Janice Dorman, Ph.D. Director Molecular Epidemiology Ronald LaPorte, Ph.D. Director Disease Monitoring and Telecommunications WHO Collaborating Center GSPH

The Importance of IDDM Registries

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.

Type I Diabetes the Epidemiologist’s Dream Disease zEasy to Diagnosis zFrequent but not too frequent zSevere but not too severe zInsulin zDynamic Epidemiology

Excess Mortality

Chronic Diseases in Children

` Identical Twins = 35% ` HLA Identical = 18% ` non asp 57 = 2%

The Search for the Magic Bullet to Prevent Type I Diabetes

Prevention of Type I Toxic!!!

Let observations with extensive view Survey mankind from China to Peru S. Johnson, 1749

The Environmental in Preventing Diabetes Challenge

Environmental Etiology of Type I diabetes zEnvironmental agents causes disease in animals zGeographic Variation zTemporal Variation zMigrants take on risk of new environment zEnvironmental Factors Found to Cause Disease in the Population

Prevention: Reducing the incidence of disease Last, Dictionary of Epidemiology

Environmental Etiology of Type I diabetes zEnvironmental agents causes disease in animals zGeographic Variation zTemporal Variation zMigrants take on risk of new environment zEnvironmental Factors Found to Cause Disease in the Population

Type I diabetes Incidence

Environmental Etiology of Type I diabetes zEnvironmental agents causes disease in animals zGeographic Variation zTemporal Variation zMigrants take on risk of new environment zEnvironmental Factors Found to Cause Disease in the Population

Allegheny County, PA

US Virgin Islands

Environmental Etiology of IDDM zEnvironmental agents causes disease in animals zGeographic Variation zTemporal Variation zMigrants take on risk of new environment zEnvironmental Factors Found to Cause Disease in the Population

Migration Effects

Asian Migration to UK

A Public Health Approach Towards Prevention of IDDM

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 friend’s affection is a setting sun. He waves good-bye, and as he goes from here, His dappled horse lets out a lonely neigh.

Where will the agent be found?

The Importance of IDDM Registries

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

WHO DiaMond Project

WHO DiaMond Project WHO Multinational Project for Childhood Diabetes WHO Diabetes Mondiale a 155 Centers a 70 Countries a 7.2% of the World’s Children

16000 New Cases At China rate = 56 Cases

The south sweet, the north salt the east pungent and the west sour

Chinese Academy of Preventive Medicine

56 different Nationalities

WHO DiaMond Project Yang Ze Beijing Hospital

To evaluate the incidence of IDDM in China zSet up a collaborative registry network; zBased on DiaMond standard protocol z22 I DDM registry centers in China. WHO DiaMond Project

Type I Diabetes Registry Network in China Advisory Committee Population < 15 yrs 1990 Census in China IDDM Registry Hospitals Incidence Cases IDDM Registry Schools Chinese IDDM Research Group Collab. Center in China PITT WHO Center

A gracefully executed work

Jan Alice Lew Yang Ze

Logistics of Registration ` Research Workers 233 ` Registry Sources 6 ` Hospitals 753 ` Schools ` Population covered 83,575,028 ` Population <15 yrs 20,659,472

Percent Ascertainment by Center Overall = 94.5%

Global Incidence of IDDM

Geographic Variation Within China

Age at Onset

North South variation

Ethnic Group 5-Fold

If one does not store up vital forces in the winter, he will be sure to suffer from an epidemic in the spring

Gulin

Chinese Migrants 4-fold

Tracking Down the Etiology of IDDM in China z Molecular Epidemiology Studies (WHO DiaMond, Jan Dorman) zEcologic Relationships zCase-Crossover Investigations

Public Health Prevention z Monitor Incidence Rapidly z Identify Epidemics z Outbreak Investigations z Reduction of factor

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

Prevention Diabetes Epidemiology Information Superhighway