The Link Between Diabetes and Psoriasis: What You Need to Know

April 17, 2024

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Diabetes and psoriasis represent two highly prevalent chronic inflammatory conditions that often co-occur in the same patients. The intimate pathogenetic connections tying these diseases together point to joint management optimizing outcomes for both. This article delves into the data illuminating factors underpinning the dangerous association of diabetes and psoriasis.

Robust population data consistently demonstrates a significantly elevated prevalence of type 2 diabetes among psoriasis patients – and vice versa. Those with psoriasis show nearly 60-90% higher likelihood of developing diabetes compared to the general public when controlling for traditional risk factors.

For a diagnosis of diabetes, patients with mild psoriasis already demonstrate double the risk. Severe psoriasis patients see risks approaching three times higher for concurrent diabetes. This bidirectional relationship persists across geographic and ethnic groups pointing to intrinsic biological drivers at play.

Understanding the factors linking diabetes and psoriasis provides critical insights for caring for patients with these conditions.

Shared Risk Factors and Genetic Overlap

Particular lifestyle and genetic traits occur more commonly among those with psoriasis and diabetes indicating shared contributors to pathophysiology exist.

Obesity

Excess adiposity drives both insulin resistance escalating diabetes risk as well as promoting systemic inflammation that can trigger immune system dysfunction and psoriasis.

Up to 63% of psoriasis patients are obese. Losing excess weight can thus improve inflammation and symptoms for both conditions.

Physical Inactivity

Sedentary habits encourage obesity and diabetes development while also amplifying inflammation. Even light regular activity counters these effects.

Genetics

A subset of gene variants including HLA-Cw6 raise risks for both diseases. Certain mutations lead to overexpression of inflammatory signaling molecules like IL-23/IL-17a to drive development of diabetes and psoriasis through shared pathways. Epigenetic influences may further link onset.

Microbiome

Imbalances in gut microbial populations can trigger chronic inflammation and autoimmunity. Dysbiosis encourages insulin resistance and skin inflammation alike.

Identifying these common antecedents provides opportunities to intervene by addressing lifestyle and inflammation early to possibly prevent comorbid disease onset.

How Might Diabetes Worsen Psoriasis?

Uncontrolled diabetes substantially worsens psoriasis through diverse inflammatory and metabolic mechanisms including:

Hyperglycemia Induced Inflammation

Chronically elevated blood glucose promotes systemic inflammation through advanced glycation end products (AGEs) and reactive oxidative species driving tissue damage and immune cell activation.

Insulin Resistance Fueling Immune Pathology

Defective insulin signaling triggers compensatory hyperinsulinemia which further disturbs immune cell metabolism and function. Aberrant T-cell responses result.

Microvascular Disease Impacting Skin

Vascular dysfunction reduces nutrient blood flow to skin tissues. Companion small nerve fiber injury generates pain and irritation.

Obesity Promoting Inflammation

Excess visceral adipose tissue inherent in diabetes pathology releases hormones and cytokines spurring inflammation.

By corrections to hyperglycemia and limiting adipose tissue inflammation through proper diabetes control, dermatologists can substantially improve psoriasis severity.

Can Psoriasis Also Worsen Diabetes Outcomes?

Just as diabetes exacerbates psoriasis, the converse also appears true. Having psoriasis similarly escalates risks for developing diabetes and its downstream health complications through mechanisms including:

Systemic Inflammation Causing Insulin Resistance

The immune system activation driving psoriasis stimulates inflammatory cytokine production which interferes with insulin signaling and glucose uptake into cells. Chronically elevated blood sugars result.

Plaques Worsening Insulin Absorption

Thick scaly psoriatic lesions physically limit insulin diffusion into deeper skin layers to take effect. Resulting higher blood insulin and glucose levels set the stage for diabetes.

Medications Impacting Glucose Metabolism

Certain psoriasis treatments like corticosteroids can influence glucose metabolism and encourage diabetes development with long term use.

Therefore, dermatologists play a pivotal role identifying early insulin resistance signs through screening labs to initiate interventions preventing clinical diabetes in psoriasis patients with worsening metabolic status.

Appreciating the bidirectional disease exacerbation between psoriasis and diabetes informs treatment considerations aiming to break this vicious cycle.

Lifestyle Modifications

Weight loss, dietary improvements emphasizing anti-inflammatory nutrition, increased activity, and stress reduction remain first line for reducing inflammation simultaneously driving both diseases.

