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Rongelap Atolls, some of whom are nowresidents
of Majuro and Ebeye, were examined in order to
establish the incidence and nature of diabetes in
the Marshall Islands.* The 2% previously diagnosed diabcuc pationts fram uther atolls were also
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Percent Ganstarnution
examined but ase nut included in this analysis. On
Majurea, 120 subjects were surveyed; on Ebeye,
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Hl; on Utirik, 81; and on Rongelap, 58. Blood
4
and urine glucose determinations were made, a
questionnaire was filled aut, and pertinent physi-
w
cal examination was done to assess the presence
Figure 2b. Sae-related change in Iviaphourte transforma.
Hon ia peripheral blood cultures shows cig (be rican pore
or absence of degenerative complications of dia-
betes. Hood was abo obtained for uric acid, cho-
then apticaty, |
lesterol, and triglyceride determinations. Plasma
glucose was ncasured in the fasting state and/or
were nearly doubled but ancuploid levels were
cola). Ta this survey a phasma glucose level, cher
rent trabsdoriiatin for cach deeade with standard
2 he after the isagestion of 73 g carbohydrate (Glu-
not atlecwe.
ln suinary, several indications have been seen
of reduction of bordering deficicney of Ue imnunological satus inthe exposed Rongelap people
in carlier years, but no evidence thitsuch deficieney was related to discase incidence, with the
possible exception that the increased development
fasting or post-prandial, > 120 mg %& was consid:
cred indicative of abnoruval glucose tolerance. In
sone cases glveusuria was accompanied by nor.
mal plana glucose and these were not included
in the group with diabetes, Some subjects with
glycosuria did net have plasta glucose determinations (for a variety of reasons): these are calego-
OF nalignaney dncthe exposed Rongelap people
tized as pessible diabetics. \ihough attempts were
made taobtain complete data on all subjects aged
dlobulindevels to comiol values indicate some dee
fe supply requested information on some questionRadios agc@uits for the discrepancies in the aume
bers given in Table 20. The results are also cates
yorized on the basis af whether the subject previ-
taay be an indication of reduced inmunological
survedilance. Recout roes of loukoovte and guia
gree of recovery, but better tests for imuimunolopi
Gul status are needed.
6. Diabetes Survey
> 15, these were nat always successfal. Vhe failure
vusly knew of the absaormality ia glucose toler-
Diabetes isa mazar probless in all che Marshall
Iams, ane iivextigation of itis inapeartant far two
reasons. First, the disesise as dithealty to manages
rules developed for O05. and European conditions
nay not apply. Choice of dict is limited. The hy-
gienw conditions favor inftctions and make foot care
4 major consideration; alse. home use of insulin is
precluded in ath but a few cases. Tr would be a sige
nificant comtabution tothe wellare of the people
to diagnose the condition carly and to deliae the
optionun cules far munagement, and advice om
cc
ance. Obesityis evaluated on the basis of height
and weight but frequently Unis inforniasion is nat
complete, The datiare being analyzed in their pres
eat form. but the missing information will be obtained, fat all possible. asthe prograin continues.
Preliminary evaluation of the data (sce Table
20), with the Hunitations mentioned, strongly sugwets that the ingidence of diabetes mellitus in the
"We are grateful te ls panes BL Field and Catherine Detre
St the Universite of Patton Ss heul of Medicine for snals us
a he iedaten bata,
Ride Ot REi BE Cy ot
tear Pe
Piatt marestagead Atm «rata Th
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Ce by ate ae‘
this problein has been requested by Trust Terriwry medical personnel, Second, the situation of
scattered, wquesiered population groups and the
large contrast in living conditions between home
atolls and district centers make it an ideal area for
investigating the relative importance of pathogenetic clements, fi this respect, the situation may
not be matched anywhere.
During carly 1974, 375 people from Utirik and
Pan videos treatanSo ivaatio as
T
ay
33