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December 9, 1939


JAMA. 1939;113(24):2137-2138. doi:10.1001/jama.1939.02800490033008

The frequent occurrence of glossitis and stomatitis in persons with diabetes is a matter of common knowledge. The usual explanation of such lesions, particularly when complicated by monilial or spirochetal infection, has been "lowered resistance" or "a toxic state" due to hyperglycemia. Since the type of glossitis and stomatitis usually seen in diabetes is in all respects similar to that seen in mild endemic pellagra or in acute pellagra secondary to parenteral nourishment with dextrose solutions, it seems probable that the cause may be an avitaminosis caused by abnormal carbohydrate metabolism. Three cases recently observed would seem to substantiate this hypothesis. In two instances, signs of avitaminosis developed when carbohydrate intake and insulin dosage were rapidly increased; in the third, signs of nicotinic acid and riboflavin deficiency were present on admission, disappeared for a short time under an abundant diet and small doses of insulin but recurred when the diet