We appreciate the interest of Sawicki and Bastian (1) in our study. They propose an alternative explanation of our results, namely, that parents with a high education level would have better controlled diabetes, leading to lesser complications during pregnancy, which, in turn, would lead to stronger liability for autoimmunity in the offspring. Although such a scenario cannot be completely ruled out, we feel that it is unlikely based on the following grounds: Firstly, an association between low social status and negative influence on pregnancy complications has been documented by the references given by Sawicki and Bastian only for parents with type 1 diabetes (2–4), and parents with type 1 diabetes constitute only a small minority of the parents of current patients with type 1 diabetes or latent autoimmune diabetes in adults. Secondly, that there exists preferential passage of autoimmunity with well-controlled versus poorly controlled diabetes from mother to child is, to our knowledge, an unproven concept. Information on educational level and on type of diabetes for some of the parents of our cases might be available by coupling our data to the Norwegian Family Registry, but there would be too few cases to answer this question properly.
Acknowledgments
No potential conflicts of interest relevant to this article were reported.
