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Severe Hypertrophic Cardiomyopathy in an Infant of a Diabetic Mother

and NIDDM, which is unsurprising given the considerable heterogeneity of the two conditions. Weitzman recommends using plasma C-peptide as the diagnostic criterion, but fails to provide a reference for the cutoff point used in his study. There is a considerable range of C-peptide levels in diabetic patients, with a clear overlap between insulin-treated and non-insulin-treated patients (2). Finding an appropriate cutoff point for C-peptide to differentiate between IDDM and NIDDM would be difficult, even if laboratory variation is not taken into account, and would of course result in some degree of misclassification. Further, the supposition that C-peptide levels provide a good indicator of insulin concentrations has been challenged (3). In the EURODIAB IDDM Complications Study, a diagnosis of diabetes had to be made before 36 years of age, with a continuous need for insulin therapy within a year of diagnosis (not an unbroken record of insulin treatment, as Weitzman indicates). This is a pragmatic definition, as many clinics still do not have access to sophisticated laboratory tests, and the diagnosis of IDDM has to be largely clinical, according to current World Health Organization criteria (4). Our study aimed to recruit a representative sample of IDDM patients, as currently identified in clinical practice. The mean BMI in our patients varied from 23.5 to 24.1 kg/m in men and women without or with cardiovascular disease, respectively (4). Thus, the majority of our patients were nonobese, which is typical for IDDM but not for NIDDM patients. We do not agree that Cpeptide measurement provides major advantages in the definition of IDDM on an epidemiological basis.