A proportion of newly diagnosed diabetic patients have features so characteristic that they form a distinct syndrome. The patients are predominantly male and present with a foot lesion which is often long established. They are subsequently found to have diabetes mellitus and diabetic retinopathy. In addition, many of them manifest a striking indifference towards their illness. 47 such patients have been seen between the years 1960-1969 at a diabetic clinic in Birmingham which saw a total of 6451 newly diagnosed patients in the same period. 26 of the 45 patients in whom follow-up was complete have died. The present state of health of the 19 surviving patients indicated that the prognosis is poor for patients who have retinopathy and foot lesions when diabetes is diagnosed.