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 differ-
ent 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 predominantly 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% cf the total population were found to have diabetes according
to the criterion of a 2-hr post-prandial blood glucose >160 mgZ (185). An
additional 11.3% of the population showed borderline glucose tolerance, with
post-prandial blood sugars between 140 and 159 mg%. Among the 52 known diabetics, complication< associated with diabetes were very common: 45% of them
had demonstrable retinopathy, and 332 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 carbohy-
drate 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 report is based primarily on laboratory results of fasting and 2-hr post-prandial
blood sugar determinations made during the 1974 studies. Subseque-tly, post-
prandial blood glucose values were obtained as well as additional laboratory
determinations of lipid and uric acid levels.
1974, 45.6% were male and 54.4% female.
Of the 410 people examined in
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 dur-
ing 1974) reported that they had been previously diagnosed as diabetic.
Of
those previously diagnosed, 59% had been found diabetic within the preceding
S yr, 26% at 6 to 10 yr before the survey, and 15% more than 10 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 62% 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 individuals 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 8.A. Conard (BNL).
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