J q t T | we — edhe “abba OE Mae bert 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 ” ome Vesper Sh ON Oe @ Pingeomal “ pa Tlie Gein ate Percent Ganstarnution examined but ase nut included in this analysis. On Majurea, 120 subjects were surveyed; on Ebeye, HD wo t-te LE. wu a ct aa fowl (ay au 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 Pea” ie 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