Insulin dependent diabetes mellitus: a lethal disease in the developing worldBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6957.754 (Published 24 September 1994) Cite this as: BMJ 1994;309:754
- K G M M Alberti
Some patients are dying for lack of insulin
Before the discovery of insulin in 1921 the diagnosis of insulin dependent diabetes mellitus was tantamount to a death sentence, with 40% or more diabetic patients dying of ketoacidosis. This changed dramatically after 1921, with ketoacidosis becoming a minor cause of death. Life expectancy increased appreciably, although not to the extent hoped for because of the emergence of nephropathy and ischaemic heart disease.
Now, with improved treatment and prevention, life expectancy is good for a patient with newly diagnosed insulin dependent diabetes mellitus. Thus someone in whom the disease was diagnosed before the age of 17 in Pittsburgh between 1950 and 1981 had an 88% chance of surviving 20 years.1 Survival now would be even better, and the results of the recent diabetic control and complications trial give hope for further improvement.2
Sadly, this is not the situation worldwide. Insulin dependent diabetes mellitus is not only a disorder of developed countries: it occurs everywhere, although its incidence varies widely from about 2-4 per 100 000 in parts of sub-Saharan Africa3 to 14 per 100 000 in Britain. A substantial number of children are affected, and in …