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From Sioux City, Iowa, USA:

I was wondering what significance geography plays in diabetes. After talking with the support group leader here in Sioux City, (about 85,000 people) I was astonished to find that there are 17 known cases of Type 1 within a 2-3 mile radius of our neighborhood. Is there any evidence of environmental issues with diabetes diagnosis or are we all sharing a particular virus? How unusual is this? Sounds like we are a perfect group for a research project! Thanks.


In Sardinia we looked for clustering of the disease and a paper from our group on that is about to be published in Diabetologia. It seems that there is indeed a geographical variation of IDDM risk at provincial level (central western area at highest risk) although no environmental agent has been identified so far. Certainly different genetic background plays a role but this does not explain the steep secular trend we observed among Sardinians during the last three decades.


Additional Comment from Dr. O'Brien

The evidence from DAISY in the U.S. and BABY-DIAB in Germany, two large scale trials, is that environmental factors are much less important than genetic ones in determining the incidence of Type 1 Diabetes. This however does not mean that these factors are not important elsewhere. Finland has an incidence of Type 1 Diabetes that is nearly four times that in England and Cook Islanders have a very small incidence in Raratonga which increases significantly when they emigrate to Auckland in New Zealand.

The incidence of Type 1 Diabetes in the population as a whole in North America is somewhere between 2 and 3 per 1000. Depending on the population density and the proportion of that population that is Hispanic or African-American, 17 cases in 30 sq.miles (c.3 mile radius) in Sioux City does not seem out of line.


Original posting 9 Jul 97


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