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Epidemiology of Type I Diabetes

Epidemiology of Type I Diabetes. WHO Collaborating Center. Janice Dorman, Ph.D. Director Molecular Epidemiology Ronald LaPorte, Ph.D. Director Disease Monitoring and Telecommunications. GSPH. The Importance of IDDM Registries. International Studies.

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Epidemiology of Type I Diabetes

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  1. Epidemiology of Type I Diabetes

  2. WHO Collaborating Center Janice Dorman, Ph.D.DirectorMolecular EpidemiologyRonald LaPorte, Ph.D.DirectorDisease Monitoring and Telecommunications GSPH

  3. The Importance of IDDM Registries

  4. International Studies

  5. 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.

  6. Type I Diabetes the Epidemiologist’sDream Disease • Easy to Diagnosis • Frequent but not too frequent • Severe but not too severe • Insulin • Dynamic Epidemiology

  7. Excess Mortality

  8. Chronic Diseases in Children

  9. Environment Genetics • Identical Twins = 35% • HLA Identical = 18% • non asp 57 = 2%

  10. IDDM Precipitator Genetics Environment

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

  12. Toxic!!! Prevention of Type I

  13. Let observations with extensive viewSurvey mankind from China to Peru S. Johnson, 1749

  14. The Environmental Challenge in Preventing Diabetes

  15. 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

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

  17. 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

  18. Type I diabetes Incidence

  19. 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

  20. Allegheny County, PA

  21. US Virgin Islands

  22. 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

  23. Migration Effects

  24. Asian Migration to UK

  25. A Public Health Approach Towards Prevention of IDDM

  26. 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.

  27. Where will the agent be found?

  28. The Importance of IDDM Registries

  29. 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

  30. WHO DiaMond Project

  31. WHO DiaMond ProjectWHO Multinational Project for Childhood DiabetesWHO Diabetes Mondiale • 155 Centers • 70 Countries • 7.2% of the World’s Children

  32. 16000 New Cases At China rate = 56 Cases

  33. The south sweet,the north saltthe east pungentand the west sour

  34. Chinese Academy of Preventive Medicine

  35. WHO DiaMond Project Yang Ze Beijing Hospital

  36. To evaluate the incidence of IDDM in China • Set up a collaborative registry network; • Based on DiaMond standard protocol • 22 I DDM registry centers in China. WHO DiaMond Project

  37. 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 < 15 yrs Incidence

  38. A gracefully executed work

  39. Jan Alice Lew Yang Ze

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

  41. Percent Ascertainment by Center Overall = 94.5%

  42. Global Incidence of IDDM

  43. Geographic Variation Within China 13 fold difference

  44. Age at Onset

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