Howard F. Root

Diabetes Mellitus in Twins

Among 242 sets of twins collected from 34,072 Joslin Clinic records from 1949 to 1966, there were 104 sets with both members alive. Of these, forty-seven sets were examined and an additional forty-three sets responded to a detailed questionnaire. A high concordance for overt diabetes was found in monozygotic sets in which the proband was age forty or greater at time of diagnosis. In the forty-seven sets examined, there were no cases of overt diabetes in the dizygotic twin siblings of a proband who was age forty and over at time of diagnosis of overt diabetes. Surprisingly, however, a high rate of chemical diabetes was diagnosed in the dizygotic twin siblings, an observation implying an etiology for diabetes mellitus more complex than inheritance by a single recessive gene.

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.

Neuropathic Foot Lesions in Diabetes Mellitus

JOINT changes associated with diseases of the central nervous system were first described by Charcot. At first these changes were considered peculiar to tabes dorsalis and syringomelia, but with ex...

Capillary fragility and diabetic retinitis; with a note on the use of rutin.

AN INCREASED incidence of retinal changes among patients with diabetes has been noted in recent years. Diabetes of long duration has been associated with the greatest increase in retinal hemorrhage...

ARTERIOSCLEROSIS AND HYPERTENSION IN DIABETES

Excerpt That arteriosclerosis occurs in excessive degree in diabetic patients has found general acceptance among American students. The importance of characteristic metabolic changes of diabetes in...

Factors in the rate of development of vascular lesions in the kidneys, retinae and peripheral vessels of the youthful diabetic

1. The incidence of vascular lesions in the kidneys, retinae and peripheral vessels of 282 patients with onset of diabetes between 15 and 30 years of age has been studied with special reference to the duration of diabetes and the character of control of diabetes.

The natural history of diabetes. I. Mortality.

Survival data are presented for five groups of diabetic patients seen at the Joslin Clinic, Boston, between 1939 and 1959. Patients were white, Massachusetts residents, and diagnosed diabetic within twelve months of first visit to the Clinic. The data are analyzed in terms of crude survival rates, relative survival ratios and mortality “attributable” to diabetes after the elimination of competing causes. The excess mortality rate experienced by diabetic patients increases with duration of diabetes. While persons with juvenile onset experience virtually no excess mortality in the first fifteen years of the disease, between the fifteenth and the twenty-fourth year they have an excess death rate of 1 to 1.5 per cent per year. In the older age groups the excess is larger and appears earlier. The mortality attributable to diabetes increases with increasing age of onset. Females have higher attributable mortality rates than males, particularly among cases with onset after forty years of age. Patients first seen in 1944 had substantially better survival rates than those first seen in 1939. However, between 1944 and 1959 no further improvement has been evident. This leveling off in the former decline in diabetes mortality has occurred at a point when diabetic patients still experience an excess mortality of approximately 30 per cent within the first twenty-five years of their disease.

Preoperative medical care of the diabetic patient.

The diabetic patient undergoing a surgical procedure presents unique problems. Special attention must be given to control of the diabetes and of infection before and after the operation. Drugs may be retained if the renal lesions of diabetes are present. Often there is failure to provide sufficient protein. Reliance on urine testing alone without blood tests in the regulation of insulin dosage can be disastrous.

Clinical Experience with Carbutamide (BZ-55): A Progress Report

From December 1955, through August 1956, we used sulfonylurea compounds in 620 patients with diabetes. Of this number 380 received BZ-55, 3° w e r e given Orinase and 10 SPTD (sulfapropylthiodiazole). In the present paper our experience with BZ-55 alone is reported. This is in the nature of a progress report; a more complete and detailed presentation of results will be made at a later date. Among the 380 who have received BZ-55, 187 patients, including 101 of fifteen years of age and under, were studied only following a single administration of the drug in the course of a response test (see below). The remainder, 193 patients, was observed while being maintained on BZ-55. Of these, in sixteen cases the period of observation was insufficient, in twenty-four the drug was discontinued because of complications and in three the preparation was stopped for other reasons. The results in the remaining 150 patients form the basis of the present discussion. These patients have been maintained on BZ-55 f° periods varying from less than one month (thirty-one cases) to more than six months (twenty cases). Of the 150 patients, 66 were males and 84 females. Most of them (116, or 77 per cent) were between the ages of 40 and 70 years; 14 were under 40 and 20 over 70. Diabetes had been present in 42 (28 per cent) of the group for 10 to 20 years; in 99 (66 per cent) the duration was under 10 years and in 9 (6 per cent) over 20 years. Of the 150 patients, 65 had never received insulin and 75 had been taking less than 40 units daily.

Report of the Gloucester Diabetes Study: Evaluation of a Method of Self-Testing for Diabetes

A need exists for a practical and economical method of identifying the numerous, undiscovered cases of diabetes mellitus. It has been estimated that in the Unites States there are approximately one million diabetics with the disease undiagnosed. To discover these cases in their incipiency requires organized case-finding programs. Such programs usually are expensive undertakings, since they require special equipment and trained professional personnel. For this reason, a relatively simple, inexpensive procedure has been sought which could be used satisfactorily as a mass case-finding method.