Cutaneous manifestations of diabetes mellitus type 2: prevalence and association with glycemic control
Keywords:
Cutaneous manifestations, diabetes mellitus type 2, glycemic controlAbstract
Objective To determine the frequency and pattern of skin disorders in patients with type 2 diabetes mellitus and their association with glycemic control in our diabetics.Methods This descriptive, cross-sectional study was conducted at departments of Medicine and Dermatology, Sir Syed College of Medical Sciences and Hospital, Karachi from 1st January to 30th June 2014. Adult patients belonging to both genders having diabetes mellitus type 2 with cutaneous manifestations were included. After taking the informed consent, demographic details, duration of diabetes, mode of treatment for diabetes, types of footwear, foot care and glycemic profile were documented.Results In 203 patients (41% male and 59% female), mean age was 50 + 11 years and mean duration of diabetes 8.5 + 7 years. Mean HbA1c was 8.6 + 1.5 with 68% patients having unsatisfactory glycemic control. Most frequently observed skin disease was bacterial infections (26%), followed by fungal infections (22%), acanthosis nigricans (20%), diabetic foot (16%), nail changes (16%), acrochordons (10%), diabetic dermopathy (9%), necrobiosis lipoidica (9%), viral infections (8%) pruritus (8%) and xanthelasma (8%). There was significant association of unsatisfactory glycemic control with bacterial infections (p = 0.037) and fungal infections (p = 0.023). Females especially had a higher frequency of association with acanthosis nigricans (p = 0.030). Conclusion Patients with type 2 DM have high frequency of infections especially bacterial and fungal. Other manifestations like acanthosis nigricans and diabetic foot are comparatively less common.References
Ahmed K, Muhammad Z, Qayum I. Prevalence of cutaneous manifestations of diabetes mellitus. J Ayub Med Coll Abbottabad. 2009;21:76-8.
Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL. Pattern of cutaneous manifestations in diabetes mellitus. Indian J Derm 2010; 55;39-41.
Bashier AH, Kordofani YM. Clinico-epidemiological study of cutaneous manifestations of diabetes mellitus in Sudanese patients. Sud J Dermatol. 2004;2:54-60.
Baloch GH, Memon NM, Ram B, Iqbal P, Thebo NK. Cutaneous manifestation of type II diabetes mellitus. J Liaquat Uni Med Health Sci. 2008;7:67-70.
Farshchian M, Farshchian M, Fereydoonnejad M, Yazdanfar A, Kimyai-Asadi A. Cutaneous manifestations of diabetes mellitus: A case series. Cutis. 2010;86:31-5.
Majeed M, Iqbal F, Mehboob A. Cutaneous manifestations in type-1 and type-2 diabetes mellitus (A study profile of 200 patients). Proc Shaikh Zayed Postgrad Med Inst. 2004;18:63-8.
Miracle LS, Barreda BF. Cutaneous manifestations of diabetes mellitus, a clinic manner for identifying the disease. Rev Endocrinol Nutr. 2005;13:75-87.
Vahora R, Thakkar S, Marfatia Y. Skin, a mirror reflecting diabetes mellitus: A longitudinal study in a tertiary care hospital in Gujarat. Indian J Endocrinol Metab. 2013;17:659-64.
Ragunatha S, Anitha B, Inamadar AC, Palit A, Devarmani SS. Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol. 2011;56:160-4.
Basit A, Hydrie MZI, Hakeem R, Ahmedani MY, Waseem M. Frequency of chronic complications of type 2 diabetes. J Coll Physicians Surg Pak. 2004;14:79-83.
Mahmood T, Ul-Bari A, Agha H. Cutaneous manifestations of diabetes mellitus. J Pak Assoc Dermatol. 2005;15:227-32.
Bhat YJ, Gupta V, Kudyar RP. Cutaneous manifestations of diabetes mellitus. Int J Diabetes Dev Ctries. 2006;26:152-5.
Mahajan S, Koranne RV, Sharma SK. Cutaneous manifestation of diabetes mellitus. Indian J Dermatol Venereol Leprol. 2003;69:105-8.
Majeed M, Iqbal F, Mehboob A. Frequency and association of cutaneous manifestations of diabetes mellitus with HbA1c. Proc Shaikh Zayed Postgrad Med Inst .2004;18:85-9.
Afridi MAR, Khan MN. Role of health education in the management of diabetes mellitus. J Coll Physicians Surg Pak. 2003;13:558-61.
Van Hattem S, Hootsma AH, Thio HB. Skin manifestations of diabetes. Cleve Clin J Med. 2008;75:772-87.
Al-Mutairi N. Skin diseases in diabetes mellitus. Bull Kuwait Inst Med Special. 2006;5:30-9.
Mansour AA, Imran HJ. Foot abnormalities in diabetics: Prevalence and predictors in Basrah, Iraq. Pak J Med Sci. 2006;22:229-33.
Mahmood K, Akhter ST, Talib A, Talib A, Abbasi B, Siraj-ul-Salekeen et al. Clinical Profile and management outcome of diabetic foot ulcers in a tertiary care hospital. J Coll Physicians Surg Pak. 2008;18:408-12.
Ali SM, Basit A, Fawad A, Mumtaz S, Hydrie MZ. Presentation and outcome of diabetic foot at a tertiary care unit. Pak J Med Sci. 2008;24:651-6.
Viswanathan V, Madhvan S, Rajasekar S, Chamukuttan S, Ambady R. Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients. Diabetes Care. 2006;29:701-3.
Korkmaz M, Erdogan Y, Yilmaz N. Preoperative medical treatment in patients undergoing diabetic foot surgery with a Wagner grade-3 or higher ulcer: a retrospective analysis of 52 patients. Diabetic Foot Ankle. 2012;3:18838-42.
Kong A, Williams R, Smith M, Sussman AL, Skipper B, Hsi AC et al. Acanthosis nigricans and diabetes risk factors: prevalence in young persons seen in Southwestern US primary care practices. Ann Fam Med. 2007;5:202-8.
Kalus AA, Chien AJ, Olerud JE. Diabetes mellitus and other endocrinal disorders. In: Fitzpatrick's Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008. P. 1461-84.
Crook MA. Skin tags and atherogenic lipid profile. J Clin Pathol. 2000;53:873-4.
Bhat Y, Gupta V, Kudyar RP. Cutaneous manifestations of diabetes mellitus. Int J Diabetes Dev Ctries. 2006;26:152-5.
Foss NT, Polon DP, Takada MH, Foss-Freitas MC, Foss MC. Skin lesions in diabetic patients. Rev Saude Publica. 2005;39:1-5.
American Diabetes Association. Standards of medical care in diabetes-2007. Diabetes Care. 2007; 30:S4–S4.