Atherosclerotic Gangrene of the Lower Extremities in Diabetic and Nondiabetic Persons

Abstract

In an autopsy study of 50,184 nondiabetic and 1878 diabetic persons who were more than 40 years of age at death, 186 instances of atherosclerotic gangrene (of 1 or both lower extremities) were found in the nondiabetic and 393 instances in the diabetic patients. Atherosclerotic gangrene is 53 times as frequent in diabetic as in nondiabetic men more than 40 years of age, and 71 times as frequent in diabetic as in nondiabetic women of corresponding age. About 2/3 of the cases of atherosclerotic gangrene in men less than 80 years of age and about 1/4 of those in men more than 80 years old are the result of diabetes. Approximately 80% of atherosclerotic gangrene in women results from diabetes. The development of gangrene in a diabetic person is not related to the requirement of insulin or to the known duration of the diabetes. The gangrene was unilateral in 74% of the diabetic and 79% of the nondiabetic persons. Infection plays an important role in diabetic gangrene, but it is of minor importance in nondiabetic patients. The average period of survival after amputation is longer in the diabetic than in the nondiabetic patients. Hyalinization of the juxtaglomerular segment of the afferent glomerular arteriole was found in 87.3% of the diabetic, but in only 10% of the nondiabetic persons. It is suggested that advanced hyalinization of the juxtaglomerular segment of the afferent arteriole indicates either frank diabetes or a prediabetic state. With the presence of intercapillary glomerulosclerosis, 48% of the diabetic persons with gangrene may be recognized as diabetic, by means of microscopic examination of the kidneys. If we accept advanced hyalinization of the juxtaglomerular segment of the afferent arteriole as diagnostic of diabetes, the number of positive diagnoses becomes 71%.