Introduction
overlap a widespread private health sector of good level.
Among the major noncommunicable dis-The Maltese archipelago consists of a eases-which are the main causes of mortality group of small islands, situated close to Sicily and morbidity in the Maltese-diabetes melin the central Mediterranean, with a population litus, which has been known to occur in the of around 365,000. Beginning with the first set-Maltese islands for at least the last 270 years, tlers, thought to have come from Sicily around has appeared to play a significant role for a 6000 years ago, Malta has had a long and long time. 2 The fact that in an earlier study 3 varied history, reflected in the ethnic backthe estimated prevalence of about 17% of diaground, culture and traditions of its inhabitants. betes in Malta (albeit using "soft" diagnostic It is thought that among the various occupiers criteria methods) was particularly high, and of the islands the Phoenicians and later the that this disease with its complications was Arabs left a Semitic genetic contribution, whilst a considerable problem in this semi-isolated more recent migrations of Spanish, Italian, community, led to the formation of a National French and British have influenced to varying Diabetes Programme (NDP), with the aims of extents the lifestyle and eating habits of the collecting epidemiological data and improving Maltese.
diabetes health care. This was run with the Malta is one of the more densely populated help of the Vuk Vruhovac diabetes centre of countries in the world. It is markedly trade Zagreb, Croatia, and the World Health Organidependent and has a fast-growing economy. zation (WHO), Geneva, Switzerland.
The nation has good living standards with a
This programme established the prevarapidly growing gross domestic product and a lence, natural history and associated factors of high level of development, as reflected in the abnormalities in glucose tolerance in adults in human development index compiled by the the Maltese islands, i.e. both impaired glucose United Nations Development Programme. 1 tolerance (IGT) and diabetes (both insulin-The standards of health and the average dependent and non-insulin-dependent types). life expectancy (76 years) compare favourably A representative sample of the population, conwith those of developed European countries, sisting of 2149 persons older than 15 years from with the pattern of disease being dominated by a randomly selected list of 1000 households, non-communicable conditions. A nation-wide participated in Phase 1 of the NDP in 1981. health service, funded mainly from general tax-Subjects were interviewed about past, family ation, is offered free of charge to everyone. and social histories; their height, weight and There are complementary and inter-linked priblood pressure were taken, their urine tested, mary and secondary health care services, which and an oral glucose tolerance test (OGTT) performed. They were also questioned about their diet and eating habits. Diagnosis was made