Epidemiology, Etiology and the Prevention of IDDM

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Epidemiology of Type I Diabetes
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Janice Dorman, Ph.D.DirectorMolecular
EpidemiologyRonald LaPorte, Ph.D.DirectorDisea
se Monitoring and Telecommunications
WHO Collaborating Center
GSPH
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The Importance of IDDM Registries
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International Studies
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Diabetes Epidemiology Team in Pittsburgh

• Allan Drash, M.D.
• Dorothy Becker, M.D.
• Janice Dorman, Ph.D.
• Lewis Kuller, M.D., Dr.PH
• Ronald LaPorte, Ph.D.
• Trevor Orchard, M.D.
• Thomas Songer, Ph.D.
• Massimo Trucco, M.D.

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Type I Diabetes the EpidemiologistsDream Disease

• Easy to Diagnosis
• Frequent but not too frequent
• Severe but not too severe
• Insulin
• Dynamic Epidemiology

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Excess Mortality
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Chronic Diseases in Children
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Genetics

• Identical Twins 35
• HLA Identical 18
• non asp 57 2

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Genetics
Environment

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The Search for the Magic Bullet to Prevent Type
I Diabetes
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Toxic!!!
Prevention of Type I
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Let observations with extensive viewSurvey
mankind from China to Peru

• S. Johnson, 1749

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The Environmental

• Challenge

in Preventing Diabetes
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Environmental Etiology of Type I diabetes

• Environmental agents causes disease in animals
• Geographic Variation
• Temporal Variation
• Migrants take on risk of new environment
• Environmental Factors Found to Cause Disease in
  the Population

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Prevention

• Reducing the incidence of disease
• Last, Dictionary of Epidemiology

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Environmental Etiology of Type I diabetes

• Environmental agents causes disease in animals
• Geographic Variation
• Temporal Variation
• Migrants take on risk of new environment
• Environmental Factors Found to Cause Disease in
  the Population

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Type I diabetes Incidence
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Environmental Etiology of Type I diabetes

• Environmental agents causes disease in animals
• Geographic Variation
• Temporal Variation
• Migrants take on risk of new environment
• Environmental Factors Found to Cause Disease in
  the Population

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Allegheny County, PA
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US Virgin Islands
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Environmental Etiology of IDDM

• Environmental agents causes disease in animals
• Geographic Variation
• Temporal Variation
• Migrants take on risk of new environment
• Environmental Factors Found to Cause Disease in
  the Population

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Migration Effects
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Asian Migration to UK
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A Public Health Approach Towards Prevention of
IDDM
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Green mountains range beyond the northern
wall White water rushes round the eastern
town right here is where, alone and restless,
he begins a journey of a thousand miles. While
travelers intents are fleeting clouds, A
friends affection is a setting sun. He waves
good-bye, and as he goes from here, His dappled
horse lets out a lonely neigh.
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Where will the agent be found?
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The Importance of IDDM Registries
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Establishment of Population Based Registries for
1990-99

• Diagnosed as IDDM
• On Insulin at Hospital discharge
• Diagnosed between 1/1/90 and 31/12/99
• Age at onset 0-14
• Member of a defined community
• Secondary Source of Case Identification

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WHO DiaMond Project
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WHO DiaMond ProjectWHO Multinational Project for
Childhood DiabetesWHO Diabetes Mondiale

• 155 Centers
• 70 Countries
• 7.2 of the Worlds Children

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16000 New Cases
At China rate 56 Cases
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The south sweet,the north saltthe east
pungentand the west sour
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Chinese Academy of Preventive Medicine
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56 different Nationalities
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WHO DiaMond Project
Yang Ze Beijing Hospital
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To evaluate the incidence of IDDM in China
WHO DiaMond Project

• Set up a collaborative registry network
• Based on DiaMond standard protocol
• 22 I DDM registry centers in China.

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Type I Diabetes Registry Network in China
PITT WHO Center
Advisory Committee
Collab. Center in China
Chinese IDDM Research Group
1990 Census
IDDM Registry
IDDM Registry
in China
Hospitals
Schools
Cases
Population lt 15 yrs
Incidence
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A gracefully executed work
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Jan Alice Lew
Yang Ze
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Logistics of Registration

• Research Workers 233
• Registry Sources 6
• Hospitals 753
• Schools
  12557
• Population covered 83,575,028
• Population lt15 yrs 20,659,472

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Percent Ascertainment by Center
Overall 94.5
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Global Incidence of IDDM
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Geographic Variation Within China
13 fold difference
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Age at Onset
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North South variation
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Ethnic Group
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If one does not store up vital forces in the
winter, he will be sure to suffer from an
epidemic in the spring
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Gulin
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Chinese Migrants
4-fold
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Tracking Down the Etiology of IDDM in China

• Molecular Epidemiology Studies (WHO DiaMond,
  Jan Dorman)
• Ecologic Relationships
• Case-Crossover Investigations

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Public Health Prevention

• Monitor Incidence Rapidly
• Identify Epidemics
• Outbreak Investigations
• Reduction of factor

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Prevention
Reduction of Precipitating Factors
Identification of Precipitating Factors
Monitoring IDDM Incidence
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Prevention
Diabetes Epidemiology
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