Diabetes Mellitus and the Skin: Recognition and Management of Cutaneous Manifestations

William B. Horton, MD; Patrick L. Boler, MD, PharmD; Angela R. Subauste, MD

Disclosures

South Med J. 2016;109(10):636-646. 

In This Article

Abstract and Introduction

Abstract

Diabetes mellitus (DM) is a heterogeneous condition characterized by hyperglycemia as a consequence of defects in insulin secretion and variable degrees of insulin resistance. DM is the most common endocrine disorder in the United States, affecting 9.3% of the population (29.1 million people) in 2014. Skin disorders are present in 79.2% of patients with DM, and cutaneous disease may appear as the first sign of DM or develop at any time in the course of the disease. Given the increasing incidence and prevalence of DM in the United States, primary care physicians should be aware of the associated cutaneous manifestations. This clinical review provides a brief guide to primary care physicians for recognizing and managing skin conditions that they may encounter when caring for patients with DM.

Introduction

Diabetes mellitus (DM) is a heterogeneous condition characterized by hyperglycemia as a consequence of defects in insulin secretion and variable degrees of insulin resistance.[1] DM is the most common endocrine disorder in the United States, which affects 9.3% of the population (29.1 million people), as of 2014.[2] DM can be further characterized into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM is a chronic immune-mediated disease that is characterized by the selective loss of insulin-producing [beta] cells in the pancreatic islet. T2DM is characterized by reduced insulin signaling and/or insulin resistance that promotes a compensatory increase in pancreatic insulin production with subsequent [beta]-cell failure. One study has demonstrated that skin disorders are present in 79.2% of patients with DM and that the most common skin manifestations include cutaneous infections, xerosis, and inflammatory skin diseases.[3] Glycemic control does appear to play a role in the rate of cutaneous involvement; this study demonstrated that patients with hemoglobin A1c values >8 mmol/mL had more skin disorders than those with hemoglobin A1c values <8 mmol/mL.[3]

Cutaneous disease may appear as the first sign of DM or develop at any time during the course of the disease.[4] Skin disorders also may be clues to the presence of associated microvascular complications of DM.[3] Given the increasing incidence and prevalence of DM in the United States,[5] primary care physicians (PCPs) should be aware of the associated cutaneous manifestations. This clinical review provides a brief guide for PCPs for recognizing and treating skin conditions that they may encounter when caring for patients with DM. Given the pathophysiologic differences, these dermatologic conditions are presented separately for T1DM and T2DM. Cutaneous infections are not covered because there are numerous comprehensive references detailing such infections in the medical literature.[6,7]

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