind spot’ towards information that stems from social media: Most HCPs have not asked whether PWD retrieve information from social media and most PWD present information that is accessed on social media without naming their source. The second theme reflects that clinical dialogues about online information rest upon trustful relationships: PWD find online peer exchanges valuable and request for HCPs to acknowledge this. Still, PWD navigate large amounts of information and treatment advice online, and while PWD may seek to discuss their information in clinical encounters, initiating these dialogues is sensitive to the reactions of HCPs. Discussion: The results suggest that HCPs should encourage curious dialogues about how PWD retrieve diabetes-related information. This serves for HCPs to learn what PWD gain from peers online and for HCPs to be able to offer their expertise to support PWD who are navigating large flows of information and advice online. Disclosure E.M.Kjærulff: None. M.A.Nexo: None. U.Bjerre-christensen: None. H.Langstrup: None. Funding Innovation Fund Denmark (Ref.no. 9163-00016B)

Malaysia seeks to transform its public healthcare sector to manage the growing number of people with diabetes. Patient engagement is a critical clinical competency for healthcare providers treating people with diabetes. In this study, we investigate the perceptions of and ability to practice patient engagement among doctors and nurses working in Malaysia’s primary healthcare system. Semi-structured interviews were conducted with nine non-specialist doctors and ten nurses working in primary healthcare clinics. Further, 12 key informants with specialist knowledge about diabetes care and the healthcare system in Malaysia were interviewed. The interviews were analyzed using qualitative content analysis. Three main themes emerged: 1) understanding barriers to self-care and treatment, 2) perceived training needs and skills within patient engagement and empowerment, and 3) challenges to the practice of patient engagement. A range of barriers was identified in healthcare providers’ ability to practice patient engagement. Future efforts should seek to improve competencies within patient engagement, identification of especially psychosocial barriers to self-care and empowerment. Yet, available manpower and time also influence whether patient engagement is practiced.

Hyperglycaemia during hospitalisation is associated with a longer and more complicated admission and with increased mortality. Therefore, guidelines suggest that blood glucose should be less than 10 mmol/l. In this audit, we aimed to describe the prevalence of diabetes patients at four orthopaedic departments in the Capital Region of Denmark and to measure the quality of in-hospital diabetes management.We conducted audits of medical records in the electronic health record system for two months in 2019. All patients admitted were included in the audit. We gathered information on diabetes status, orthopaedic diagnosis, glycosylated haemoglobin and diabetes management.Among 2,463 included patients, 10% had diabetes. The three most frequent diagnosis groups were infection, fracture of lower extremity and hospitalised for alloplastic surgery. The number of blood glucose measurements during 24-hour perioperative care was 6.5. Among patients analysed, 10-20% did not have their blood glucose measured in the days following surgery. Among patients, 64% received insulin 1-50% of the required times.We demonstrated that 10% of hospitalised patients suffer from diabetes. The audit also showed that blood glucose is generally measured according to guidelines, whereas the treatment of an elevated blood glucose is far from being given according to guidelines. This may potentially delay recovery and prolong hospitalisation.none.not relevant.

Background: The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision. Methods: This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics. Results: Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel ‘personalized care’, ‘one-stop-centre’ and utilization of patients’ waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance. Conclusion: We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources – a potential that may be tapped into by systematic learning from ongoing innovation.

Introduction: Studies from many parts of the world have explored factors associated with poor diabetes self-management including Diabetes Self-Management Education (DSME). Research Methodology: This study was conducted among 162 diabetes patients at primary healthcare clinics in Malaysia using semi-structured exit-interviews to explore their perceptions, attitudes and practices in relation to self-care and encounters with primary health care providers. Results and Discussion: Generally, the patients had limited knowledge, lack of motivation and encountered difficulties in diabetes self-management. The DSME was inadequate due to limited time allocated for consultations with doctors, language barriers and the lack of interpersonal and communication skills of HCPs. Conclusion: In view of the positive effects of quality DSME on the health outcomes and quality of life among diabetes patients, it is important for the primary healthcare clinics in Malaysia to strengthen the diabetes services through training in communication of all HCPs, awareness of language difference and task shifting.

Background: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). Objective: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia. Design: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme. Results: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes. Conclusion: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.

