Vascular Complications of Diabetes Mellitus*
VASCULAR disease is by far the most serious complication of clinical diabetes mellitus. Atherosclerosis of the medium-sized arteries, according to Warren and LeCompte,1 is the largest single cause of death among diabetic persons. The most alarming feature is the high incidence of serious vascular degeneration in relatively young people who have had diabetes for a long time. Coronary thrombosis is the cause of death in diabetics less than 40 years of age ten times as frequently as in nondiabetics of the same age.2 Patients in this age group who have had diabetes mellitus for more than 20 years almost never escape the development of intercapillary glomerulosclerosis.
Clinical and Pathologic Manifestations
The most important clinical effects are caused by involvement of the coronary and the cerebral arteries, the arteries of the legs, the arterioles of the kidneys, and the capillaries of the glomeruli and the retinas. The atherosclerotic lesion is characterized by focal thickening of the intima with the deposition first of lipid and later of calcium. Renal arteriosclerosis associated with chronic glomerulo-nephritis and hypertension is much more frequent and severe in patients with long-standing diabetes, particularly young patients.
Intercapillary glomerulosclerosis is the name used originally by Kimmelstiel and Wilson to describe the hyaline masses between the glomerular tufts in diabetes. They formerly were thought to originate between the capillaries. Recently, Bergstrand and Bucht,3 using the electron microscope, have demonstrated that the early lesions are in the capillary basement membrane and in the basement membrane of Bowman’s capsule. The disease may. . .