Long-Term Diabetes
We have examined 92 patients who have had diabetes mellitus for 40 years or longer. Their average age at diagnosis was 19 and most had attended the clinic at King's College Hospital for more than 30 years.

Absence of severe complications was striking. Over a third of the patients showed no retinopathy; in 16 there were proliferative changes but only six patients were blind. Of other complications, two patients were in early renal failure and two had symptomatic neuropathy. Clinical or E.C.G. evidence of ischaemic heart disease was found in one-third of the group—more often in women than in men. More than half the patients had no evidence of peripheral vascular disease. Few were overweight and none hypertensive.

Accurate assessment of diabetic control over 40 years is impossible but, as far as could be judged, there was no correlation between control and the incidence of complications.

We conclude that long-standing diabetes is compatible with good health, diabetic complications are not inevitable and, when present, their progress may be slow and unpredictable; furthermore they are often not of great significance.

Apart from normal weight and blood-pressure, we were not able to identify reasons for these patients having fared so well.