MORTALITY AND OUTCOME OF INSULIN-DEPENDENT DIABETES IN SOWETO, SOUTH-AFRICA

Sixty-four insulin-dependent (Type 1) diabetic patients (IDDM) in Sowe to, South Africa were followed over a 10-year period. Patients were as sessed in 1982 and again in 1992. There were 10 deaths (16 %), half of which were due to renal failure. Ketoacidosis, hypoglycaemia, and sep sis accounted for the rest. At the 10-year follow-up mean age (+/- SD) was 32.4 +/- 5.0 years and diabetes duration 13.6 +/- 2.6 years. Reti nopathy affected 52 %, peripheral neuropathy 42 %, and nephropathy 28 % (all significantly increased from the 1982 assessment). Microalbumin uria and autonomic neuropathy were also common. Serum cholesterol was over 6.5 mmol l(-1) in 19 %, hypertension affected 22 %, and 28 % were cigarette smokers; though no patient had evidence of macroangiopathy. We conclude that IDDM in South Africa is associated with excess morta lity, a significant proportion of which is related to nephropathy. Dia betes of long duration is now not uncommon in South Africa, and althou gh diabetic complications frequently occur, most patients have good li fe quality and freedom from large vessel disease.