33 this problem has been requested by Trust Terri- In vitro transformation — 1 o- | | | tory medical personnei. Second, the situation ot \ scattered, sequestered population groups and the large contrast in living conditions between home atolls and district centers makeit an ideai area for investigating the relative importance of patho- Percent transformation genetic elements.In this respect, the situation may not be matched anywhere. 30 omg Unexposed Y¥ = 70.20~-0.16% @---© Exposed a Y= 72,47-0.24% 20 — 10 ~ ! 20 | 30 i 40 | Age 30 ! 60 | 70 80 Figure 24. Age-related change in lymphocyte transformation in peripherai blood cultures showing the mean percent transformation for each decade with standard deviation. !3 During early 1974, 375 people from Uurik and Rongelap Atolls, some of whom are now residents of Majuro and Ebeye, were examinedin orderto establish the incidence and natureof diabetes in the Marshall Islands.* The 28 previously diagnosed diabetic patients from otheratolls were also examined butare 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 physi- cal examination was doneco assess the presence | or absence of degenerative complicationsof diabetes. Blood was also obtained for uric acid, cho- lesterol, and triglyceride determinations. Plasma glucose was measured in the fasting state and/or 2 hr after the ingestion of 75 g carbohydrate (Glu- were nearly doubled but aneuploid levels were not affected. In summary, several indications have been seen of reduction or borderline deficiency of the immunological status in the exposed Rongelap people in earlier years, but no evidence that such deficlency was related to disease incidence, with the cola). In this survey a plasma glucoselevel, either fasting or post-prandial, > 120 mg % was considered indicative of abnormalglucose tolerance. In some cases glycosuria was accompaniedby normal 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- 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 rized as possible diabetics. Aithough attempts were made to obtain complete data on ail subjects aged gree of recovery, but better tests for immunological status are needed. bers given in Table 20. Theresults are also cate- globuiin levels to control values indicate some de- 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. Choice of diet is limited. The hy- gienic conditions favorinfections and makefoot care a major consideration; also, home use ofinsulin is precludedin ali 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 “A for management, and advice on 3006150 > 15, these were not always successful. The failure to supply requested information on some question- naires accounts for the discrepancies in the num- gorized on the basis of whether the subject previously knew of the abnormality in glucose toler- ance. Obesity is evaluated on the basis of height and weight butfrequently this informationis not complete. The data are being analyzed in their present form, but the missing informationwill be obtained, 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 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 analysis of the diabetes data,