Herbert H. Marks

Longevity of Diabetic Patients in Recent Years

A virtually complete follow-up of diabetic patients treated at the Joslin Clinic since 1930 shows a downward trend in the mortality and corresponding improvement in the survivorship record. The mortality rates of diabetics, however, remain higher than those in the general population; the excess is relatively greatest at ages twenty-five to thirty-four and least in older patients. The death rates among diabetic females tend to be lower than among diabetic males, but the difference is less than in the general population. The survivorship rate among cases seen within a year of onset of the disease is better than in the aggregate experience. The pattern of causes of death among diabetics has changed radically. There has been a marked increase in the proportion of deaths caused by vascular disease, with small vessel disease playing a more and more important role. Reductions have been recorded for diabetic coma, diabetic gangrene and infections. Analysis of causes of death by age at onset and duration of diabetes show the effect of these factors on mortality and, in particular, the outstanding importance of diabetic nephropathy in juvenile diabetics with long duration ofdisease. Mortality from all types of vascular disorders is higher in diabetics than in the general population. In this experience the mortality for renal vascular disorders was seventeen times as high as in the general population.

Evaluation of type and degree of change in postexercise electrocardiogram in detecting coronary artery disease.

Summary Ischemic ST segment depression after exercise is due usually to coronary atherosclerosis and insufficiency. Our data suggest that type and degree of ischemic ST segment depression after exercise reflects the severity of the coronary disease. The results of this investigation indicate also that ST junction depression is a normal response to exercise.

Diabetes in 1964: A World Survey

World-wide morbidity and mortality statistics of the disease and data on the longevity and causes of death of diabetics are reviewed and summarized. Estimates of the global prevalence of diabetes which run as high as thirty million are unreliable. Known diabetics in the United States number about two million or eleven per 1,000 population. The proportion increases with age from about one in 900 for persons under twenty-five years of age to one in twenty for those sixty-five and over. For many countries deaths ascribed to diabetes comprise less than half of all persons dying with the disease. Death rates range from 23.2 per 100,000 population in Belgium down to 0.4 in South Korea. In most countries the death rate from diabetes among females exceeds that among males. Recent mortality trends, however, are more favorable for females generally than for males. Longevity of diabetics has substantially increased, although it remains significantly less than that of nondiabetics. Among patients of the Joslin Clinic first observed in 1940 and later, the survivorship rate after ten years exceeded 90 per cent for patients under thirty years of age, and even for sixty- to seventy-four-year-old patients it was 40 per cent. Today more than ever the chief problem is the prevention and control of vascular complications.

Stress Tests in the Detection of Coronary Disease

(1958). Stress Tests in the Detection of Coronary Disease. Postgraduate Medicine: Vol. 24, No. 4, pp. 419-430.

Mortality from diabetes throughout the world; characteristics and trends.

The statistics on mortality from diabetes in most countries have been profoundly affected by the new procedure of death certification inaugurated in connection with the Sixth Revision of the International Lists of Diseases and Causes of Death. This procedure came into use in 1949 in some areas and in 1950 in others. In contrast, previous revisions of the International List, which were made at approximately 10-year intervals since 1900, had little effect on the comparability of the statistics of diabetes mortality. While deaths since 1949 or 1950 have been classified for certain series by both the new and the previous procedures, the resulting figures by the latter are only approximate, primarily because the change in certification itself affects the frequency with which diabetes is mentioned. Moreover, physicians and vital statistics offices have not had sufficient experience with the new certificate and procedure to permit accurate evaluation of the effects of the change. This will take a number of years yet and until then, the recent trends in mortality from the disease will remain obscure. For all these reasons, it is necessary to divide the record of diabetes mortality into two parts, with 1949* as the dividing line or, in certain cases, 1950. The major part of this paper will deal with the record for 1948 and prior years.