Observations on the pathogenesis, complications and treatment of diabetes in 115 cases of haemochromatosis

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      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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