33 this problem has been requested by Trust Terri- In vitro transformation l 80+. I oT T [ _ 70 |- 7 © = A- 4 g E 50h During early 1974, 375 people from Utirik and 5 S40 = = o—o Unexposed Y¥=70.20-0.16% 30 bE o---6 Exposed ~ Y= 72.47-0.24X% 20 10 tory 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 not be matched anywhere. = tj 20 ! 30 i 40 Age I 50 I 60 i 70 80 Figure 24. Age-related change in lymphocyte transformation in peripheral blood cultures showing the mean percent transformation for each decade with standard deviation. 14 were nearly doubled but aneuploid levels were not affected. In summary,several indications have been seen of reduction or borderline deficiency of the im- munologicalstatus in the exposed Rongelap people in earlier years, but no evidence that such deficiency was related to disease incidence, with the possible exception that the increased development of malignancy in the exposed Rongelap people maybe anindication 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 dificult to manage; rules developed for U.S. and European conditions may not apply. Choiceofdiet is limited. The hygienic conditionsfavor infections and makefoot care a major consideration; also, homeuseof insulin is precluded in 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 Rongelap Atoils, some of whom are nowresidents of Majuro and Ebeye, were examinedin orderto establish the incidence and nature of diabetes in the Marshall Islands.* The 28 previously diagnosed diabetic patients from otheratolls were also examined but are not included in 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 wasfilled out, and pertinent physical examination was done to assess the presence or absence of degenerative complicationsof dia- betes. Blood was also obtained for 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 plasmaglucoselevel, either fasting or post-prandial, > 120 mg % was considered indicative of abnormal glucose tolerance. In some cases glycosuria was accompanied bynor- mal plasma glucose and these were not included in the group with diabetes. Some subjects with glycosuria did not have plasmaglucose determinations (for a variety of reasons}; these are catego- rized as possible diabetics. Although attempts were madeto obtain complete data on all! subjects aged > 15, these were not always successful. The failure to supply requested information on some questionnaires accounts for the discrepancies in the numbers given in Table 20. The results are also categorized 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 analyzed in theirpresent form, but the missing information will be obtained,if at all possible, as the program continues. Preliminary evaluation of the data (see Table 20), with the limitations mentioned, strongly suggests that the incidence of diabetes mellitus in the *Weare grateful to Drs. James B. Field and Catherine Detre at the University of Pittsburgh School of Medicine for anaivsis of the diabetes data.