Diabetes is raging with the population of La Palma, El Hierro and Gran Canaria
Palmeros, Herreños and Gran Canaria are the most prone to suffering from some type of diabetes throughout their lives. La Palma and El Hierro are the islands that have a higher incidence of diabetes linked more closely to genetic inheritance, type 1; Meanwhile in Gran Canaria It is the island with the highest proportion of diabetes cases linked to poor lifestyle habits, such as sedentary lifestyle, obesity or smoking, that is, type 2 diabetes.
According to the Strategy for addressing diabetes mellitus in the Canary Islands for 2021, the Canary Islands Health Service (SCS) counts 13,947 patients with type 1 diabetes, which represents 0.66% of the population of the Islands. However, in some regions, such as La Palma, with 745 patients, the prevalence is almost 1%. This type of pathology usually debuts in childhood or adolescence, in such a way that the Canary Islands account for 594 cases in the smallest. "There are scientific studies that show that the Canary Islands have the highest incidence of type 1 diabetes in children and this is not due to risk genetics," emphasizes the study carried out by the Ministry of Health.
Ana Wägner, an endocrinology and nutrition specialist at the Maternal-Child University Hospital of Gran Canaria, agrees with this, assuring that an international project carried out in the early 2000s concluded that there was no difference at the genetic level. between the canaries and the rest of the world. Specifically, this disease develops due to a malfunction of the HLA genes, known as "human leukocyte antigen", which is a set of molecules involved in immune recognition and signaling between cells of the immune system.
However, Wägner considers that it is still possible to go further because at that time "there were very few families studied". In this way, Wägner is committed to studying a larger number of families to determine whether there really is a "particular genetics" behind type 1 diabetes in the Canary Islands.
The population affected by type 2 diabetes amounts to 168,011 people on the islands -according to the latest available data, from 2018- which represents 7.90% of the population. Gran Canaria, in this sense, is the one with the highest incidence of this subtype of the disease, associated with a less healthy lifestyle. 8.8% of the population on the island suffers from this chronic pathology, which is the highest figure in the entire Canary Islands. El Hierro (8.79%) and La Palma (7.83%) follow in incidence. This condition affects more the population over 40 years of age and is closely related to obesity. In the province of Santa Cruz de Tenerife there are areas where the percentage of diabetic patients with obesity is very high, varying from 25% to 37%. In the case of the province of Las Palmas, such extreme values are not reached in any area, so in these islands diabetes does not depend so much on obesity.
There are at least 80 genes that influence the development of type 2 diabetes
Among the risk factors for developing type 2 diabetes are age - the risk increases after 45 years of age - race or ethnicity - those of Hispanic, Asian, African and Native American origin are more prone-, family history and personal history - especially in the case of women who have suffered gestational diabetes. At the genetic level, there are at least 80 genes that influence the development of the pathology and "they all have a similar relative weight", as Wägner points out.
In this sense, the Endocrinology and Nutrition service of the Maternal and Child Insular University Hospital Complex is investigating the genetics of type 2 diabetes in a multicenter study called ImpactT2D. The objective is to develop genomic instruments that help define the origin of the development of this disease in order to personalize its clinical management. The study has proposed to include at least a thousand patients who present an early onset of the disease and without obesity to maximize the discovery of relevant genes.
The Canary Islands spend 96.3 million euros annually on oral antidiabetic treatments and insulins
And it is that the variability of the precursors of type 2 diabetes is so wide that there are times when it is difficult to establish which therapy is most effective for each patient. This research is relevant precisely because the Canary Islands spend 96.3 million euros annually on oral antidiabetic treatments and insulin. This figure has grown by 21% as a result of the increase in patients (in 2019 there were 5.7% more than in 2017) and the improvement of treatments, which have forced an increase in the price of the annual treatment of one patient to 557 euros (7% more).
During the execution of this project, it is intended to develop an app that can be used in healthcare environments, to integrate genomic and clinical information in order to guide therapeutic decisions based on efficacy and toxicity criteria, easily interpretable by healthcare professionals. In addition, researchers from the SCS Evaluation Service will carry out an economic evaluation of the health costs and benefits of decisions based on risk stratification based on the clinical and genomic information obtained, compared to normal clinical practice.
The findings of this project will not only have a direct application in the therapeutic management of patients with type 2 diabetes, but will also establish the bases for future studies that provide a better understanding of the biological processes underlying the development of this disease.
The best treatments, as well as the prevention programs that have been implemented in the Islands, have reduced mortality from 35% in 2010 to 11% in 2018. However, the Canary Islands continue to be the community with the highest rate of mortality throughout Spain.