Type 1 diabetes in the young: the harvest of sorrow goes on

Excerpt

Elliott Joslin was 53 years old and had spent his career watching children dying of diabetes. In 1922 he watched in awe as insulin restored the moribund to life, and realised that ‘a new race of diabetics has come upon the scene’ [1]. He could only speculate as to how long they would survive. Eighty years later, hundreds of thousands of children are kept alive by insulin, and we too must keep asking what their future will hold. The pioneers of insulin therapy found that only one patient in two who started insulin before the age of 20 would see their 55th birthday [2]; mercifully, children on insulin now live very much longer. One important reason for this, as discussed by Peter Rossing in this issue of Diabetologia [3], is that the proportion destined to develop diabetic nephropathy continues to fall. For example, the cumulative incidence of persistent proteinuria in Danish children diagnosed from 1933 to 1942 was 40.6% after 25 years of diabetes, compared with 26.9% in those diagnosed from 1953 to 1962 [4]. More recently, a longitudinal study from Linköping in Sweden found that 30.3% of children diagnosed from 1961 to 1965 developed nephropathy within 25 years, as compared with 8.2% in the 1966–1970 cohort, with indications that subsequent cohorts are doing better still; the number needing laser treatment for retinopathy had also fallen [5]. This accords well with a Danish report that 31.1% of children and young adults diagnosed from 1965 to 1969 developed nephropathy within 20 years, as compared with 13.7% of those diagnosed from 1979 to 1984; here too there was a clear fall in the rate of proliferative retinopathy [6]. …