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Two Dilemmas of Diabetes

Norman M. Kaplan, MD
Arch Intern Med. 1991;151(7):1270-1272. doi:10.1001/archinte.1991.00400070048002.
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Two articles in this issue of the Archives1,2 report different aspects of the major problem facing the 7 million diabetic patients in the United States—premature death from either coronary disease or nephropathy, which are now the leading causes of mortality in diabetics. Both articles present pessimistic data, one1 suggesting lethal effects of the most widely used agent for the treatment of hypertension that is so common in diabetes, the other2 portraying the frequent development of nephropathy over a short term. Despite the dour data, both articles also provide a window of opportunity that could significantly reduce the current excess of early mortality in diabetics.

THE THREAT OF DIURETIC THERAPY  Warram et al1 present a retrospective analysis of the determinants of mortality in 759 diabetics, mostly insulin-dependent and middle-aged, followed up for a median of 4.5 years as part of a trial of laser therapy against blindness.


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