Diabetic gangrene in Japan: analysis of 487 cases

Diabetic gangrene was thought of as a rather rare complication in Japan. Since the first report in 1917, only 16 cases were reported up to 1945. However, the number of reports increased rapidly in the manner of a geometric series after 1965. Sex and age distributions of the syndrome in Japan corresponded closely with those of Western countries. A distinct tendency in the inducement of gangrene was found, i.e. thermal trauma had preceded 43.6% of the cases. This might be the result of the local habit of warming the feet using hot-water bottles or foot warmers. The number of patients with normal pulses in the affected extremities in Japan was distinctly higher compared with that reported in Western countries. But functional and morphological changes in large peripheral vessels were frequently demonstrated when more detailed examinations were conducted. The cause for the rapid increase in the incidence of diabetic gangrene has not been elucidated, but changes in lifestyle may be partly responsible. The most conspicuous change was the increase in meat and fat intake during the 1960's. The changes in total calorie, total protein or sugar intake over this period were inconspicuous. Changes in dietary habits seem to be responsible, but further research will be necessary to clarify the details.