On the problem of type 2 diabetes-related mortality in the Canary Islands, Spain. The DARIOS Study.

AIMS: To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions. METHODS: In a cross-sectional study of 28,887 participants aged 35-74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions. RESULTS: Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p<0.001) and women (9.5 versus Madrid; p<0.001). Excess mortality was prevalent from the age of 45 years and above. CONCLUSIONS: Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response.

Relationships between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population.

AIMS: The serum resistin level is associated with the incidence of ischemic heart disease in the general population. We analyzed the associations between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population. METHODS: A cross-sectional study of 6,637 randomly recruited adults was conducted. The resistin levels were measured in thawed aliquots of serum using an enzyme immunoanalysis technique. RESULTS: The resistin level exhibited a positive nonparametric correlation with saturated fat intake(p < 0.001) and an inverse correlation with adherence to the Mediterranean diet(p < 0.001), monounsaturated fat intake(p < 0.05), total serum cholesterol(p < 0.001), non-HDL cholesterol(p < 0.001), LDL cholesterol(p < 0.001), body mass index(p < 0.001), waist circumference(p < 0.001) and the waist/height ratio(p < 0.001). An elevated resistin concentration(fifth quintile) was associated with adherence to the Mediterranean diet(OR=0.82 CI95%=0.71-0.93), saturated fat intake(OR=1.34 CI95%=1.16-1.56), monounsaturated fat intake(OR=0.88 CI95%=0.78-0.99), a total cholesterol level of ≥200 mg/dL(OR=0.81 CI95%=0.72-0.91), a low HDL cholesterol level(OR=0.84 CI95%= 0.76-0.93), a high non-HDL cholesterol level(OR=0.84 CI95%=0.72-0.99), a high LDL cholesterol level(OR=0.82 CI95%=0.70-0.97) and a waist/height ratio of ≥0.55(OR=0.76 CI95%=0.67-0.85). The multivariate models corroborated the positive associations between the resistin level and saturated fat intake(p < 0.001) and serum triglycerides(p=0.004) and the inverse associations between the resistin level and adherence to the Mediterranean diet(p=0.002), total serum cholesterol(p < 0.001) and cholesterol fractions and the waist/height ratio(p=0.02). CONCLUSIONS: In the general population, the serum resistin level is associated with fat intake: positively with saturated fat intake and inversely with monounsaturated fat intake. As a consequence, the resistin level is also inversely associated with adherence to the Mediterranean diet. In addition, the resistin level is inversely associated with the serum cholesterol level and adiposity.

Hemodynamics and metabolism at low versus moderate altitudes.

Despite the higher prevalence of diabetes and hypertension in populations residing at moderate altitudes, mortality in these populations is lower than in populations residing at low altitudes. To examine whether metabolic and hemodynamic differences can explain this apparent paradox, we performed a cross-sectional study of a general population sample recruited in the Canary Islands, Spain (n=6729). We recorded altitude of residence, age, heart rate, blood pressure, body mass index, social class, physical activity, energy intake, alcohol intake, smoking habit, prevalence of type 2 diabetes mellitus and hypertension. In a subsample (n=903), we recorded serum concentration of cholesterol, triglycerides, glucose, C peptide, leptin, soluble leptin receptor (sObR), C-reactive protein, resistin, soluble CD40 ligand (sCD40L), and paraoxonase activity (PON), and we estimated insulin resistance and free leptin index. We found an inverse association between altitude and heart rate (p<0.001), leptin (p<0.001), free leptin index (p<0.001), resistin (p<0.001), and sCD40L (p<0.05) and a direct association between altitude and hypertension (odds ratio=1.29 for altitude >600 m; 95% confidence interval=1.03-1.62), glycemia (p<0.05), C peptide (p<0.001), insulin resistance (p<0.001), sObR (p<0.05), and PON (p<0.05). When social class was included in the multivariate model, the association with PON was no longer significant. In conclusion, individuals residing at moderate altitudes have a lower heart rate and lower serum concentration of total leptin, free leptin, and sCD40L. These differences may partially explain the lower mortality in these populations.

Autoantibody detection with indirect immunofluorescence on HEp-2 cells: starting serum dilutions for systemic rheumatic diseases.

Antinuclear antibodies (ANA) are determined, among other reasons, to identify samples which need a second test to detect the associated specificities. Our aim was to evaluate the clinical and economic impact generated by using an initial dilution for ANA of 1:160. We analyzed all samples for which ANA, anti-ENA and anti-dsDNA were requested over a 1-year period. ANA were detected by indirect immunofluorescence. Anti-ENA were analyzed with a combination of techniques. Anti-dsDNA were detected by radioimmunoassay. Cost analysis was performed by calculating the difference between two cut-offs (ANA 1:40 and 1:160). A total of 13,233 samples were processed for ANA, of which 59.9% were positive with the 1:40 cut-off and 39.2% with the 1:160 cut-off. At ANA titer 1:40, 0.2% of the samples were anti-ENA-positive and 2.2% were anti-dsDNA positive. Only ANA dilutions of 1:160 and higher showed significantly increased positive predictive value for anti-ENA (1.5 versus 0.2, p=0.029) and anti-dsDNA (8.3 versus 2.2, p<0.001) compared to the 1:40 titer. With the 1:160 cut-off, 16.6% fewer ANA tests, 41.8% fewer anti-ENA determinations and 36.4% fewer anti-dsDNA tests would have been needed. The average saving was 0.87 cost-units per sample (1 unit=2.06euro). We conclude that setting the starting dilution for ANA at 1:160 avoids unnecessary studies, increases the positive predictive values of ANA for anti-ENA and anti-dsDNA, and generates clinical and economic benefits.

[Lifestyle and treatment adherence of type 2 diabetes mellitus people in the Canary Islands]. / Estilo de vida y adherencia al tratamiento de la población canaria con diabetes mellitus tipo 2.

BACKGROUND: The Canary Islands population experiences the highest type 2 diabetes (DM2) mortality in Spain. We studied lifestyle, unknown DM2 and treatment adherence in diabetics of these islands. METHODS: Cross-sectional study of 6729 subjects from the general population (age 18-75) that participate in the cohort study "CDC of the Canary Islands". We found out their medical problems, diet, physical activity, medications, smoking, etc. RESULTS: Prevalence of DM2 was 12% in men and 10% in women (p=0.005). The disease was unknown in 22% of men and 9% of women (p < 0.001). Considering unknown DM2, lack of treatment and lack of adherence, 48% of men and 28% of women did not follow a regular treatment. Diabetics' men prevalences of smoking (28%; CI(95%)=23-33) and sedentariness (62%; CI(95%)=56-68) were similar to non diabetic men, but obesity was more frequent in diabetics (45 versus 25%; p < 0.001). Diabetics women showed a higher obesity (54 versus 27%; p < 0.001) and a lower smoking prevalence (11 versus 22%; p < 0,001) than non diabetics, but they presented a similar sedentariness (75%; CI(95%)=70-79). In both sexes, energy intake was lower in diabetics (p < 0.001), but 93% of them (CI(95%)=91-95) showed a high consumption of calories from saturated fat and 69% (CI(95%)=65-72) presented metabolic syndrome. CONCLUSIONS: The Canarian diabetics are a sedentary and obese population that show a high consumption of saturated fats and high prevalence of metabolic syndrome. The proportion of them following regular treatment is low, specially in diabetic men that, in addition, still smoke.