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Summary  Forty-eight patients with a mean duration of diabetes of 36 years were examined in an attempt to establish the clinical and social factors responsible for this unusually long survival. The exceptional course of these patients was demonstrated by a comparison with 48 matched patients 9 of whom had died within 10 years and 19 within 25 years of the onset of diabetes. — Of the 48 patients examined, 24 had received earlier the Quarter-Century Victory Medal for having passed 25 years of documented diabetes without vascular complications. The remaining 24 Long Term Diabetics were matched to the Medal patients as to sex, age and duration of diabetes. — A striking feature of all 48 patients and especially the Medal group was the low prevalence of large vessel disease. Microangiopathy was more frequent. Thus nonproliferative retinopathy was present in 5 of the Medal patients and in 11 of the Long Term Diabetics. Proliferative retinopathy was found in 10 Long-Term Diabetics, but in none of the Medal patients. Clinical evidence of nephropathy was found in 8 and neuropathy in 28 of the 48 patients. — A relatively high prevalence of parental longevity and a low frequency of obesity and of heavy cigarette smoking, were found in the Medal patients. Other factors apparently contributing to the favourable prognosis in the 48 patients examined included regular sports and other physical activity (93%) and maintenance of fair to good diabetic control (79%). Thirty-five percent of the patients had close relatives in the medical profession.

Twenty-five to forty-five years of diabetes with and without vascular complications