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A Synopsis of the Record

The prolongation of life afforded diabetic patients by advancements in diagnosis and treatment has unfortunately been accompanied by an increased incidence of vascular complications. Aside from problems related to early development and rapid progression of arteriosclerosis and athero-sclerosis, the clinical course of diabetes mellitus is also complicated by a specific type of angiopathy.

Whereas arteriosclerosis and atherosclerosis are viewed as nonspecific diseases of the larger blood vessels, the angiop-athy associated with diabetes is considered to involve specifically the small blood vessels and microcirculation of the body.

. The manifestations of diabetic microangiopathy are most readily seen and recognized in the kidney, and particularly in the renal glomerulus. Under the light-microscope, histologi-cal evidence of diabetes in the glomerulus is characterized by diffuse glomerulosclerosis and in more advanced disease by nodular glomerulosclerosis, frequently referred to as Kim-melstiel-Wilson nodules. With the electron-microscope, the true specificity of the glomerular lesions is obvious, and this is seen as a thickening of the glomerular capillary basement membrane. Thickening of the basement membrane from the normal of about 3,000 angstroms may be quite limited in fairly early cases of diabetes. In long-standing cases a thickness of 10,000 angstroms may be reached.

The material of which the thickened basement membrane is composed has been identified as glycoprotein. It is suspected that the thickening may be due to an aging process in which there is a decreased removal of the material in the course of normal turnover.

In a comprehensive discussion of retinal lesions associated with diabetes, it was emphasized that both kidney and retinal lesions involve the capillary walls and show deposition of

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Pfizer

metachromatic material. It was noted that in contradistinc-tion to the renal vascular changes where the lesions involve the arteries, the microaneurysms found in the retina occur on the venous side of the circulation. Characteristic of the retinal lesions on ophthalmologic examination is their localization in the posterior pole, while aneurysms associated with diseases other than diabetes are usually found in the periphery of the retina.

Although the panelists suspect that the basement-mem-brane thickening found in diabetes occurs all over the body, this change is not as striking as in the kidney and eye, and further research in the field is required before definitive answers can be given.

In discussing factors other than insulin deficiency as the cause of diabetic angiopathy, mention was made of a possible relationship with the pituitary growth hormone. Methods intended to destroy or interfere with pituitary function were enumerated. Although dramatic effects have been obtained with these methods in selected cases, not all patients survive the procedures and if they do survive, patients so treated do not necessarily improve.

Since excess growth hormone production generally has not been found in the diabetic population, the panel members felt that a study of other factors related to the actions of growth hormone might provide more insight into the problem.

With no completely satisfactory methods available either to prevent or treat diabetic angiopathy, maintenance of proper diet and blood sugar regulation in the diabetic patient remains of primary importance. Weight reduction, when in-dicated, is a desirable goal. Attention to the constituents of the diet, with regard to the use of certain fats and vitamins, was also strongly recommended.