Insulin-Dependent Diabetes Mellitus

Insulin-dependent diabetes mellitus (IDDM), now usually called type I diabetes, is the most common endocrine disorder of childhood and adolescence, affecting at least 1 in 400 youngsters. In addition, the prevalence appears to be increasing, particularly as noted in Scandinavia, where registries for this disease are maintained. During the past 10 to 15 years, astounding advances have been made, both in the treatment of this disease and in understanding its etiology. However, perfect treatment, prevention, and cure of this disease and its long-term sequelae, which include cardiovascular disease, nephropathy requiring dialysis and renal transplantation, neuropathy, and retinopathy, are still lacking. During the next two decades, progress in these areas will surely be made, and the prognosis for children and adolescents with IDDM will continue to improve. Until the discovery of insulin in 1921, virtually all children, adolescents, and young adults with IDDM died within 3 years of disease onset, often reduced to mere skeletons as their weight rapidly decreased secondary to low calorie diets. With the advent of insulin administration, mortality rapidly decreased and expectations increased that, as in other endocrine disorders requiring replacement therapy, diabetes would no longer be a problem after insulin was widely available. Indeed, the use of short-acting regular or crystalline insulin four times per day along with dietary restriction in the 1920s more closely parallels recommendations for control of the disease today than did the modes of therapy in vogue from the 1930s through the middle 1970s.