Long-term study of mortality and vascular complications in juvenile-onset (type I) diabetes.

A cohort of 372 insulin-dependent diabetic children, diagnosed between October 1949 and December 1960, were followed-up until December 1976 by the same team of physicians. At the time of diagnosis all patients were under 16 yr of age and were given standardized treatment which did not change from 1949 to 1976. The therapy consisted of daily insulin adjustment based on clinical assessment, the degree of physical activity, and the results of semi-quantitative urine tests for sugar and ketone bodies. These tests were systematically performed before breakfast, lunch, and dinner. Diet was normal, unmeasured, rich in carbohydrates (approximately 60%), and quantitatively unrestricted unless the patient was overweight. Rates for mortality and for the principal complications among this cohort were computed by the actuarial method. During the 26 yr of study, 26 deaths occurred, 16 of which were directly connected with diabetes. After 16 yr of follow-up, rates of proteinuria and hypertension were 4% and 2.1% respectively. The incidence of retinopathy reached 27%, including 1.5% proliferative retinopathy. After 26 yr, the rates rose to 14% for proteinuria, 16% for hypertension, and 85% for retinopathy, including 18% in the proliferative phase.