Epidemiology, Etiology and the Prevention of IDDM - PowerPoint PPT Presentation

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Epidemiology, Etiology and the Prevention of IDDM

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Title: Epidemiology, Etiology and the Prevention of IDDM


1
Epidemiology of Type I Diabetes
2
Janice Dorman, Ph.D.DirectorMolecular
EpidemiologyRonald LaPorte, Ph.D.DirectorDisea
se Monitoring and Telecommunications
WHO Collaborating Center
GSPH
3
The Importance of IDDM Registries
4
International Studies
5
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6
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7
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8
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9
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.

10
Type I Diabetes the EpidemiologistsDream Disease
  • Easy to Diagnosis
  • Frequent but not too frequent
  • Severe but not too severe
  • Insulin
  • Dynamic Epidemiology

11
Excess Mortality
12
Chronic Diseases in Children
13
Genetics
  • Identical Twins 35
  • HLA Identical 18
  • non asp 57 2

14
Genetics
Environment

15
The Search for the Magic Bullet to Prevent Type
I Diabetes
16
Toxic!!!
Prevention of Type I
17
Let observations with extensive viewSurvey
mankind from China to Peru
  • S. Johnson, 1749

18
The Environmental
  • Challenge

in Preventing Diabetes
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
Prevention
  • Reducing the incidence of disease
  • Last, Dictionary of Epidemiology

21
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

22
Type I diabetes Incidence
23
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

24
Allegheny County, PA
25
US Virgin Islands
26
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

27
Migration Effects
28
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29
Asian Migration to UK
30
A Public Health Approach Towards Prevention of
IDDM
31
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
friends affection is a setting sun. He waves
good-bye, and as he goes from here, His dappled
horse lets out a lonely neigh.
32
Where will the agent be found?
33
The Importance of IDDM Registries
34
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

35
WHO DiaMond Project
36
WHO DiaMond ProjectWHO Multinational Project for
Childhood DiabetesWHO Diabetes Mondiale
  • 155 Centers
  • 70 Countries
  • 7.2 of the Worlds Children

37
16000 New Cases
At China rate 56 Cases
38
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39
The south sweet,the north saltthe east
pungentand the west sour
40
Chinese Academy of Preventive Medicine
41
56 different Nationalities
42
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43
WHO DiaMond Project
Yang Ze Beijing Hospital
44
To evaluate the incidence of IDDM in China
WHO DiaMond Project
  • Set up a collaborative registry network
  • Based on DiaMond standard protocol
  • 22 I DDM registry centers in China.

45
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 lt 15 yrs
Incidence
46
A gracefully executed work
47
Jan Alice Lew
Yang Ze
48
Logistics of Registration
  • Research Workers 233
  • Registry Sources 6
  • Hospitals 753
  • Schools
    12557
  • Population covered 83,575,028
  • Population lt15 yrs 20,659,472

49
Percent Ascertainment by Center
Overall 94.5
50
Global Incidence of IDDM
51
Geographic Variation Within China
13 fold difference
52
Age at Onset
53
North South variation
54
Ethnic Group
55
If one does not store up vital forces in the
winter, he will be sure to suffer from an
epidemic in the spring
56
Gulin
57
Chinese Migrants
4-fold
58
Tracking Down the Etiology of IDDM in China
  • Molecular Epidemiology Studies (WHO DiaMond,
    Jan Dorman)
  • Ecologic Relationships
  • Case-Crossover Investigations

59
Public Health Prevention
  • Monitor Incidence Rapidly
  • Identify Epidemics
  • Outbreak Investigations
  • Reduction of factor

60
Prevention
Reduction of Precipitating Factors
Identification of Precipitating Factors
Monitoring IDDM Incidence
61
Prevention
Diabetes Epidemiology
Information Superhighway
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