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The cause of death and the patho-anatomical changes of various organs were analyzed in 3, 151 diabetic autopsy cases, which were collected from Annual Reports of Pathological Autopsy Cases (1958-1970) published by the Japanese Society of Pathology. In 2, 754 primary diabetics, the causes of death were as follow: diabetic coma 4.5%, arteriosclerotic cardiovascular diseases 41.2% (renal 19.3%, cerebral 11.1%, coronary 6.5%), infections 19.4% (tuberculosis 4.6%, lung 5.8%, urinary tract 3.3%, biliary tract 1.0%), malignant neoplasms 15.9% (stomach 3.9%, lung 3.7%), miscellaneous 15.2%. Diabetic coma was most common in the first decade and decreased with age. Infections were high in the third and fourth decades but showed no tendency to increase with age. Among the infections, the highest was purulent pulmonary disease. The arteriosclerotic cardiovascular disease was not seen in the first and the second decade as the main cause of death. They appeared at the third decade and increased with age. As compared with the reports from American and European countries, a high incidence of diabetic nephropathy and a low incidence of ischemic heart disease are characteristic of this series. As a cause of the low incidence of ischemie heart disease, the low consumption of fat in this country was proposed. Diabetic glomerulosclerosis was high in the third to sixth decades, especially in females. The incidence of cerebral infarction in this diabetic series was significantly higher than that in the general population, but that of cerebral hemorrhage was not different from that in the general population. 397 cases were classified as secondary diabetes (12.6%). These consisted of 96 pancreatic cancer, 25 pancreatitis, 175 liver cirrhosis, 22 hemochromatosis, 16 endocrine diseases and 63 steroid diabetes.

Causes of death in 3151 Diabetic Autopsy Cases