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Seventy-three patients with diabetic neuropathy have been followed for periods ranging from two to four and three-quarter years. Symptoms of neuropathy tended to improve though some patients thought that numbness became more severe. Of the signs of neuropathy, weakness and hyperalgesia or hyperesthesia usually improved, impaired pain sensation deteriorated twice as often as it improved, and ankle jerks, vibration sense at the ankles, and position sense in the big toes usually remained the same. Impairment of these last three signs occurred as frequently in a random group of diabetic patients as in the present selected series and was therefore not a feature of symptomatic neuropathy.

Thirteen diabetic patients with chronic diarrhea have been studied clinically and subjected to jejunal biopsy. Eleven conformed to the accepted clinical picture of “diabetic diarrhea,” all showing evidence of gross neuropathy and a normal jejunal mucosa was found in every case. The other two were found to have a flat jejunal biopsy; in one celiac disease had been diagnosed at the age of two, but in the other there was no remote history of gastrointestinal disorder. The diagnosis of “diabetic diarrhea” is one of exclusion and there is no single feature which can be regarded as diagnostic. The nature of the diarrhea is uncertain but the response in some patients to antibiotics suggests an abnormal colonization of bacteria in the intestine though this cannot be demonstrated. The association of diarrhea with diabetic neuropathy is strong.