[Late diabetic sequelae]

Diabetic patients are exposed to higher risk of morbidity and mortality. However, it is difficult to define this in advance and to predict the degree of inability for work. The risk is depending on type of diabetes, age of manifestation, age of the patient course and duration of the disease and mainly from glycemic control. Educational programs may markedly ameliorate the overall situation and decrease of risk of late complications which may threat kidney, eyes, nerves and the cardiovascular system. However, it is an erroneus notion that most diabetics may be crippled by complications of their disease which may result in unwarranted bias against them in both work and leisure activities. Most diabetics may undertake any occupation or hobby, of course with some exceptions when hypoglycemia due to insulin or hypoglycemic agents represents risk for themselves and other persons. Those patients may not serve as pilots and cannot hold public service vehicle driving licences. They should not take over the supervision in power-stations etc. Ordinary driving licences can be held by diabetic patients if on insulin or not, provided that they are otherwise physically fit and do not suffer from blackouts. From many studies it is known that the rate of accidents is not higher with respect to diabetic patients than in the normal population. Life assurance premiums are often raised by amounts which depend on the result of a medical examination but it is very important that the judgement is not made on the basis of a single checkup at a given time. To get information about the presence or development of late complications which have a very broad spectrum it is necessary to have insight into the course of the metabolic disorder and the tendency of worsening or amelioration.