Patients with psoriasis were 14% more likely to develop type 2 diabetes than those without the skin condition, Rahat S. Azfar, MD, from the University of Pennsylvania in Philadelphia, and colleagues determined after adjusting for a range of potential confounding factors.
Risk was highest among patients with severe psoriasis (adjusted hazard ratio=1.46; 95% CI: 1.30-1.65), but remained significant among those with mild psoriasis (aHR=1.11; 95% CI: 1.07-1.15), the researchers reported in Archives of Dermatology.
“These findings, combined with the large literature linking psoriasis to cardiovascular and metabolic disease, suggest that patients with psoriasis should be encouraged to lower their risk of diabetes mellitus and its complications by undergoing therapeutic lifestyle changes and appropriate screenings for signs of insulin resistance,” they wrote.
Previous research has suggested that the inflammatory process in psoriasis may play a role in the associations found between the skin disorder and myocardial infarction, stroke, metabolic syndrome and cardiovascular mortality.
Azfar and colleagues hypothesize that the same may be true for diabetes. To examine the association further, they analyzed electronic health records from 108,132 patients with diabetes and 430,716 patients without psoriasis, who were matched by location and when seen for an office visit. Only patients who developed incident diabetes during the study time frame were included.
The relationship between incident diabetes and psoriasis appears to be “dose”-dependent, the researchers found, with fully adjusted HRs for indicent diabetes at 1.14 overall (95% CI: 1.10-1.18), 1.11 in the mild psoriasis group (95% CI: 1.07-1.15) and 1.45 in the severe psoriasis group (95% CI: 1.30-1.65).
Furthermore, patients with severe psoriasis had a 53% higher chance of being prescribed an oral hypoglycemic agent for incident diabetes (aHR=1.55; 95% CI: 1.15-2.10). However, patients with mild psoriasis were no more likely than those without psoriasis to be prescribed a diabetes medication.
“Further research into the extent to which psoriasis and its treatment play a role in the development of type 2 diabetes mellitus and its complications is warranted,” the authors write. “In addition, it is necessary to determine why patients with severe psoriasis who develop diabetes mellitus are more likely to receive prescription hypoglycemic treatments.”