With the discovery of insulin in 1921 and its general availability in 1922 and 1923, the prevention and successful treatment of diabetic ketoacidosis and coma became possible. As a result of this and the lower mortality from infections, the life expectancy of the diabetic patient has increased steadily, particularly in those with onset of diabetes before the age of twenty years. However, with increased duration of diabetes has come a high frequency of cardiovascular-renal disease as a cause of death (76.6 per cent of 5,009 deaths from 1960 to 1968). Such vascular disease affects both large and small vessels. The cause, prevention and treatment of these complications, including retinopathy, present the major problem and challenge in diabetes today. There is much evidence to suggest that if one could correct the metabolic defect (insulin deficiency) completely and continuously from its inception, the solution of the problem might well be in hand.

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