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July 21, 1989

From an Excess of Fat, Diabetics Die

JAMA. 1989;262(3):398-399. doi:10.1001/jama.1989.03430030086041

In 1927, Joslin1 prophetically wrote: "I believe the chief cause of premature development of arteriosclerosis in diabetes, save for advancing age, is an excess of fat, an excess of fat in the body (obesity), an excess of fat in the diet, and an excess of fat in the blood. With an excess of fat diabetes begins and from an excess of fat diabetics die, formerly of coma, recently of arteriosclerosis." Despite the seven decades that have passed and the considerable knowledge that has been gained since that time, physicians continue to pay little attention to the control of plasma lipid disorders in their diabetic patients. This is the conclusion reached by Stern and colleagues2 in this issue of The Journal.

It is well recognized that coronary artery disease is approximately 2.5 times more common in diabetics than in nondiabetics. The comparable figure for peripheral vascular disease is an