JOSIAH BROWN, M.D.; BRADLEY R. STRAATSMA, M.D.; LEONARD APT, M.D.; ROBERT E. CHRISTENSEN, M.D.; ROBERT Y. FOOS, M.D.; ARTHUR GORDON, M.D.; HARRISON LATTA, M.D.; THOMAS H. PETTIT, M.D.; ROBERT W. RAND, M.D.; NATHAN H. ROTH, M.D.
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The cause of diabetes mellitus in man is still uncertain. Theories of etiology have gone full circle, starting from pancreatic disease to absence of consistent pancreatic pathology to demonstration of normal amounts of insulin in adult-onset diabetes, and now to relative insulin deficiency. It is now accepted that a long period of prediabetes precedes the onset of hyperglycemia or glucose intolerance, the latter often appearing incident to a metabolic stress such as obesity, infection, pregnancy, or corticosteroid or growth hormone excess.
Renal disease in diabetes may be the cause of death in one half of juvenile-onset cases and consists of four types of glomerular lesions: nodular, diffuse, "fibrin cap," and "capsular drop." Diffuse or nodular lesions, or both, are found in almost all diabetics with clinical evidence of renal disease; the condition is usually progressive. There is a direct correlation between the severity of the diffuse glomerular lesion and clinical renal disease—proteinuria, impaired renal function, hypertension, and nephrotic syndrome.
Diabetic retinopathy is best considered as a syndrome, characterized in its full-blown form by angiopathy, exudates, proliferative changes, and vitreous hemorrhages. This condition is present to some degree in approximately half the patients with diabetes mellitus. The course of diabetic retinopathy is variable, and the prognosis is therefore difficult to determine, but a substantial percentage of the patients eventually develop vision impairment from diabetic retinopathy. Thus, it constitutes one of the leading problems, if not the leading problem, in ophthalmology today.
In terms of management, every effort should be made to prevent retinopathy by giving the patient the benefit of careful and continuing medical management. When the problems of diabetic retinopathy do develop, there are several methods of therapy that we now use—selectively, cautiously, and with an awareness that there is still much to be learned about this disorder and about its response to treatment.
BROWN J, STRAATSMA BR, APT L, et al. Diabetes Mellitus: Current Concepts and Vascular Lesions (Renal and Retinal). Ann Intern Med. 1968;68:634–661. doi: https://doi.org/10.7326/0003-4819-68-3-634
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Published: Ann Intern Med. 1968;68(3):634-661.
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