A virtually complete follow-up of diabetic patients treated at the Joslin Clinic since 1930 shows a downward trend in the mortality and corresponding improvement in the survivorship record. The mortality rates of diabetics, however, remain higher than those in the general population; the excess is relatively greatest at ages twenty-five to thirty-four and least in older patients. The death rates among diabetic females tend to be lower than among diabetic males, but the difference is less than in the general population. The survivorship rate among cases seen within a year of onset of the disease is better than in the aggregate experience. The pattern of causes of death among diabetics has changed radically. There has been a marked increase in the proportion of deaths caused by vascular disease, with small vessel disease playing a more and more important role. Reductions have been recorded for diabetic coma, diabetic gangrene and infections. Analysis of causes of death by age at onset and duration of diabetes show the effect of these factors on mortality and, in particular, the outstanding importance of diabetic nephropathy in juvenile diabetics with long duration ofdisease. Mortality from all types of vascular disorders is higher in diabetics than in the general population. In this experience the mortality for renal vascular disorders was seventeen times as high as in the general population.

World-wide morbidity and mortality statistics of the disease and data on the longevity and causes of death of diabetics are reviewed and summarized. Estimates of the global prevalence of diabetes which run as high as thirty million are unreliable. Known diabetics in the United States number about two million or eleven per 1,000 population. The proportion increases with age from about one in 900 for persons under twenty-five years of age to one in twenty for those sixty-five and over. For many countries deaths ascribed to diabetes comprise less than half of all persons dying with the disease. Death rates range from 23.2 per 100,000 population in Belgium down to 0.4 in South Korea. In most countries the death rate from diabetes among females exceeds that among males. Recent mortality trends, however, are more favorable for females generally than for males. Longevity of diabetics has substantially increased, although it remains significantly less than that of nondiabetics. Among patients of the Joslin Clinic first observed in 1940 and later, the survivorship rate after ten years exceeded 90 per cent for patients under thirty years of age, and even for sixty- to seventy-four-year-old patients it was 40 per cent. Today more than ever the chief problem is the prevention and control of vascular complications.

The electrolyte content of paraffin-stimulated, whole, mixed saliva obtained from patients with congestive heart failure is characterized by lower sodium, lower chloride, and higher potassium concentrations than saliva of normal subjects (1). Since these data suggested possible increased adrenal cortical activity in patients with heart failure, desoxycorticosterone acetate (DCA) was administered to nineteen normal subjects. It also seemed of interest to study additional pharmacological and physiological mechanisms that may play a role in the regulation of salivary electrolyte concentrations. Thus, the aims of this communication are to present: 1) Data on normal salivary concentrations of sodium, chloride, and potassium; 2) data relating to physiological mechanisms regulating the concentrations of salivary electrolytes; and 3) the effects on salivary electrolytes of ard methods of statistical analysis were employed (3); the "t" test was used to determine the statistical significance of mean differences between groups, and the method of "paired differences" was employed in evaluating the effects of pharmacologic agents on the electrolyte concentrations of saliva.Ten mgm. DCA in oil were injected intramuscularly, daily, for 5 to 15 days into normal subjects who received a regular diet and 10 gm. supplemental salt by mouth per day. Duplicate collections of saliva were collected on consecutive days both before and during the administration of DCA in order to test the reproducibility of the values for salivary electrolyte concentrations. The concentration of potassium was not measured in one of these subjects.Twenty-nine pairs of observations were made on the effect of 6 mgm. of subcutaneously-administered pilocarpine on the salivary electrolyte concentrations in subjects without cardiac disease. Thirty minutes after the injection of pilocarpine the subject began to chew paraffin again, and 30 ml. of saliva were collected (usually in about 10 minutes).Two ml. of Mercuhydrin® were injected intramuscularly into 10 patients with congestive heart failure and on a low salt diet. Collections of saliva were made at the time of administration, and at 1Ih, 3, and 24 hours, respectively, after the injection of the mercurial diuretic.Fifteen experiments on nine normal subjects on a regular salt diet were performed in which saliva was collected in two successive 10-minute periods in order to compare the salivary electrolyte concentrations during varying rates of flow. RESULTS Normal concentrations of salivary electrolytesFor the 73 control subjects on a regular salt diet, including the 16 values obtained from our earlier studies (1), the normal salivary concentrations of sodium, chloride, and potassium are 26.4 + 11.8, 29.0 + 8.8, and 19.7 ± 3.9 mEq. per L., respectively. 246

Life expectancy among diabetics in Iowa was estimated by using mortality data for the state. The Iowa general population had a higher life expectancy than the diabetic population at every age, except at ages 80 and over for men and ages 75 and over for women. The estimated life expectancy of 59.7 years at birth for diabetic males and of 69.8 years for diabetic females was lower than that for the Iowa general population by 9.1 years among males and 6.7 years among females. This difference narrowed with increasing age. The Iowa figures were similar to the estimates of life expectancy for the diabetic popullation of Pennsylvania.

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