The relationship of abnormal vascular responses to retinopathy and nephropathy in diabetics.

Abstract

The increasing importance of vascular disease in the diabetic is reflected in recent mortality studies. Whereas in the preinsulin era approximately 18% died of cardiorenal vascular disease, this figure had risen to 54% in 1936 and to as much as 76% in 1955.1Furthermore, in juvenile diabetics surviving 25 to 30 years of their disease, 88% have retinopathy (46% retinitis proliferans), 39% have albuminuria, and 44% hypertension.2 Only little is known about the etiology and pathogenesis of the vascular disease. It is evident, however, that the more specific lesions, retinopathy and glomerulosclerosis, result from a slowly progressive degeneration of the smaller blood vessels. Retinopathy and glomerulosclerosis are related to various factors, including the duration of diabetes.3,4 With use of an ophthalmoscope (magnification X 15), the initial visible change found in the retinopathy of young diabetics is venous congestion (phlebopathy) and small sanguinolent dots (microaneurysms).5,6By using