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Seasonal affective disorder (SAD) is known as a form of depres− sion that usually occurs in the winter, with hyperphagia and a craving for carbohydrate−rich foods and weight gain observed in these depressive episodes [1,2]. It therefore seemed highly likely that the correlation between leptin levels in individuals with SAD was altered, which was the topic of interest in the study re− ferred to here. However, no change of leptin levels according to season was detected in persons with known SAD compared to the control group, whereas increased appetite and weight gain were present [1].As mentioned in the article, this may be due to a change in the highly pulsatile circadian secretion of leptin, which was not measured in the study. A strong indicator that leptin levels are linked to SAD is that leptin levels are significantly higher in women [1], as is the prevalence of SAD itself [3]. A more far− reaching disturbance at HPA axis level not only incorporating leptin, but also several transmitters known to play a crucial role in the regulation of appetite such as ghrelin and neuropeptide Y would seem far more likely. Melatonin would be a particularly interesting candidate, as its secretion is known to be highly de− pendent on light exposure, which is apparently an important fac− tor in SAD since it occurs typically in the "darker" periods of the year and it is more prevalent at higher rather than lower lati− tudes [4]. Another interesting finding is that leptin levels in sportsmen and sportswomen may reach as low as a third of lev− els in normal individuals, so the effects of physical exercise [5] ± typically performed more intensively in the spring and summer months ± also seem to be involved in the regulation of leptin.For further investigation, a broader view on the HPA axis may prove useful in understanding the pathogenesis of SAD. References1 Cizza G, Romagni P, Lotsikas A, Lam G, Rosenthal NE, Chrousos GP. Plasma leptin in men and women with seasonal affective disorder and in healthy matched controls. Horm Metab Res 2005; 37: 45 ± 48 2 Krauchi K, Reich S, Wirz−Justice A. Eating style in seasonal affective disorder: who will gain weight in winter? Compr Psychiatry 1997; 38: 80 ± 87 3 Magnusson A, Boivin D. Seasonal affective disorder: an overview. Chronobiol Int 2003; 20: 189 ± 207 4 Miller AL. Epidemiology, etiology, and natural treatment of seasonal affective disorder. Altern Med Rev 2005; 10: 5 ± 13 5 Popovic V, Duntas LH. Leptin TRH and ghrelin: influence on energy homeostasis at rest and during exercise. Horm Metab Res 2005; 37: 533 ± 537

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, as well as pharmacological preventive strategies reduce the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes, these studies offer a compelling evidence base for the important translation of the research findings into community-based prevention strategies and the development of a national diabetes prevention program. The work group "diabetes prevention" of the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a national program. This comprises a three-step intervention: in a first step individuals at high risk of developing type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes, and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise as well as pharmacologic preventive strategies reduced the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes these studies offer a compelling evidence-base for the important translation of the research findings into community-based prevention strategies and the development of a National Diabetes Prevention Program. The workgroup "diabetes prevention" from the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a National Program. This comprises a 3-step-intervention: in a first step individuals at high risk to develop type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

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