Prognosis for Juvenile Diabetics With Late Diabetic Manifestations1

Prognostic studies were made on a series of 101 juvenile diabetics (onset before the age of 30 years) who developed late diabetic manifestations in the form of retinopathy and/or proteinuria between 1944 and 1958 and in whom the beginning of these manifestations could be dated with reasonable accuracy. Retinopathy developed after the diabetes had been present for 11–20 years, average 16.9 years, the nephropathy as a rule some years later. The patients were followed for an average of 9.5 years after the first complication had been diagnosed. About half the patients developed persisting proteinuria during the follow‐up period. Of this group 63% died, 83% developed uraemia, and 58% severe retinopathy, as a rule accompanied by permanent visual impairment. The other half did not develop persisting proteinuria in spite of a longer duration of diabetes. Only 2% of this group died, 6% developed uraemia and 25% severe retinopathy. Factors of prognostic importance appear to be: 1. Appearance of proteinuria before or within five years after the diagnosis of retinopathy; 2. Occurrence of persisting proteinuria; 3. Proteinuria exceeding 0.2%; 4. Occurrence of retinopathy and/or nephropathy before the diabetes has been present for 15 years; 5. Repeated episodes of diabetic coma; 6. Onset of diabetes between the ages of 10 and 20 years.