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

4. The Importance of IDDM Registries

10. 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.

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

12. Excess Mortality

13. Chronic Diseases in Children

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

16. The Search for the Magic Bullet to Prevent Type I Diabetes

17. Prevention of Type I Toxic!!!

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

19. The Environmental in Preventing Diabetes Challenge

20. 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

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

22. 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

23. Type I diabetes Incidence

24. 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

25. Allegheny County, PA

26. US Virgin Islands

27. 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

28. Migration Effects

30. Asian Migration to UK

31. A Public Health Approach Towards Prevention of IDDM

32. 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.

33. Where will the agent be found?

34. The Importance of IDDM Registries

35. Establishment of Population Based Registries for 1990-99 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

36. WHO DiaMond Project

37. 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

38. 16000 New Cases At China rate = 56 Cases

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

41. Chinese Academy of Preventive Medicine

42. 56 different Nationalities

44. WHO DiaMond Project Yang Ze Beijing Hospital

45. 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

46. 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

47. A gracefully executed work

48. Jan Alice Lew Yang Ze

49. Logistics of Registration ` Research Workers 233 ` Registry Sources 6 ` Hospitals 753 ` Schools 12557 ` Population covered 83,575,028 ` Population <15 yrs 20,659,472

50. Percent Ascertainment by Center Overall = 94.5%

51. Global Incidence of IDDM

52. Geographic Variation Within China

53. Age at Onset

54. North South variation

55. Ethnic Group 5-Fold

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

57. Gulin

58. Chinese Migrants 4-fold

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

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

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

62. Prevention Diabetes Epidemiology Information Superhighway