1979 Volume 16 Issue 6 Pages 489-497
Diabetic autopsy cases were collected from the Annual Report of Pathological Autopsy Cases published by Japanese Society of Pathology for the year 1971-1975. Total number of collected cases were 2921 and 2515 cases were classified as primary diabetics. The causes of death and pathoanatomical findings in various organs were analysed in these primary diabetic cases, and following results were obtained.
1) The main causes of death were cardiovascular disease (40.2%), infections (19.6%), malignant neoplasms (19.4%), diabetic coma (2.4%) and hypoglycemia (0.8%).
2) In cardiovascular diseases, the leading cause was diabetic nephropathy (15.0%), followed by cerebral (12.5%) and coronary artery disease (9.2%).
3) Tuberculosis and pneumonia, which had been frequent among infectious diseases before 1970, decreased to 2.3% and 0.6%, respectively. Infection in urinary tract (4.1%) was the most frequent in infectious diseases, and its frequency was higher in female than in male.
4) In malignant neoplasms, cancer of the stomach (4.0%), lung (3.8%) and liver or biliary tract (3.5%) were frequent.
5) The frequency of arteriosclerotic cardiovascular diseases and malignant neoplasms as causes of death increased with age. Infectious diseases increased with age until 5th decade and remained similar levels during 6th to 8th decade, but it increased again after 9th decade. Diabetic coma was the most common cause of death before 3rd decade and decreased with age. Diabetic nephropathy appeared as a cause of death in 3rd decade and became the leading cause of death in 4th decade, then decreased with age.
6) In pathoanatomical findings the frequencies of glomerulosclerosis, myocardial infarction, cerebral infarction and hemorrhage were 34.1%. 15.1%, 14.8% and 6.9%, respectively. Myocardial and cerebral infarction were found at 4th decade and increased with age, while no change with age was observed in cerebral hemorrhage. Diabetic glomerulosclerosis was found in the cases of 2nd decade. In 4th decade glomerulosclerosis was revealed in 49.4% of the cases. Although the frequency of glomerulosclerosis decreased with age after 5th decade, it was higher than those of other vascular lesions.
These results showed that the characteristics in the causes of death of diabetics in Japan are a low incidence of coronary artery disease and a high incidence of diabetic nephropathy. These are the same as those pointed out in our previous report on the cases before 1970. But the dietary fat intake in Japanese is increasing recently. Moreover, the elongation of life span results in increase in number of elder diabetics, and consequently increase in the frequency of the death due to arteriosclerotic cardiovascular diseases. On the other hand, the incidence of death due to diabetic nephropathy in younger patients will decrease reflecting the progress of the therapy and medical care. It is expected that the incidence of arteriosclerotic coronary disease will increase and that of diabetic nephropathy will decrease.