• linkedin
  • Increase Font
  • Sharebar

    Diabetes risk in psoriasis increases with disease severity

    Psoriasis is an important predictor of diabetes risk and the more severe the disease, the higher the diabetes risk, researchers report in the Journal of the American Academy of Dermatology.

    This was a population-based study of 8,124 adults with psoriasis and 76,599 adults without psoriasis who were followed for four years.  Researchers found that patients with severe psoriasis have about a 60 percent increased annual risk of type two diabetes, which equates to about 25,000 additional new diabetes cases worldwide each year or 125,650 new cases of diabetes among all psoriasis patients.

    "These findings are independent of traditional risk factors for diabetes and still show a strong connection between the increasing severity of psoriasis and the increasing risk of developing diabetes, which makes a strong argument for a causal relationship between the two,” said Joel M. Gelfand, M.D., of the University of Pennsylvania Perelman School of Medicine.

    By comparison, a review of five studies showed that psoriasis is associated with a 27 percent increased risk for type two diabetes mellitus.

    The association with diabetes was shown in studies suggesting that some of the same loci and inflammatory cytokines that are up-regulated in psoriasis also promote insulin resistance.


    To determine diabetes risk in adults with psoriasis versus those without the disease, researchers analyzed four years of data from 8,124 adults with psoriasis and 76,599 adults without psoriasis.

    They found incident diabetes cases in 3.44 percent of the psoriasis group compared to 2.44 percent of the non-psoriasis group. After adjusting for age, sex, body mass index and other risk factors, they found that compared to those without psoriasis, the risk for developing diabetes was 21 percent higher among psoriasis patients with 2 percent or less body surface area affected; 1 percent more in psoriasis patients with three to 10 percent body surface area; and 64 percent higher in severe patients with more than 10 percent of their body surface area impacted.

    "Psoriasis body surface area should be routinely measured in clinical practice, and patients should be educated about ways in which diabetes can be prevented through adopting a healthy lifestyle. Dermatologists should consider screening for diabetes using a simple blood test such as a Hemoglobin A1c, especially in patients with a body surface area of greater than 10 percent," Dr. Gelfand says.

    Further analysis of the severe group of psoriasis patients showed that for every 10 percent increase in affected body surface area, diabetes risk rises by an additional 20 percent.

    While the study shows a positive dose-response relationship between psoriasis severity and type 2 diabetes risk, it’s unclear why the researchers didn’t see a significantly increased diabetes risk in the group with 3 percent to 10 percent of their body surface area affected, but it did in patients with less severe disease impacting 2 percent or less of their body surface area. It’s possible that the sample size and follow-up duration were not sufficient to detect a prospective association in the middle group of psoriasis patients, they write.  

    While the findings are likely applicable to the general population of psoriasis patients, the authors write, questions remain about how treatment, including systemic agents or phototherapy, impacts diabetes risk among psoriasis patients.



    In the previous 12 months, Dr Gelfand served as a consultant for BMS, Coherus (DSMB), Dermira, GSK, Janssen Biologics, Menlo Therapeutics, Novartis Corp, Regeneron, Dr Reddy’s labs, Sanofi, and Pfizer Inc, receiving honoraria; he receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Regeneron, Sanofi, Celgene, and Pfizer Inc, and he has received payment for CME work related to psoriasis that was supported indirectly by Lilly, Valeant, and Abbvie.


    Wan MT, Shin DB, Hubbard RA, Noe MH, Mehta NN, Gelfand JM. “Psoriasis and the risk of diabetes: A prospective population-based cohort study,” JAAD. February 2018. DOI: 10.1016/j.jaad.2017.10.050. 

    Armstrong AW, Harskamp CT, Armstrong EJ. "Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis,” JAMA Dermatology. January 2013. DOI: 10.1001/2013. 


    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Latest Tweets Follow