1 Chairman, University of Toronto Medical School, Toronto
Total absence of vascular disease occurred infrequently after 20 years of diabetes, but 8% only of the 702 twenty-year survivors died from their vascular lesions. Juvenile diabetic patients survive to more than middle age. Nearly all (oven 90%) after 30 and after 25 years of diabetes were free from blindness, gangrene and cerebrovascular accidents. Two-thirds were free from the potentially incapacitating lesions proliferating retinitis and vascular nephritis. Vascular lesions did not appear to he dependent upon duration of diabetes alone. Poor control of diabetes paralleled both the degree and the frequency of the vascular lesions. Sepsis, too, appeared to be an important inciting factor. Some remedial measures have been attempted with apparent success. Despite the preponderance of vascular lesions after 20 years, they are not disabling in the majority of the cases. It is apparent that, just as lethal coma, lethal sepsis and lethal tuberculosis are no longer inevitable, lethal vascular disease can be averted or, at least, postponed.