To the Editor.
—The August 1973 issue of the Archives carried a very interesting article on renal disease as being the first manifestation of diabetes mellitus. Now, while this article is interesting, it has to be interpreted with great caution. Here are some of the reasons for my statement.First, I found no convincing proof of the alleged recent character of the patients' onset of diabetes. In fact, unless postprandial sugar determinations are performed, many a mild or even not so mild diabetic will escape diagnosis because of the unreliability of the fasting blood sugar test in such patients. I am sure that every internist has seen such cases.Second, in my own experience and in that of my collaborators, there is no parallelism between the "mildness" of diabetes and the gravity of its renal manifestations. Among the 100 or so diabetics on whom I have performed renal biopsies, I