Jacob E. Poulsen

Prognosis of Diabetics with Diabetes Onset before the Age of Thirtyone I. Survival, Causes of Death, and Complications

A follow-up on three hundred and seven patients diagnosed before 1933 and before the patient was thirty-one years old was conducted as of 1.1. 1973, i.e. after at least forty years of diabetes. All patients were seen at the Steno Memorial hospital and were referred from all parts of Denmark. A small proport ion of the patients (5.9%) could not be traced. Of the remaining two hundred and eightynine patients 40% were alive. Three-hundred and six patients were insulin dependent, 87% being treated with insulin twice daily. More than 50% survived their diabetes for more than thirty-five years. The mortality rate was 2-6 times that in an ageand sexmatched non-diabetic population. In 31% of the deceased patients the cause of death was uraemia; in 25% myocardial infarction. The excess mortality among patients exhibiting persistent proteinuria before forty years of diabetes was 3 -4 times higher than in patients who did not have proteinuria after forty years. 167/o of the whole study population became blind, and another 14% had severely impaired vision; 21% exhibited objective signs of myocardial infarction, 10% of stroke, and 12% had gangrene or had undergone amputation of the foot or lower leg; 38% had proteinuria and 22% uraemia. Death with or from hypoglycaemia was more common than death in ketoacidotic coma. Clinical manifestations of late diabetic complications were considerably less common in patients who were still alive after more than forty years of diabetes than in patients who died before their fortieth year of diabetes.SummaryA follow-up on three hundred and seven patients diagnosed before 1933 and before the patient was thirty-one years old was conducted as of 1.1.1973, i.e. after at least forty years of diabetes. All patients were seen at the Steno Memorial hospital and were referred from all parts of Denmark. A small proportion of the patients (5.9%) could not be traced. Of the remaining two hundred and eightynine patients 40% were alive. Three-hundred and six patients were insulin dependent, 87% being treated with insulin twice daily. More than 50% survived their diabetes for more than thirty-five years. The mortality rate was 2–6 times that in an age- and sexmatched non-diabetic population. In 31% of the deceased patients the cause of death was uraemia; in 25% myocardial infarction. The excess mortality among patients exhibiting persistent proteinuria before forty years of diabetes was 3–4 times higher than in patients who did not have proteinuria after forty years.16% of the whole study population became blind, and another 14% had severely impaired vision; 21% exhibited objective signs of myocardial infarction, 10% of stroke, and 12% had gangrene or had undergone amputation of the foot or lower leg; 38% had proteinuria and 22% uraemia. Death with or from hypoglycaemia was more common than death in ketoacidotic coma. Clinical manifestations of late diabetic complications were considerably less common in patients who were still alive after more than forty years of diabetes than in patients who died before their fortieth year of diabetes.

Prognosis of diabetics with diabetes onset before the age of thirty-one. II. Factors influencing the prognosis.

SummaryIn 307 patients with diabetes mellitus, developed prior to 1933 and before age 31 it was demonstrated that: (1) frequent contact with a specialized diabetes clinic from an early stage of the disease; (2) a good quality of “metabolic control”; (3) a low insulin dose; (4) a body weight of 10% less than ideal; and (5) a mean blood pressure below 100 mm Hg, all had significantly beneficial effects upon the survival. It was also found that patients domiciled in Copenhagen had a significantly better prognosis than patients domiciled outside Copenhagen. Frequent contact with a diabetes centre was accompanied by an appreciable decrease in disabling late diabetic complications.

Diabetic nephropathy: Fault or destiny?

SummaryTwenty-one young onset Type 1 (insulin dependent) diabetics who developed severe diabetic nephropathy after 14.5±3.3 years (mean ± SD) and 21 age and sex matched Type 1 diabetics without evidence of nephropathy after more than 32 years of disease were compared with particular reference to body build, insulin requirements, stability of diabetes, heart rate and blood pressure before the development of nephropathy. Attempts were made to evaluate the quality of metabolic control during the first 20 years of diabetes from more than 1,600 out-patient measurements of blood and urinary glucose in each group. The renal tubular reabsorption capacity for glucose was calculated in both groups. No differences between the two groups were found for any of the parameters examined, except that the frequency of ketoacidosis was higher in the patients who developed nephropathy. It is concluded that many Type 1 diabetics seem to be protected against the deleterious effect of diabetes on the kidney. The nature of the protecting factors is unknown.