2. Ronald E. LaPorte

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 Type 1 Registries

6. 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.

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

8. Excess Mortality

9. Chronic Diseases in Children

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

12. Prevention 1970 ICA HLA B Childhood diabetes

13. Prevention Insulin Antibodies HLA DR 1980 Type I diabetes

14. Prevention HLA DQ 1990 Cyclosporin Insulin Dependent Diabetes

15. Prevention 2020 ICA 7873 T cell receptor Gene Growth Hormone Therapy Name--Unknown

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 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

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

22. 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

23. Type I diabetes Incidence

24. 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

25. Allegheny County, PA

26. US Virgin Islands

27. 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

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 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

36. WHO DiaMond Project

37. WHO DiaMond Project WHO Multinational Project for Childhood Diabetes WHO Diabetes Mondiale 155 Centers 70 Countries 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

43. WHO DiaMond Project Yang Ze Beijing Hospital

44. To evaluate the incidence of IDDM in China Set up a collaborative registry network; Based on DiaMond standard protocol 22 Type 1 registry centers in China. WHO DiaMond Project

45. A gracefully executed work

46. Jan Alice Lew Yang Ze

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

48. Percent Ascertainment by Center Overall = 94.5%

49. Global Incidence of IDDM

50. Geographic Variation Within China

51. Age at Onset

52. North South variation

53. Ethnic Group 5-Fold

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

55. Gulin

56. Tracking Down the Etiology of IDDM z Molecular Epidemiology Studies (WHO DiaMond, Jan Dorman) zEcologic Relationships zOutbreak Investigations zCase-crossover design Monitor Incidence

57. Chinese Migrants 4-fold

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

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

60. Prevention Diabetes Epidemiology Information Superhighway

61. Talking Points We know more about the incidence of Type 1 diabetes than any chronic disease. Why cannot we find the environmental factor? Type 1 diabetes is increase in almost all countries, what might be driving this? The Pattern of Type 1 diabetes is virtually the same as rheumatic fever, the early part of the center. Why does this give us hope to find its cause?

62. Review Questions (Developed by the Supercourse team) Why is Type 1 diabetes considered to be a “dream disease” for epidemiologists For 30 years we have been told that the cure to type 1 diabetes is around the corner, while Type 1 diabetes has never been prevented. Why? Epidemiology of Type 1 diabetes typically focuses on incidence, and type 2 on prevalence, Why?