Study suggests that psoriasis may be associated with development of type 2 diabetes

June 18, 2012

CHICAGO - A population-based study from the United Kingdom suggests that the common skin condition psoriasis may be a risk factor for the development of Type 2 diabetes mellitus (T2DM), according to a report published Online First by Archives of Dermatology, a JAMA Network publication.

Psoriasis, a chronic inflammatory disease characterized by scaling of the skin, affects 2 percent to 4 percent of the adult population, according to the study background.

Rahat S. Azfar, M.D., of the University of Pennsylvania, Philadelphia, and colleagues used data from The Health Improvement Network (THIN), an electronic medical records database in the United Kingdom, to conduct a population-based study of adults ages 18 to 90 years with psoriasis vs. patients without psoriasis. They matched 108,132 patients with psoriasis with 430,716 patients without psoriasis.

"The adjusted attributable risk of developing T2DM among 1,000 patients with psoriasis per year is 0.9 extra cases overall, 0.7 cases in those with mild psoriasis, and 3.0 cases in those with severe psoriasis," the authors report in the study findings.

A secondary aim of the study was to determine whether patients with diabetes and psoriasis were more likely to receive prescription diabetic therapy compared with patients with DM but no psoriasis.

"We observed no difference in use of oral hypoglycemic agents or insulin among patients with mild psoriasis; however, patients with severe psoriasis were more likely to be prescribed oral hypoglycemic agents and had a trend toward being more likely to be prescribed insulin," the authors note.

"The data from this study suggest that psoriasis is a risk factor for the development of T2DM and that this relationship is dose dependent, with severe psoriasis conferring a higher risk than mild psoriasis," the authors comment. "Mechanistically, this relationship may be driven by chronic inflammation because both psoriasis and T2DM are associated with elevated levels of TH1-driven inflammatory markers, and because several studies have pointed to endogenous insulin resistance in patients with psoriasis."
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(Arch Dermatol. Published online June 18, 2012. doi:10.1001/archdermatol.2012.1401. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: One author disclosed serving on the data safety monitoring boards for several companies. Another has received grants and is a consultant for several companies. This work was supported by grants from the National Institute for Arthritis and Musculoskeletal and Skin Diseases, the National Heart, Lung and Blood Institute and a T32 University of Pennsylvania dermatology departmental training grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact Rahat S. Azfar, M.D., call Kim Menard 215-662-6183 or email kim.menard@uphs.upenn.edu.

The JAMA Network Journals

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