Medications Targeting Shared Drivers

Older diabetes medications like metformin demonstrate independent anti-inflammatory and insulin sensitizing benefits to improve psoriasis symptoms. Novel agents combatting hyperglycemia may offer similar advantages.

Biologics Addressing Key Pathways

Newer injectable biologics like IL-17 and IL-23 cytokine inhibitors interrupt immune signaling pathways critically involved in psoriasis, diabetes, and associated cardiovascular complications.

Careful attention towards screening, monitoring, diagnosing, and treating the interconnected metabolic-inflammatory disturbances underpinning psoriasis and diabetes comorbidities should become standard practice given the implications for overall wellness.

Frequently Asked Questions About Diabetes and Psoriasis

Can psoriasis cause someone to develop diabetes?

Yes, the chronic inflammation of psoriasis promotes insulin resistance and higher rates of type 2 diabetes. Early screening for blood sugar elevations allows preventing clinical diabetes with appropriate lifestyle interventions targeting inflammation.

Is diabetes a trigger for psoriasis flares?

Absolutely – poor glycemic control in diabetes correlates with worsening psoriasis severity. Monitoring glucose levels and adjusting treatment helps avoid diabetes exacerbating skin symptoms. Lifestyle changes reducing inflammation also beneficial.

What diabetes medications can help with psoriasis symptoms?

Older agents like metformin have demonstrated efficacy treating psoriasis through combined anti-inflammatory effects and improving insulin sensitivity that drives flares. Emerging diabetes drugs combatting downstream inflammation may also hold promise for dual treatment.

Does having psoriasis increase risks for diabetes complications?

Yes research indicates the added inflammation from psoriasis increases likelihood for microvascular complications like diabetic neuropathy and nephropathy by 30-40% over diabetes alone. Controlling psoriasis and blood sugars crucial to limit these outcomes.

Can injections for psoriasis affect blood sugar levels?

Certain psoriasis biologic medications essentially act as immunosuppressants. While rare, altered glucose metabolism is a potential side effect to monitor with certain injections like ustekinumab or infliximab. However IL-17 and IL-23 antagonists appear neutral if not beneficial for comorbid diabetes.

Key Takeaways on Diabetes and Psoriasis

  • Strong bidirectional disease exacerbation exists
  • Shared contributors include genetics, obesity, inflammation
  • Diabetes worsens psoriasis through hyperglycemia and insulin resistance
  • Psoriasis drives diabetes via inflammation and plaques hindering absorption
  • Lifestyle interventions, metformin, biologics offer dual treatment benefits

Despite extensive evidence already illuminating the dangerous association between psoriasis and diabetes, critical unanswered questions persist at this intersection ripe for ongoing investigation including:

  • Defining tipping points for metabolic disease progression in psoriasis
  • Studying early screening for insulin resistance before diabetes onset
  • Identifying patients most likely to respond to off-label anti-diabetes treatments
  • Comparing newer diabetes medications combatting inflammation as psoriasis therapies
  • Developing dietary and microbiome interventions improving both concurrently
  • Exploring psoriatic arthritis implications on worse metabolic status
  • Investigating potential for bidirectional worsening of complications

Advancing scientific insights to this intimate relationship between psoriasis and diabetes will surely continue improving multidisciplinary collaborative care for patients suffering from both debilitating conditions.

Conclusion

In summary, extensive evidence demonstrates psoriasis and diabetes endemic diseases promoting a vicious cycle of worsening inflammation and immune-metabolic disturbances in predisposed patients. Appreciating the shared genetic risks, lifestyle triggers, and inflammatory pathways driving pathology equips providers to screen proactively for comorbidities. Simultaneously addressing uncontrolled blood sugars and psoriatic inflammation through lifestyle adjustments, select medications, and advanced biologic therapies also breaks this dangerous vicious cycle. Ultimately integrating dermatology, endocrinology, and primary care management of diabetes and psoriasis comorbidities begets superior patient outcomes by addressing root causes holistically.

References

  • Papoutsaki, M., & Costanzo, A. (2013). Treatment of psoriasis and metabolic syndrome. World journal of diabetes, 4(3), 68–74.
  • Romaní, J., Caixàs, A., Carrascosa, J. M., Ribera, M., & Rigla, M. (2018). Association of psoriasis severity with hypoglycemia, and glycated hemoglobin level in patients with diabetes mellitus. JAMA dermatology, 154(4), 424–431.
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