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Psoriasis severity associated with incident diabetes
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An additional 115,500 people will develop diabetes each year due to the risk posed by psoriasis, according to data published in Archives of Dermatology.
The population-based cohort study comes after recent data suggest a link between psoriasis and myocardial infarction, stroke, metabolic syndrome and cardiovascular mortality. This link is thought to be due to the chronic inflammation, besides the link between type 2 diabetes and elevated Th1-driven inflammatory markers, researchers said.
Patients who already have type 2 diabetes and severe psoriasis are also more likely to undergo medication intervention.
Rahat S. Azfar, MD, of the University of Pennsylvania in Philadelphia, and colleagues conducted the study by collecting data from The Health Improvement Network (THIN), an electronic medical records database representing 4.6% of the United Kingdom population, from 2003 to 2008.
Among the adults aged 18 to 90 years with psoriasis (n=108,132) and patients without psoriasis (n=430,716), 101,870 were categorized as having mild psoriasis and 6,229 were labeled as having severe disease based on treatment patterns.
Azfar and colleagues reported that incident diabetes was linked to psoriasis severity (overall psoriasis: HR=1.18; 95% CI, 1.14-1.23; severe psoriasis: HR=1.75; 95% CI, 1.56-1.98).
In adjusted models that accounted for age, sex, BMI, hypertension and hyperlipidemia, psoriasis remained an independent risk factor for incident diabetes (HR=1.14; 95% CI, 1.10-1.18) and was greater in those with severe psoriasis (HR=1.46; 95% CI, 1.30-1.65).
“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,” researchers said.
Among 1,000 patients with psoriasis, the adjusted attributable risk for developing type 2 diabetes per year was 0.9 extra cases overall, 0.7 cases among those with mild psoriasis and 3.0 cases among those with severe psoriasis.
Azfar and the research team examined diabetes treatment patterns among patients who developed incident disease and found no difference in the use of oral hypoglycemic medications (OR=1.03; 95% CI, 0.95-1.11) or insulin (OR=1.06; 95% CI, 0.89-1.25) in the group of patients with mild psoriasis.
However, patients with severe psoriasis were more likely to be administered oral hypoglycemic medications (OR=1.53; 95% CI, 1.14-2.07) and were also more likely to be prescribed insulin (OR=1.32; 95% CI, 0.75-2.33).
Despite the impressive results, researchers conducting the study said further research is needed.
Disclosures:
- Dr. Azfar reports no relevant financial disclosures. Two researchers report financial ties with Abbott, Amgen, Astellas, Celgene, Centocor, Pfizer and Novartis.
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