OBSERVATIONS ON CLINICAL PATTERNS OF DIABETES MELLITUS IN INDIA

Several points of difference can be made between features of diabetics of the Western world and the tropical countries. In addition to a lower incidence of juvenile diabetes and diabetic coma in the tropics there is a high incidence of marked underweight among diabetics of the older age group as well as the young.

Observations on ninety-six patients at Cuttack, India, reveal that apart from a few cases of juvenile diabetes and a moderate number of elderly-obese patients there is a high incidence of atypical cases. Some of these are young and very lean but require large doses of insulin for control and are not prone to ketosis (“J”) type. Others are middle-aged and generally responsive to sulfonylurea compounds but are very lean even at onset of disease (elderly-lean type).

Division of the patients into two groups, one seen in the hospital wards and the other in the private clinics (domiciliary), makes it apparent that the unusual types of diabetics are for the most part the poorer hospital (ward) patients. Of these 39.8 per cent are “J” type and 43.7 per cent are elderly-lean types compared with zero and 4.9 per cent, respectively, in the domiciliary group.

The hospital patients have been subject to chronic undernutrition and most of them take large carbohydrate meals at long intervals, often only one a day. It is postulated that imposition of this dual stress of intermittent starvation and overload on carbohydrate metabolism may be related to the atypical patterns of clinical diabetes.

THE COURSE OF JUVENILE DIABETES TREATED WITH UNMEASURED DIET

Prospective observations over a ten-year period of 108 juvenile diabetics treated with unmeasured diet are reported. Description is given of the patient material, circumstances at diagnosis, and course of management.

Hyperglycemia and glycosuria were common, and ketoacidosis occurred often. Total plasma lipidswere elevated. Chemical control was unsatisfactory according to current popular standards.

Growth was less in those with onset before puberty, and the men were underweight. Infections may have been excessive. Adolescent emotional difficulties were exaggerated. Educational, athletic, and vocational achievements probably equaled the normal expectation.

Pregnancies were only 55 per cent successful when fetuses were viable.

The prevalence of degenerative complication was similar to that reported from restricted diet studies. No factors were found to account for vascular disease. It is surmised that the general course of the patients compared favorably to those reported to be following diets. It is also suggested that if diet control does have favorable effects, then those reported to follow diets are not following them, or factors other than control are more influential on the progression of juvenile diabetic vascular disease.

REVERSAL OF RETINAL VASCULAR CHANGES IN DIABETES

Serial retinal photographs have been taken of a fourteenyear-old girl with long-standing, poorly controlled diabetes mellitus who presented with severe hypercholesterolemia. Selective fluorescence contrast photography revealed masses of dilated hairpin capillary loops in the retina. Over a period of eight months of strict diabetic control the retinal vasculature returned to normal. The findings are discussed with reference to the origin and reversibility of retinal vascular changes in diabetes.