33 In vitro transformation L 80) TO po T I I ] 4 | 70t< 2 60 gs not be matched anywhere. po $50 fi E 40 2 30f- this problem has been requested by Trust Territory medical personnel. Second, the situation of scattered, sequestered population groups and the large contrast in living conditions between home atolls and district centers makeit an ideal area for investigating the relative importance of pathogenetic elements. In this respect, the situation may = o—o Unexposed Y =70.20-0.16X% @---© Exposed — ~Y¥=72.47-0.24X% 20 '4 = i | L L i | Age Figure 24. Age-related change in lymphocyte transforma- tion in peripheral blood cultures showing the mean percent transformation for each decade with standard deviation. 15 were nearly doubled but aneuploid levels were not affected. In summary,several indications have been seen of reduction or borderline deficiency of the immunologica!status in the exposed Rongelap people in earlier years, but no evidence that such defi- ciency was related to disease incidence, with the possible exception that the increased development of malignancy in the exposed Rongelap people may be an indication of reduced immunological surveillance. Recentrises of leukocyte and gamma globulin levels to control values indicate some degree of recovery, but better tests for immunological status are needed. 6. Diabetes Survey Diabetes is a major problem in all the Marshall Islands, and investigation ofit is important for two reasons. First, the disease is difficult to manage; rules developed for U.S. and European conditions may not apply. Choiceof dietis limited. The hy- gienic conditionsfavor infections and makefoot care a major consideration; also, homeuse ofinsulin is precludedin all but a few cases. It would be a significant contribution to the welfare of the people to diagnose the condition early and to define the optimum rules for management, and advice on During early 1974, 375 people from Utirik and Rongelap Atolls. some of whom are nowresidents of Majuro and Ebeye, were examinedin order to establish the incidence and natureof diabetesin the Marshall Islands.* The 28 previously diag- nosed diabetic patients from other atolls were also examinedbutare not includedin this analysis. On Majuro, 120 subjects were surveyed; on Ebeye. 116; on Utirik, 81; and on Rongelap, 58. Blood and urine glucose determinations were made. a questionnaire was filled out, and pertinent physical examination was doneto assess the presence or absence of degenerative complicationsofdiabetes. Blood was also obtainedfor uric acid, cho- lesterol, and triglyceride determinations. Plasma © glucose was measuredin the fasting state and/or 2 hr after the ingestion of 75 g carbohydrate (Glucola). In this survey a plasma glucose level, either fasting or post-prandial, > 120 mg % was considered indicative of abnormalglucose tolerance. In some cases glycosuria was accompanied by nor- mal plasma glucose and these were not included in the group with diabetes. Some subjects with glycosuria did not have plasma glucose determinations (for a variety of reasons); these are catego- rized as possible diabetics. Although attempts were madeto obtain complete data onall subjects aged >15, these were not always successful. Thefailure to supply requested information on some questionnaires accounts for the discrepancies in the numbers given in Table 20. Theresults are alsocategorized on the basis of whether the subject previously knew of the abnormality in glucose tolerance. Obesity is evaluated on the basis of height and weight but frequently this informationis not complete. The data are being analyzedin their pres- ent form, but the missing information will be ob- tained,if at all possible, as the program continues. Preliminary evaluation of the data (see Table 20), with the limitations mentioned, strongly sug- gests that the incidenceof diabetes mellitus in the “We are grateful to Drs. James B. Field and Catherine Detre at the University of Pittsburgh School of Medicine for analysis of the diabetes data.