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Abstract
The findings in 115 patients with idiopathic haemochromatosis seen personally by us
have been analysed, with particular reference to the incidence, pathogenesis and effects
of the diabetes. Clinical diabetes developed in seventy-two patients (63 per cent).
The previously held view that the complications of diabetes are rare in haemochromatosis
was not supported. Nephropathy, neuropathy and peripheral vascular disease, either
singly or together, were found in nine patients (22 per cent). A similar number showed
a mild retinopathy with microaneurysms or exudates or both. Unusual features of the
diabetes were the frequency of insulin resistance, which occurred in five patients
shortly after diagnosis, and the high incidence of insulin fat atrophy.
A family history of diabetes was more common in the diabetic group—25 per cent had
a first degree relative with diabetes as compared with 4 per cent in the nondiabetic
group. An abnormal oral glucose tolerance test was found in one third of the patients
without clinical diabetes; in some of them who were further examined by an intravenous
glucose tolerance test, elevated serum insulin levels were also found. Such changes,
indicative of insulin insensitivity, are described in varieties of cirrhosis not due
to iron overload and are also associated with an increased incidence of diabetes.
Thus the presence of cirrhosis, a family history of diabetes and direct damage to
the pancreas by iron deposition may all be involved in the development of diabetes
in haemochromatosis. This might explain why only some of the patients (40 per cent
in this series) with diabetes showed improvement in carbohydrate tolerance following
venesection therapy.
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Article info
Publication history
Received:
February 18,
1971
Identification
Copyright
© 1972 Published by Elsevier Inc.
