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An attempt to alter the course of early type 1 diabetes by inducing immune tolerance with the islet cell antigen, glutamic acid decarboxylase (GAD) plus an alum adjuvant (GAD-alum) has given disappointing results. The study (N Engl J Med 2012;366:433–42) at 63 centres in nine European countries included 334 people aged 10–20 years within 3 months of a diagnosis of type 1 diabetes. They had serum antibodies against the 65-kD isoform of GAD and fasting C-peptide concentrations of >0.1 nmol/l. Randomisation was to three groups, each with subcutaneous doses at 1, 30, 90, and 270 days: GAD-alum for all four doses, GAD alum for two doses followed by placebo for the third and fourth doses, or placebo for all four doses. The decrease in stimulated C-peptide concentrations was similar in all three groups and the change in concentration from baseline to 15 months did not differ significantly between groups. There were also no significant intergroup differences in glycated haemoglobin concentration, insulin dosage, and rates of hypoglycaemia. GAD-alum did not influence the course of early type 1 diabetes.

Evidence is accumulating that selective serotonin reuptake inhibitors (SSRIs) taken in pregnancy increase the risk of persistent pulmonary hypertension of the newborn (PPHN). A study in the five Scandinavian countries (BMJ 2012;344:d8012: see …