Vascular disease and its devastating end-results constitute one of the major problems faced by the medical profession today. The steadily increasing duration of life, with large numbers of the population living to sixty-five years of age and over, is bringing in an era in which degeneration of all systems must constitute a challenge. The diabetic too must pay the price of living longer by being more likely to develop degenerative disease and its complications.
The remarkable contributions in the field of vascular disease during the last three decades have added to the insight into these disorders. It is commonly considered that involvement of the vascular system is inevitable in the diabetic, provided he lives long enough. One does see, however, a few individuals with diabetes of many years’ duration who seem to have escaped the ravages of time and have no demonstrable changes in their vascular tree.
That arteriosclerosis in diabetes increases with the duration of the disease is evidenced by the figures quoted by Root, who noted that this process as a cause of death increased from 17 per cent at an average age of 44.5 to 70 per cent at an average age of 65.3.
As will be discussed below, diabetics seem to have a greater incidence of arteriosclerosis and atherosclerosis than does the general population. Although these conditions appear to differ in no respect from those found in nondiabetics, nevertheless, there is evidence that certain vascular changes, particularly in the retina and kidneys, may well be peculiar to the complicated metabolic disturbance found in diabetes mellitus. In many organs of the diabetic, vascular lesions are found with special frequency. They will be more fully described as the individual anatomic units are discussed. White, who studied juvenile diabetics who had lived twenty years or more after developing the disease, noted some evidence of vascular disease in 92 per cent, an astounding figure.
Factors playing a role in this increasing incidence, such as an inheritance of a defective vascular tree, seem to have some influence. Nutrition in a broad sense, infection (which is notoriously more frequent in the diabetic), so-called toxic factors, hormone imbalance, and capillary fragility all may play a part, although one cannot justifiably accuse any one of these.