Ronald E. LaPorte

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

The Importance of Type 1 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%

Prevention 1970 ICA HLA B Childhood diabetes

Prevention Insulin Antibodies HLA DR 1980 Type I diabetes

Prevention HLA DQ 1990 Cyclosporin Insulin Dependent Diabetes

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

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 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

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

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

Type I diabetes Incidence

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

Allegheny County, PA

US Virgin Islands

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

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 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

WHO DiaMond Project

WHO DiaMond Project WHO Multinational Project for Childhood Diabetes WHO Diabetes Mondiale 155 Centers 70 Countries 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 Set up a collaborative registry network; Based on DiaMond standard protocol 22 Type 1 registry centers in China. WHO DiaMond Project

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

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

Chinese Migrants 4-fold

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

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

Prevention Diabetes Epidemiology Information Superhighway

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?

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?