VII. DIABETES SURVEY* Diabetes mellitus is perceived to be an important public health problem among the people of the Pacific islands. Health surveys among several different populations in Micronesia and Polynesia have indicated very high preva- lences of diabetes compared with that in more affluent societies (74-76,208). These surveys suggest that the diabetes in the Micronesian populations is pre- dominantly of the maturity-onset, Type II form, being relatively asymptomatic despite marked hyperglycemia. One of the most detailed of the Micronesian surveys, that dealing with the population of Nauru (77), found a diabetes prevalence among the highest ever reported in any population. In the population aged 15 and older, 10.4% of individuals were known to have diabetes before the survey, and 34.4% of the total population were found to have diabetes according to the criterion of a 2-hr post-prandial blood glucose >160 mg% (186). additional An 11.3% of the population showed borderline glucose tolerance, with post-prandial blood sugars between 140 and 159 mg%. Among the 52 known dia- betics, complications associated with diabetes were very common: 45% of them bad demonstrable retinopathy, and 33% of them had some form of renal dysfunc-— tion (76). In addition, 12 of the known diabetics included in the original studies had died from diabetes-related causes. To determine the severity of the health problem presented by diabetes in the Marshall Island populations of Micronesia, a survey to determine carbohydrate tolerance and diabetes-related health problems was initiated in 1974. Over the next several years historical data taking, physical examinations, and laboratory evaluations were carried out on 437 individuals aged >15, of whom 410 were examined at least during the first survey of 1974. This initial re- port is based primarily on laboratory results of fasting and 2-hr post-prandial blood sugar determinations made during the 1974 studies. Subsequently, post- prandial blood glucose values were obtained as well as additional laboratory determinations of lipid and uric acid levels. Of the 410 people examined in 1974, 45.6% were male and 54.4% female. Most of the individuals studied came from the two principal islands, 170 listing their home as Utirik and 120 as Rongelap. Of the individuals included in the study, 57 (14% of those examined during 1974) reported that they had been previously diagnosed as diabetic. Of those previously diagnosed, 59% had been found diabetic within the preceding 5 yr, 26% at 6 to 10 yr before the survey, and 15% more than !0 yr before. At the time of the survey, 39 of the 57 were being treated with oral hypoglycemic agents and none with insulin. Three individuals had reported onset prior to age 20 (ages 2, 10, and 17). The age distribution for the diagnosed diabetics in the survey showed 6% aged <24 yr, 8% aged 25 to 34 yr, 8% aged 35 to 44 yr, 31% aged 45 to 54 yr, 31% aged 55 to 64, and 33% aged >65. Of the 263 individ- uals who were able to provide information, 43.3% reported a positive family history of diabetes. In this population, there was not a significant *Drs. J.B. Field (St. Luke's Episcopal Hospital, Houston, TX); Drs. R. Ferrell and P. Fuerst (Graduate School of Public Health, U. of Texas, Houston); Dr. A. Cooper (U. of Pennsylvania, Philadelphia); Dr. E.R. Larsen (Peter Bent Brigham Hospital, Boston, MA); Dr. A. Lowrey (Lorton, VA); Drs. R. Rittmaster and R.A. Conard (BNL). - 43 -