Support is requested for development of plans for a collaborative research project to determine prevalence of diabetes, hyperinsulinemia, cardiovascular risk factors, and certain genetic markers among Siberian Yupik Eskimos living on St. Lawrence Island in Alaska. The project would also investigate dietary patterns, physical activity levels, and anthropometric data and attempt to correlate these with the occurrence of diabetes, cardiovascular risk factors, diabetes complications, and insulin levels. As part of the ongoing Alaska-Siberia Medical Research Program, data will also be gathered in the population of Yupik Eskimos across the Bering Straits on the Chukotka Peninsula, USSR. Experience in Alaska has shown that screening projects provide a means to educate village residents about lifestyle risks for diabetes and to detect and treat cases of diabetes and other cardiovascular risk factors. Village leaders and health aides would be closely involved in the planning process as requested by Norton Sound Health Corporation. Age-adjusted prevalence of non-insulin dependent diabetes mellitus (NIDDM) among Alaska's Eskimos, Indians, and Aleuts overall increased 11%, from 15.7 to 17.4 per 1000 over the two-year period from 1985 to 1987 (Schraer et al., 1988). Rates in 1987 varied from 6.7 to 40.8 per 1000 in various Indian Health Service Units in Alaska. The estimated age-adjusted rate among Siberian Yupiks of St. Lawrence Island in 1989 was 9.2/1000 (7 cases, 1110 estimated population). These estimates are based only on clinically recognized cases. Comparing preliminary rates to Chukotka Natives 15 years old and older, we find that the St. Lawrence Island rate is 9.7/1000 while the Chukotka rate is 1/1000 (1989 data, Soviet rate based on screening studies). Since Siberian Yupik Eskimos of Chukotka and Alaska are genetically closely related, our working hypothesis is that dietary and lifestyle differences account for the difference in diabetes prevalence. We believe this represents a unique situation in that these populations were essentially united until 1949, when contact ceased due to political reasons, and lifestyles diverged as a result. Preliminary planning for this study began a year ago, but detailed plans remain to be formulated. We propose to bring together village leaders, the Norton Sound Health Board, scientists and clinicians in coordinated, identical surveys in Alaska and Siberia. Surveys among Native people of St Lawrence Island and the Chukotka region would include data similar to that being collected in the ongoing Strong Heart Study among other groups of Native Americans (Lee et al., 1990). Proposed planning activities will result in a grant proposal for a study likely to provide significant insights into the etiology of NIDDM and may lead to identification of causative lifestyle factors that can be modified to prevent diabetes.
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