In view of the present state of our knowledge, the title of this paper is ambitious. I may begin with the unequivocal statement that neither my associates nor I have any magic formula which predictably will prevent vascular disease in the diabetic. However, I should like to consider with you some of the observations of others, and some observations of our own which bear upon this subject.
In our own thinking, diabetes mellitus is divided into two diseases: the form that occurs typically in middle age, which, from a functional standpoint, we consider as presenting essentially a problem in hypoinsulinism with associated metabolic abnormalities; and juvenile diabetes, which represents a combined problem of hyperpituitarism and hypoinsulinism.
In both groups one deals with two vascular problems. One, atherosclerosis, is identical with that which afflicts the average nondiabetic member of the American population, if he lives sufficiently long. Statistically, the onset of this vascular disease in the diabetic is earlier and the progress more rapid. The other is a rather specific disease, in which characteristic changes occur in the retinal and glomerular capillaries. This latter problem is most distressing in the juvenile diabetic, because of its occurrence at an early age.
Atherosclerosis in Association With Diabetes With the possible exception of cancer, no field of clinical investigation is receiving more attention than that of degenerative vascular disease. Since atherosclerosis in the diabetic appears earlier and progresses more rapidly than in the nondiabetic, and since we have some knowledge of the endocrine and metabolic abnormalities which occur in diabetes and which, at least in part, are presumably related to the pathogenesis of the vascular disease, it seems logical to conclude that the answer to the over-all problem of atherosclerosis might very well be found more readily in the diabetic than in the nondiabetic population.