The burden of diabetes continues to increase in Malaysia, and the public primary health sector has an insufficient number of health care providers well-trained in diabetes care. The Ministry of Health Malaysia collaborated with Steno Diabetes Center to educate primary care doctors and nurses on the fundamentals of clinical diabetes care using a competency-based approach that blends e-learning, classroom-based learning, and clinic-based group work. This programme is called Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). The aim of this study was to assess the effectiveness of the SRCC intervention in improving diabetes-related knowledge, attitudes, skills and clinical practices among non-specialised doctors and general nurses working in public health clinics in Malaysia. This paper presents the study protocol. A quasi-experimental, mixed-methods study based on Solomon’s Four Group Design was applied. Non-specialist doctors and general nurses from ten health clinics were randomly selected to receive the educational intervention. Comparison clinics were purposive selected matching on proxy indicators for quality of diabetes care. The intervention consisted of 50 hours of e-learning, 48 hours of classroom-based learning and approximately 25 hours of work-based learning that covered all main aspects of clinical diabetes care and delivered over a six-month period. Primary outcomes were changes in diabetes-related knowledge, attitudes, skills, and clinical practice. Patients’ perceptions regarding the quality of care provided were classified as a secondary outcome. Other outcome measures included patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery. Results from this study will inform future educational approaches within the Malaysian health system. The study is unique because it evaluated a pertinent public health topic using a very robust methodology.

The Practical Diabetology (PD) course for multidisciplinary health care professionals (HCPs) is directed at building a team-based approach to diabetes care delivery. Participants were asked to apply course learning to identify deficiencies in care delivery in their own settings and develop action plans to improve care and continuing self-development. The objective of the study was to evaluate the short- and mid-term impact of seven PD courses held between March 2011 and March 2012. Three methods of assessment were carried out: an end of course evaluation; pre- and post-tests to assess gain in knowledge and change in attitudes; and self-assessment of action plan implementation at six months to determine level of behaviour change. In total, 327 multidisciplinary HCPs participated in the seven PD courses. End of course evaluation indicated that the PD course was valued by course participants in terms of relevance of the topics and learning experience. A significant gain in knowledge and positive changes in attitudes were seen immediately post course in both groups. Of the 160 action plans prepared by participating teams (consisting of at least two members each – one medical and one non-medical HCP), 68 (42.5%) were implemented. At six months, continued positive change was demonstrated through self-assessment of action plan implementation. PD courses were appreciated by the participants; significant gain in knowledge and positive change in selected attitudes were seen in the short term. Implementation of action plans helped enhance participants’ competency for teamwork, problem solving and self-development skills. Copyright © 2015 John Wiley & Sons.

Udgivelsesdato: 2006-May-26 Pro-apoptotic cytokines are toxic to the pancreatic beta-cells and have been associated with the pathogenesis of Type 1 diabetes (T1D). Proteome analysis of IL-1beta exposed isolated rat islets identified galectin-3 (gal-3) as the most up-regulated protein. Here analysis of human and rat islets and insulinoma cells confirmed IL-1beta regulated gal-3 expression of several gal-3 isoforms and a complex in vivo expression profile during diabetes development in rats. Over-expression of gal-3 protected beta-cells against IL-1beta toxicity, with a complete blockage of JNK phosphorylation, essential for IL-1-mediated apoptosis. Mutation scanning of regulatory and coding regions of the gal-3 gene (LGALS3) identified six polymorphisms. A haplotype comprising three cSNPs showed significantly increased transmission to unaffected offspring in 257 T1D families and replicated in an independent set of 170 T1D families. In summary, combined proteome-transcriptome-genome and functional analyses identify gal-3 as a candidate gene/protein in T1D susceptibility that may prove valuable in future intervention/prevention strategies.

