Skin Diseases in the Da Qing Diabetes Study: A Cross – Sectional Study

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Skin Diseases in the Da Qing Diabetes Study: A Cross-Sectional Study

The interplay between diabetes mellitus (DM) and dermatological conditions has long been recognized, yet comprehensive epidemiological data remain limited. This cross-sectional study, nested within the Da Qing Diabetes Study, investigates the prevalence and characteristics of skin diseases in individuals with varying glucose tolerance statuses, including normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM). The findings highlight a remarkably high burden of skin diseases in this population and identify critical associations between skin disorders, diabetes duration, and demographic factors.

Study Design and Population

The Da Qing Diabetes Study, initiated in 1986, is a longitudinal investigation tracking glucose tolerance and health outcomes in residents of Da Qing, China. This cross-sectional analysis included 383 participants (161 males, 222 females; age range: 53–89 years) recruited between July and September 2016. Participants were stratified into three groups: NGT (n=164), IGT (n=130), and T2DM (n=89). Diagnostic criteria for glucose tolerance followed World Health Organization (WHO) guidelines, with T2DM defined as fasting plasma glucose ≥7.8 mmol/L or 2-hour postprandial glucose ≥11.0 mmol/L. Skin diagnoses were confirmed by experienced dermatologists through clinical evaluation, laboratory tests, and medication records.

High Prevalence of Skin Diseases

The study revealed a striking prevalence of skin diseases across all groups. Overall, 93.5% (358/383) of participants exhibited at least one skin condition, with 75.7% (271/358) having two or more concurrent dermatoses. Among T2DM patients, 47 distinct skin disorders were identified, eight of which had prevalence rates exceeding 10%. The most common categories included:

  1. Infectious skin diseases (89.8%): Predominantly onychomycosis (60.6%), tinea pedis (52.2%), and bacterial infections (17.2%).
  2. Disturbances of pigmentation (41.0%): Including hyperpigmentation (25.1%), freckles (14.6%), and vitiligo (3.9%).
  3. Neurological and psychogenic dermatoses (25.3%): Notably pruritus (21.4%) and neurodermatitis (4.4%).
  4. Skin tumors (27.4%): Primarily seborrheic keratosis (17.2%) and skin tags (10.7%).

Associations Between Skin Diseases and Glucose Tolerance

While the overall prevalence of skin diseases did not differ significantly between NGT (93.3%), IGT (91.5%), and T2DM (96.6%) groups, category-specific variations emerged:

  • Disturbances of pigmentation were significantly more prevalent in T2DM (56.2%) compared to NGT (29.3%) and IGT (33.1%) groups (χ²=19.14, P<0.01).
  • Neurological and psychogenic dermatoses showed higher rates in T2DM (33.7%) versus IGT (15.4%) and NGT (27.4%) (χ²=10.58, P<0.01).

Sex-specific differences were notable. Males exhibited higher rates of pigmentation disorders in both NGT (males: 41.7% vs. females: 20.9%, P<0.01) and T2DM (males: 67.7% vs. females: 48.3%, P<0.01) groups.

Impact of Diabetes Duration

Diabetes duration strongly influenced dermatological outcomes. Among 264 T2DM patients (89 originally diagnosed in 1986 and 175 progressing from NGT/IGT during follow-up), those with ≥30 years of diabetes had higher rates of pigmentation disorders (56.2% vs. 34.3% in those with <30 years; χ²=11.64, P<0.01) and neurological dermatoses (33.7% vs. 21.1%; χ²=4.92, P=0.03). A dose-response relationship was evident, with longer diabetes duration correlating with increased risk of pigmentation abnormalities (χ² trend=12.85, P<0.01).

Hypertension and Skin Disease

Hypertension prevalence rose from 37.9% in 1986 to 64.9% in 2016. However, blood pressure changes did not significantly alter skin disease rates. Stratified analysis of normotensive versus hypertensive participants in NGT and IGT/T2DM groups showed no significant differences in dermatological outcomes, suggesting hypertension alone does not drive skin pathology in this cohort.

Multivariable Analysis of Risk Factors

Logistic regression identified two independent predictors of pigmentation disorders:

  1. T2DM status: Odds ratio (OR)=5.29 (95% CI: 2.70–10.36, P<0.01).
  2. Male sex: OR=0.15 (95% CI: 0.08–0.29, P<0.01).
    Age, BMI, and hypertension showed no significant associations.

Clinical and Public Health Implications

The study underscores several critical observations:

  1. High Comorbidity Burden: Nearly all participants (93.5%) had skin conditions, emphasizing the need for integrated dermatological screening in diabetes care.
  2. Diabetes-Specific Patterns: Pigmentation disorders and neurological dermatoses are strongly linked to T2DM duration and severity, suggesting shared pathophysiological mechanisms such as chronic hyperglycemia, oxidative stress, and microvascular damage.
  3. Sex Disparities: Higher rates of pigmentation disorders in males challenge traditional assumptions about gender differences in dermatological conditions, warranting further investigation into hormonal or behavioral factors.

Limitations and Future Directions

The study’s cross-sectional design limits causal inferences, and the homogeneous Chinese cohort may restrict generalizability. Longitudinal studies tracking skin changes alongside glycemic control metrics could clarify temporal relationships. Additionally, mechanistic research is needed to explore how insulin resistance and advanced glycation end products directly affect skin biology.

Conclusion

This analysis from the Da Qing Diabetes Study provides robust evidence of the high dermatological burden in individuals with dysglycemia. The findings advocate for routine skin examinations in diabetes management protocols, particularly for long-standing T2DM patients. Early identification and treatment of skin conditions may improve quality of life and reduce complications in this vulnerable population.

doi.org/10.1097/CM9.0000000000001453

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