Psoriasis May Increase Risk of Diabetes

Psoriasis, especially more severe cases, may raise the risk of developing diabetes, a recent study determined.  Incident diabetes was a modest but significant 14% more likely among individuals who have the skin condition.
Rahat S. Azfar, MD., of the University of Pennsylvania in Philadelphia and colleagues found that severe psoriasis raised the risk of diabetes the most- at 1.46%, but the risk was also high among mild cases as well.
Reported in the Archives of Dermatology, the authors extrapolated the statistics from the 125 million cases of psoriasis worldwide, finding that the skin disease may add 115,000 new cases of diabetes each year.
"These findings, combined with the large literature linking psoriasis to cardiovascular and metabolic disease, suggests that patients with psoriasis should be encouraged to lower their risk of diabetes mellitus and its complications by undergoing lifestyle changes and appropriate screenings for signs of insulin resistance," the researchers recommended.
Links to heart attack, stroke, metabolic syndrome, and cardiovascular mortality found in those from prior studies are thought to be due to the chronic inflammation of psoriasis. The same may be true for the link between diabetes and psoriasis, as the inflammatory cytokines that promote psoriasis also promote insulin resistance and metabolic problems.
Researchers used The Health Improvement Network (THIN), an electronic medical records database of general practitioners covering 5% of the British population. The study included 108,132 adults with psoriasis and 430,716 patients without psoriasis. The relationship between incident diabetes and psoriasis seemed to be "dose" dependent. Adjustments were made for sex, age, body mass index, hypertension, and high cholesterol.
When looking at patients who developed diabetes in a nested study, patients with mild psoriasis weren't more likely to be treated with diabetes medications than those who did not have psoriasis. However, those with severe psoriasis were 53% more likely to be prescribed an oral hypoglycemic agent for incident diabetes with a nonsignificant trend for a greater likelihood of a prescription for insulin as well.
The reason why those with severe psoriasis are more likely to be prescribed medications is not clear, and Azfar's group acknowledged that more research is necessary. Overall diabetes risk and treatment findings were sensitive to analyses including psoriatic arthritic patients, those without annual visits, etc.
Researchers also noted that their findings may be limited by misclassification of psoriasis because of treatment patterns to determine severity and possible information bias.
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