The rarity of rheumatic heart disease in diabetic patients is significant. Several authors have made references to the infrequency of the development of the former condition in these patients. In a study of fifty-eight cases of active rheumatic heart disease, I have been impressed by the high blood sugar tolerance and low blood sugar curve found to be present in many of these patients.
Joslin1 observed only six cases of acute rheumatic fever in approximately 6,000 cases of diabetes during the course of twenty-nine years. He said: "Rheumatic heart disease is of extraordinary rarity. In 1917 I could recall no case of diabetes under fifty years of age in which the patient complained of shortness of breath or presented the signs of an incompetent heart due to valvular disease of a definite and unquestionable rheumatic origin. In a series of fifty-six autopsies performed on young adult diabetics, only one
Steincrohn PJ. THE BLOOD SUGAR AND CARDIAC INVOLVEMENT IN RHEUMATIC FEVER. JAMA. 1938;111(20):1837–1838. doi:10.1001/jama.1938.72790460001007
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