SUMMARY

Summary Factors considered of primary importance in the development of late complications of diabetes were studied in an adult series of 217 patients, treated at the medical department Växjö Hospital and in a childhood series consisting of 42 juvenile diabetics treated at the pediatric department University of Lund. Both series were on a free diet. Attention was directed mainly to the importance of diet and to problems bearing on liver metabolism and endocrine function and the results are accounted for against the background of literature‐studies of earlier investigations in this field. The observations of interest may be summarized as follows: 1. Of the Växjö series, which consisted of patients in whom diabetes had occurred before the age of 40 years, the following late complications were noted after 5–25 years of duration of diabetes: Nephropathy in 65 per cent, retinopathy in 60 per cent and hypertension in 65 per cent. Nephropathy was practically always the first of these late symptoms. Of the patients who had had their diabetes for more than 10 years, only 7 (6.2 percent) were free of vascular complications. The Kimmelstiel‐Wilson syndrome was diagnosed on clinical grounds in 24 cases and in one third of them the diagnosis was confirmed post mortem. The serum hexosamine was found often to be increased, especially in the presence of vascular lesions. 2. Of the Lund series (19 boys and 23 girls) the liver parenchyma was found to be involved in 40 per cent. Typical of these liver complications is that they appear about 5 years after the onset of diabetes, that they are fairly often (about 30 per cent) seen in combination with moderate retardation of growth and sometimes (about 20 per cent) with co‐existent or subsequent vascular complications in the form of nephropathy and/or retinopathy. Endocrine function studies in the Lund series suggested that a primary endocrine non‐pancreatogenic form of diabetes is rare and that the functional patterns of the adrenal cortex during ketosis or “stressful life situations” readily changes. The observations described above suggest the following conclusions: 1. The development of long‐term diabetes is influenced not only by duration of the diabetes but also by any impairment of liver function and by endocrine factors probably mediated via the adrenohypophyseal axis and by stressful life situations. 2. The disturbed liver function and endocrine homeostasis of the body is ascribable or at least favoured by unrestricted diet. 3. Dietary restrictions should be observed in the management of diabetes, especially as a prophylactic measure against long‐term diabetes.