some of the time, were reported by 77.8% of the affected population and by 47.9% of the unaffected population. Data have also been obtained on levels of plasma cholesterol, triZimmet et al. (77) reported a high prevalence of glycerides, and uric acid. elevated uric acid levels and gout in the Micronesian inhabitants of Nauru, and such a pattern has also been reported for Polynesians (79). In the Nauru population 64% of men and 60% of women aged >20 had elevated serum uric acid In the 1974 survey of the Marshall levels (>7 mg% in men and 6 mg% in women). EleIslands, of 347 individuals tested, 23.1% had uric acid levels >7 mg%. vated triglycerides, >200 mgt, were found in 4.8% of all subjects examined, hut none of the people tested had cholesterol values 7300 mg’. Relationships among the various measurements (fasting blood sugar, 2-hr post-prandial blood sugar, serum cholesterol, serum triglycerides, uric acid values, and diastolic and systolic blood pressures) were studied, with corrections for the confounding effects of sex, age, and obesity (as measured by the As expected, significant partial correlations were ponderal index wt/ht2). observed between systolic and diastolic blood pressures, between cholesterol and triglyceride levels, and between the two measures of blood glucose. Additionally, triglyceride level was significantly correlated with both measures of blood glucose, with uric acid level, and with diastolic blood presUric acid levels showed additional significant partial correlations sure. All other with both cholesterol level and the two measures of blood pressure. comparisons were not significant when the effects of age, sex, and obesity were accounted for. Thus, preliminary evaluation of the data collected during the diabetes survey of 1974 suggests a very high incidence of diabetes mellitus in the population of the Marshall Islands, which, although perhaps not as high as that observed in some Micronesian populations (77), is consistent with the general pattern seen in several Pacific populations (75-80). The diabetes of the Marshall Islands is primarily of the adult-onset type, probably associated with obesity, and may be less severe than similar Type II diabetes seen in Caucasians despite quite significant hyperglycemia. It does not appear to re- Two features of this form of diaquire insulin treatment to prevent ketosis. (a) Despite the apparent excess of females over betes deserve further study. males among previously diagnosed diabetics in this population, no apparent sex difference was found in the distribution of either of the measures of blood glucose levels in the 1974 survey. (b) The involvement of complications, espe- cially diabetic retinopathy and severe peripheral vascular disorders, seems to Cardiovascular disease attributed to diabe less marked in this population. betes was not seen during the 1974 survey, but further studies would be necessary to determine the prevalence of diabetes-related macrovascular disease. The population of the Marshall Islands appears to have a high prevalence not only of abnormalities of glucose metabolism but also of elevated serum uric acid levels. Whether this is accompanied by gout, as in some other Pacific populations, also remains to be studied (78,186). Additional data collected during the 1974 survey and further investiga- tions of the relationships among the variables reported above are currently being evaluated so that a more complete report can be prepared on the impact It is hoped that this information will proof diabetes on this population. vide a better characterization of the problem of diabetes in the Marshall Islands and will serve as a basis for its treatment and management. - 46 -