Type 1 diabetes (T1D) is characterized by selective autoimmune destruction of the insulin producing beta-cells in the islets of Langerhans. When the beta-cells are destroyed exogenous administration of insulin is necessary for maintenance of glucose homeostasis. Allogeneic islet transplantation has been used as a means to circumvent the need for insulin administration and has in some cases been able to restore endogenous insulin production for years. However, long life immunosuppression is needed to prevent the graft from being rejected and destroyed. Changes in protein expression pattern during spontaneous diabetes development in the diabetes prone BioBreeding rat (BB-DP) have previously been described. In the present study, we have investigated if any of the changes seen in the protein expression pattern during spontaneous diabetes development are also present during allograft rejection of BB-DP rat islets. Two hundred neonatal islets were syngeneically transplanted under the kidney capsule of 30 day old BB-DP rats and removed prior to and at onset of diabetes. Allogeneically transplanted islets from BB-DP rats were removed before onset of allograft rejection and at maximal islet graft inflammation (rejection). The protein expression profiles of the transplants were visualised by two-dimensional gel (2-DG) electrophoresis, analysed and compared. In total, 2590 protein spots were visualised and of these 310 changed expression (p < 0.01) in syngeneic islet transplants in the BB-DP rats from 7 days after transplantation until onset of diabetes. In BB-DP islets transplanted to WK rats 53 protein spots (p < 0.01) showed changes in expression when comparing islet grafts removed 7 days after transplantation with islet grafts removed 12 days after transplantation where mononuclear cell infiltration is at its maximum. Only four protein spots (1%) were significantly changed in both syngeneic (autoimmune) and allogeneic islet destruction. When comparing protein expression changes in syngeneic BB-DP islet transplants from 37 days after transplantation to onset of diabetes with protein expression changes in allografts from day 7 to 12 after transplantation only three spot were found to commonly change expression in both situations. In conclusion, a large number of protein expression changes were detected in both autoimmune islet destruction and allogeneic islet rejection, only two overlaps were detected, suggesting that autoimmune islet destruction and allogeneic islet rejection may result from different target cell responses to signals induced by the cellular infiltrate. Whether this reflects activation of distinct signalling pathways in islet cells is currently unknown and need to be further investigated.

To evaluate if improvements in the quality of diabetes care in Indian clinics can be obtained by simple self-surveillance PC-based software. Method Nineteen Indian diabetes clinics were introduced to the principles of quality assurance (QA), and to a software program, the Steno Quality Assurance Tool (SQAT). Data was entered for an initial 3 months period. Subsequently data were analyzed by the users, who designed plans to improve indicator status and set goals for the upcoming period. A second data entry period followed after 7–9 months. Results QA data was analyzed from 4487 T2DM patients (baseline) and 4440 (follow-up). The average examination frequency per clinic of the following indicators increased significantly: lipid examination (72–87%) ( p =0.007), foot examination (80–94%) ( p =0.02), HbA1c investigation (59–77%) ( p =0.006), and urine albumin excretion investigation (72–87%) ( p =0.006). Outcome parameters also improved significantly: mean (SD) fasting and post prandial BG reduced from 144(16) to 132(16)mg/dl ( p =0.02) and 212(24)–195(29)mg/dl ( p =0.03), respectively. Systolic BP reduced from 139(6) to 133(4) ( p =0.0008)mmHg and diastolic BP from 83(3) to 81(3)mmHg ( p =0.002). Conclusion Quality of diabetes care can be improved by applying SQAT, a QA self-surveillance software that enables documentation of changes in process and outcome indicators.

Recently, the synthetic immunomodulator Linomide (quinoline-3-carboxamide, LS 2616) was reported to prevent IDDM and insulitis in NOD mice. The mechanism for this protective effect is not known. The cytokine interleukin 1 (IL-1) may be a pathogenetic factor in the initial destruction of the beta-cells leading to IDDM. This study was undertaken to investigate the influence of Linomide on IL-1beta induced diabetogenic and hormonal changes in the rat in vivo, and on IL-1beta mediated synthesis of NO and inhibition of insulin secretion in isolated islets of Langerhans ex vivo. Normal male Wistar Kyoto rats received 4.0 microg/kg of recombinant human IL-1beta (rhIL-1beta) i.p. daily for 5 days with or without Linomide (8-9 mg/kg/day) in the drinking water. Litters of neonatal Wistar rats were pretreated for 3 days with injections of 10 mg/kg of Linomide i.p., and pancreatic islets of Langerhans were isolated for ex vivo studies. Linomide alone caused significant hypercorticosteronemia, hypoglucagonemia, lymphopenia and neutrophilia. Linomide had no effect on IL-1beta induced hyperglycemia, hyperglucagonemia, lymphopenia, neutrocytosis, or hypercorticosteronemia on day three and hypocorticosteronemia on day five. Further, Linomide did not prevent rhIL-1beta mediated reduction in insulin secretion or increase in NO synthesis ex vivo. In conclusion, Linomide does not seem to exert its protective effect on IDDM development via inhibition of interleukin 1 action on islet insulin release or NO production, but the increase in plasma corticosterone may contribute to the understanding of the immunomodulatory effects of Linomide.

