Diabetes-associated dermatological manifestations in primary care and their association with vascular complications

Abstract

Introduction

Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications.

Methods

Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley’s papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD).

Results

213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001).

Conclusion

In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.

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Correspondence to Jean-Eudes Trihan.

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Highlights

• Diabetes-associated dermatological manifestations (DADM) are frequent and underdiagnosed.

• This study provides prevalence rates of 7 frequent DADM in primary care.

• Prevalence rates in primary care seems similar to available data on tertiary care.

• They are associated with both macro- and microvascular involvement.

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Trihan, J., Lanéelle, D., Metcalfe, N. et al. Diabetes-associated dermatological manifestations in primary care and their association with vascular complications. J Diabetes Metab Disord (2020). https://doi.org/10.1007/s40200-020-00594-1

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Keywords

  • Dermatological manifestations
  • Diabetes mellitus
  • Primary care
  • Vascular complications
  • Diabetic dermopathy
  • Necrobiosis lipoidica diabeticorum