THE PREVENTION of the vascular disease accompanying long-term diabetes mellitus is the most important problem in diabetes at the present time. The importance of this problem is dramatized by the following statistics from the Metropolitan Life Insurance Company Policy Holder Statistics and those of the Joslin Clinic for 1954. Diabetic coma accounted for 4.8% of all deaths in diabetic patients among the Metropolitan Life Insurance Company policy holders and 0.7% amongst the deaths of diabetics in the Joslin Clinic group. Eighty-three per cent of the deaths in diabetics in the Metropolitan Life Insurance Company group were due to vascular changes. The comparable figure for the Joslin Clinic group is 72%. Table I shows the figures in tabular form. It has been shown that, whatever other factors there may be in the causation of the vascular components of diabetes, these degenerative manifestations do increase with increasing length of survival with diabetes mellitus. There seems to be general agreement on this fact. Therefore, [SEE TABLE I IN SOURCE PDF.] the increase in vascular manifestations associated with diabetes would be expected in association with the decline of deaths from coma and the survival of diabetics for an appreciable period of time.
The emotionalism aroused in the proponents of the various regimens to prevent vascular changes in diabetes mellitus makes it difficult to ascertain the facts about this problem but at the same time emphasizes its importance.
An impartial review is needed of what is known about the etiology and prevention of these dread manifestations of diabetes mellitus. That is the main purpose of this article. To do this properly will require consideration of many factors related to the disease.
Diabetic Coma; Its Relation to Acetonæmia and Fat Embolism
