Psoriasis Linked to Diabetes Risk

Greater psoriasis severity was associated with greater disease burden

Psoriasis is linked to a 22% increased risk for type 2 diabetes as well as a greater prevalence of other systemic comorbidities, according to a population-based study online ahead of print in JAMA Dermatology. Greater psoriasis severity was associated with greater disease burden from these comorbidities, the study authors found.

“These findings suggest that inflammatory diseases like psoriasis predispose patients to developing diabetes,” senior author Joel M. Gelfand, MD, MSCE, told “Previous work from our group and others has shown that psoriasis patients have an increased risk of developing diabetes independent of common risk factors such as obesity. In this current work we show that as psoriasis severity increases (based on body surface area affected), so too does the likelihood that the patient will develop diabetes and diabetes with end organ complications,” said Dr. Gelfand, Associate Professor of Dermatology and Epidemiology at University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Psoriasis May Be An Indicator of Other Systemic Diseases

“We are coming to understand that chronic inflammatory disorders of the skin contribute to systemic disorders including cardiovascular disease, diabetes, and kidney disease,” commented Keith Adam Choate, MD, PhD, Assistant Professor of Dermatology and of Pathology at Yale University School of Medicine, New Haven, CT. “The Gelfand et al article highlights this, showing that even mild psoriasis increases risk of co-morbid illness, with worsening skin disease further increasing risk,” Dr. Choate said.

“For some, psoriasis has been considered a ‘cosmetic’ more than a medical issue, but this article suggests that it may be an important sign of systemic disease risk,” Dr. Choate continued. “As such, primary care providers and dermatologists may wish to consider additional screening in patients with psoriasis for potentially associated systemic disease and may consider counseling patients on early lifestyle modifications, which may help to reduce their risk. Further research is needed to fully evaluate whether early or thorough treatment of inflammatory skin disorders can help to mitigate risk for developing systemic disease or improve active disease,” Dr. Choate said.

“Diabetes, pre-diabetes, and metabolic syndrome commonly affect patients with psoriasis and these conditions often complicate the treatment of psoriasis in patients with severe disease,” Dr. Gelfand commented. “Efforts at diabetes prevention in patients with psoriasis especially if disease is more severe are indicated,” Dr. Gelfand said.

Study Design and Findings

The study involved data from United Kingdom–based electronic medical records of 9,035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without this disease. 

Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08), diabetes mellitus (1.22), diabetes with systemic complications (1.34), mild liver disease (1.41), myocardial infarction (1.34), peptic ulcer disease (1.27), peripheral vascular disease (1.38), renal disease (1.28), and rheumatologic disease (2.04). Psoriasis severity was significantly associated with an increased between prevalence of each comorbid disease (P<0.05 for all comparisons).

Possible Mechanisms Behind the Psoriasis-Diabetes Link

“Psoriasis shares susceptibility genes with diabetes (CDKAL1) so there may be common genetic etiology,” Dr. Gelfand said. “Psoriasis also is a Th1 and Th17 inflammatory disorder. Cytokines such as TNF-alpha are upregulated in psoriasis and are thought to promote insulin resistance. Psoriasis also has a substantial health burden on patients and may be associated with lifestyle choices that further increase the risk of diabetes,” he explained.

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