Introduction The purpose was to examine the effectiveness of flexor tenotomy in a modified technique to prevent and heal neuropathic and neuroischaemic pressure ulcers on the tip of the toe in claw- or hammer-toe deformities in people with diabetes. Patients and methods A consequetive 4 years series of 38 patients was retrospectively studied. Percutaneous tenotomy on the superficial and deep flexor tendons was performed in 65 toes through a small transverse plantar stab incision just proximal to the web level. There were 16 (42%) patients with 27 ulcerated toes and 22 (58%) patients with 38 toes with impending ulceration. Ten patients had neuropathic ulcers and six patients had neuro-ischaemic ulcers. Sixteen patients (42%) had macrovascular disease. Ten (26%) had proliferative rethinopathy, 7 (18%) macroalbuminuria and 18 (47%) microalbuminuria. Results All surgical incisions healed uneventfully. Twenty-five (93%) of the toe ulcers healed in median 21 days (range 7–224 days). Three patients had recurrence of the ulcer. There were no infections in the incisions or toe amputations. No patients treated with preventive tenotomy experienced toe ulceration. No complications were recorded in neuro-ischaemic ulcers. During the follow up period of median 31 months (range 2–48 months) 33 other ulcers were recorded in 18 patients (47%). One of these developed a transfer ulceration under the adjacent metatarso-phalangeal joint and another had a late pressure ulcer on a neighbouring toe. The other 31 ulcers were not related to ulcers treated with tenotomy. Conclusion Tenotomy is a simple, safe and effective procedure for preventing and treating distal plantar neuropathic toe ulcers in claw toe or hammer toe deformities in people with diabetes with or without serious co-morbidity. The results suggest that tenotomy should be considered also in neuroischaemic ulcers.

Type 1 Diabetes Mellitus is characterized by selective destruction of the pancreatic beta-cells in the islets of Langerhans and insulitis. Subcutaneous insulin injections given to diabetes prone BioBreeding (BB-DP) rats reduce diabetes incidence. The underlying mechanism(s) are not known in detail. Previously, we showed that transplantation of 200 syngeneic neonatal islets under the kidney capsule is useful for studying molecular events during diabetes development in BB-DP rats. In the present study we tested if prophylactic insulin treatment of syngeneically transplanted BB-DP rats would protect both islets in situ and transplanted islets from destruction.BB-DP rats received transplants of 200 syngeneic neonatal islets under the kidney capsule at 30 days of age. They were given a subcutaneous insulin or placebo implant and were compared to control rats. Blood glucose was measured three times weekly. In total, 193 rats were transplanted and rats were sacrificed 7, 23, 50, 90 days post-transplantation or at onset of diabetes. Pancreatic and transplant sections were stained for insulin and mononuclear cell infiltration and insulitis was graded.Eight (19%) rats developed diabetes in the insulin-treated group and 19 (63%) and 19 (65%) rats in the control and placebo, respectively (p = 0.0002 and p = 0.0001). Onset of diabetes in the insulin treated group was delayed compared to control and placebo, (102, 77 and 81 days of age, respectively (p = 0.0001 and p = 0.0001)). Insulin treatment diminished mononuclear cell infiltration in the islets at day 50 after transplantation compared to placebo. Infiltration pattern in islets in situ correlates with infiltration in transplants (r is 0.9076 and p0.001).These results suggest that insulin-treatment of syngeneically transplanted BB-DP rats considerably decreases the incidence of diabetes and that this model is well suited for studying molecular changes in the islet transplants.

