Studies continue to show a link between psoriasis and type 2 diabetes, underlining the importance for people with the skin disease to pay attention to their overall health.
A Danish study published in August 2013 in the journal Diabetes Care followed more than 52,000 people with psoriasis ages 10 and older for 13 years, and compared them to the rest of the Danish population. The researchers found that everyone with psoriasis, whether it was mild or severe, was at higher risk for developing type 2 diabetes — and the more severe the psoriasis, the higher the risk for diabetes.
A University of Pennsylvania study published in September 2012 in JAMA Dermatology compared more than 100,000 people with psoriasis to 430,000 people who didn’t have it. The researchers found that those with a severe case of psoriasis were 46 percent more likely to develop type 2 diabetes than those without psoriasis. People who had a mild case of psoriasis had an 11 percent higher risk of developing type 2 diabetes.
The risk was higher even among psoriasis patients who didn’t have other risk factors commonly associated with diabetes, such as obesity. As a result, the researchers estimated 115,500 new cases of diabetes a year are due to the risk from psoriasis.
In addition to diabetes, psoriasis complications include a higher risk for metabolic syndrome, heart disease, stroke, and death related to cardiovascular problems. Researchers at the University of Pennsylvania published a study in October 2013 in JAMA Dermatology showing that psoriasis is associated with many diabetes complications, including those affecting the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy), and blood vessels (vasculopathy).
Understanding the Connection
There are a few explanations for the connection between psoriasis and type 2 diabetes, but recent research suggests both conditions share genes in common. A study published in July 2016 in JAMA Dermatology compared data from 33,588 Danish twins and found that psoriasis was more common in those with diabetes — 7.6 percent of 459 people — than in those without (4.1 percent of the remaining 33,129). Researchers noted that these results indicate that psoriasis, type 2 diabetes mellitus, and obesity are all strongly linked, and the relationship between psoriasis and obesity could be partly due to a common genetic cause. The two diseases also share other factors in common:
Both increase inflammation. Chronic inflammation caused by psoriasis is the most important and significant contributing factor for the increased diabetes risk, says Nadia Yaqub, MD, endocrinologist at University of Cincinnati Health in West Chester, Ohio and associate professor of medicine at the University of Cincinnati College of Medicine.
Type 2 diabetes is also a condition of chronic inflammation.
Inflammation caused by psoriasis can also increase the amount of an insulin-like growth factor in the body that is linked to diabetes, explains Andrea Neimann, MD, clinical assistant professor and dermatologist at the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York City.
In addition, psoriasis affects your immune system in ways that have been linked to insulin resistance and type 2 diabetes, notes Dr. Neimann.
They share related conditions. Psoriasis is associated with obesity, higher body mass index, high cholesterol, high blood pressure, cardiovascular disease, and stroke. All of those conditions are also intricately related to type 2 diabetes, Neimann says.
Psoriasis and type 2 diabetes are affected by lifestyle. Both diseases are associated with certain lifestyle habits, including smoking, drinking alcohol, and an unhealthy diet. Also, some treatments for psoriasis may make cholesterol and blood sugar levels more difficult to control.
When researchers look for evidence that one disease may potentially affect the risk for another condition, they consider the “dose-response effect,” Neimann says. That's why the more severe the psoriasis, the higher the risk of diabetes seems to be.
Healthy Living With Psoriasis
Psoriasis complications are not something to ignore, particularly if they include a serious chronic disease like type 2 diabetes. Pay attention to your other risk factors, and work on minimizing them as part of your psoriasis management strategy. That means losing weight if you’re overweight or obese, plus quitting smoking, eating healthy, and exercising regularly, advises Dr. Yaqub.
Some studies have found that weight loss can improve psoriasis, Yaqub says, and certainly losing weight and exercising regularly will improve your body’s ability to regulate blood sugar and help stave off type 2 diabetes.
Lowering your weight by just 5 to 10 percent has been found to lower both blood sugar and blood pressure, and reduce your risk for diabetes. Plus, exercising 30 to 60 minutes a day, even if it’s just brisk walking and nothing fancy, is good for your health.
It’s also vital that you get regular screenings for type 2 diabetes, high blood pressure, and high cholesterol. Talk with all of your doctors, including your dermatologist and primary care physician, about psoriasis and the possible risk of diabetes, Neimann urges.
Finally, keep up with your psoriasis treatment and treat flares when they occur. Doctors don’t know yet if controlling psoriasis will help lower your chances of getting diabetes, but Neimann says there’s hope that future research will answer that question.
A study published in July 2009 in the Journal of Rheumatology compared more than 120,000 patients with rheumatoid arthritis or psoriasis, and found that treatment with tumor necrosis factor (TNF) alpha-blockers helped improve insulin sensitivity and lowered the risk of type 2 diabetes. “Future studies hopefully will closely investigate the association between psoriasis, the use of anti-inflammatories and biologics, and diabetes,” says Neimann.
In the meantime, don’t ignore the risks involved with psoriasis. Psoriasis is more than the rash on the surface of your skin — the effects of this disease can run deep in your body. But becoming aware of psoriasis complications means you can be proactive in protecting your health.