Interleukin 1beta (IL-1) is cytotoxic to rat pancreatic beta-cells in vitro, and increased expression of IL-1 mRNA is found in the islets of Langerhans during development of diabetes in BB/Wor/Mol-BB2 (BB-DP) rats and NOD mice. It has been proposed that IL-1 induces a race between protective and deleterious proteins in the beta-cells during development of diabetes, and that heat shock proteins 70 and 90, and manganese superoxide dismutase, all inducible by IL-1 are potentially protective proteins. We have established a database of approximately 2000 neonatal rat-islet proteins by two-dimensional gel (2-D gel) electrophoresis of [35S]-methionine labelled neonatal Wistar Furth rat islets. In these IL-1 was shown to up- or down-regulate the islet-expression level of 99, and to induce de novo synthesis of 6 proteins. The identity of most of the IL-1 induced proteins is unknown and under study. In this study we wished to investigate if changes in protein expression induced in vitro by IL-1 stimulation of islets are also seen in vivo during spontaneous development of diabetes in BB-DP rats, and during islet allograft rejection. Two-hundred neonatal BB-DP rat islets were grafted under the kidney capsule of either 30-day-old BB-DP rats killed at onset of diabetes or of 30-day-old Wistar Kyoto (WK) rats, killed 12 days after grafting. Proteins in excised islet-grafts and in vitro IL-1 exposed isolated neonatal BB-DP rat islets were labelled with [35S]-methionine, and processed for 2-D gel electrophoresis. Fluorographs of the gels were analysed by computer. A total of 1815 proteins were found in 3 of 3 12.5% polyacrylamide gels. Interleukin-1 was found to change expression level of 82 of these proteins (22 up- and 60 down-regulated) in neonatal BB-DP rat islets in vitro. Of these 82 proteins 33 (4 up- and 29 down-regulated) also changed level of expression during disease occurrence in syngeneic islet grafts from diabetic BB-DP rats, and 29 (4 up- and 25 down-regulated) during rejection of BB-DP islets grafted to WK rats. Changes in the expression level of 14 (3 up- and 11 down-regulated) of the 82 proteins altered by IL-1 in vitro were only found in syngeneic islet grafts in diabetic BB-DP rats, and changes in the expression level of 8 (2 up- and 6 down-regulated) of these 82 proteins expression were only found in BB-DP islet allografts in WK recipients. Identification of these proteins may be important in understanding the mechanisms of islet destruction during development of insulin-dependent diabetes mellitus and during islet allograft rejection.

During development of IDDM mononuclear cell infiltration is seen in the islets of Langerhans in both man and rodent models. This process is not synchronized in time and space. To create a synchronized model for investigation of the cellular and molecular events during IDDM development, we isolated and transplanted 200 neonatal BB-DP rat islets under the kidney capsule of 30 day old BB-DP rats. Islet transplantations were also carried out from Wistar Furth (WF) to WF rats, from WF to Wistar Kyoto (WK) rats and from WK to BB-DP rats to compare disease occurrence in an islet syngraft with changes in islet syngrafts or allografts in non-diabetes prone recipients and with changes in islet allografts in diabetes prone recipients, respectively. Pancreata and grafts were harvested at pre-scheduled time points before onset of diabetes and at onset of diabetes, and stained for insulin, MHC class I, MHC class II, alphabeta-TCR, CD4, CD8 or ED1. Diabetes incidence in the syngrafted BB-DP rats was 75% at 78 +/- 5 days of age. The incidence and time of onset of IDDM was unaffected by islet syngrafting. Positive correlations were found between the percentage of infiltrated islets in situ and the number of infiltrating cells in the islet syngraft from the same BB-DP rats (p = 0.003-p < 0.0001, r = 0.5-0.7). The number of infiltrating cells regardless of cell type in the graft was inversely correlated to the graft insulin content (p = 0.0003-p < 0.0000, r = -0.6 to -0.8). The graft insulin content was 70% and 90% in BB-DP rats before onset of diabetes and BB-DP rats not developing diabetes respectively, and 30% in the diabetic rats (p < 0.01). Interestingly only 5% of the allografted BB-DP rats developed diabetes. No correlation was found between the number of infiltrating cells in the graft and islets in situ in the BB-DP rats not developing diabetes. Only baseline infiltration was seen in grafts from syngrafted WF rats. In allografted WF islet to WK rats graft rejection was seen 12 days after transplantation. No correlation was found between the number of infiltrating cells in the graft and islets in situ. In conclusion the cellular infiltration in syngeneic but not allogeneic islets grafted to 30 day old BB-rats mirrors that seen in islets in situ. Syngeneic islet grafting in BB-DP rats may be useful for studying the cellular and molecular events during the development of IDDM.

In any epoque and in any field of biomedicine a few major figures stand out as being particularly influential. Some because they contributed very significantly to science, some because their personalities made them natural centres of learning and research. Albert E. Renold did both and will be remembered as one of the greatest names in diabetology of this century. His curiosity, his emphatic interest in young people and their ideas, his open-mindedness and intuitive understanding of new and sometimes rather vaguely formulated concepts made conversations with Albert Renold delightful and encouraging experiences. One of us (J.N.) remembers a long conversation in Geneva several years ago where seemingly odd and certainly less than solidly substantiated ideas on the pathogenesis of insulin-dependent diabetes mellitus (IDDM) were discussed. Pointing out these shortcomings Renold said, quoting Thomas Huxley: “He who does not go beyond the facts, he will seldom get as far as the facts”. With this in mind, however, still going to the limits of the facts and probably beyond, we wish to dedicate this chapter on the pathogenesis of IDDM to the memory of Albert E. Renold.