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Friday, Nov 22, 2019

That acne could be a sign of pre-diabetes

New findings suggest that patients with certain skin disorders may be at risk for metabolic and androgen-mediated diseases, such as polycystic ovary syndrome in women.

columns Updated: Nov 04, 2019 00:19 IST
Sanchita Sharma
Sanchita Sharma
Hindustan Times

Stubborn acne in young adults could be an early sign of insulin intolerance, a pre-diabetes condition where the cells in the body cannot use insulin efficiently to absorb and convert glucose to energy. If insulin sensitivity is not improved by adopting a healthier lifestyle that includes being active, reducing abdominal obesity and eating a diet high in fibre and low in sugar and refined carbs, it can progress to Type 2 diabetes.

Diabetes-related acne is fairly common in India, found a cross-sectional study of 20- to 32-year-old men published online in the international journal, JAMA Dermatology. The study demonstrated that young adult men with acne were more likely to have insulin resistance and higher fasting plasma glucose levels than men of the same age without acne.

“Insulin resistance may be a stage of prediabetes and the patients may develop hyperinsulinemia or Type 2 diabetes in the future. These patients should be followed up to determine whether they develop conditions associated with insulin resistance,” wrote study author Dr Mohit Nagpal, of the Postgraduate Institute of Medical Education and Research, Chandigarh.

For the study, the researchers compared 100 men with acne with 100 age-matched men who did not have acne and were being treated for non-acne dermatoses in the institute’s outpatient department. Insulin resistance, as defined by a Homeostasis Model Assessment–Insulin Resistance (HOMA-IR) value greater than 2.5, was present in 22% of those with acne, vs 11% of those without acne.

Blood pressure readings were higher among those with acne, compared with controls, as were mean fasting plasma glucose levels. Metabolic syndrome, defined as a group of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal blood fats (cholesterol or triglyceride) levels — and measured using the modified National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III), was also slightly more common among those with acne, but the difference was not significant.

Metabolic syndrome, including higher blood pressure and plasma glucose levels, are risk factors for heart disease and stroke. While insulin resistance and metabolism syndrome had no effect on the severity of acne (mild, moderate, severe or very severe), those with very severe acne tended to be more overweight than those with mild acne, the study found.

There are 70 million adults in India with diabetes, which affects 422 million people worldwide. ‘Adult-onset’ Type 2 diabetes occurs when the body cannot use insulin produced efficiently because of metabolic reasons, forcing the pancreas to overwork and finally stop insulin production. This forces people with diabetes to take medicines and then insulin injections every day for the rest of their lives.

Unhealthy, inactive lifestyles have led to people developing Type 2 diabetes at a very young age. Recent data from the Indian Council of Medical Research’s (ICMR) youth diabetes registry shows that 25.3% of people under 25 with diabetes in India have adult-onset Type 2 diabetes, which, by definition, should strike only older adults with a family history of diabetes, obesity, unhealthy diets and inactivity.

Family history is strong risk factor, with most young Type 2 diabetes patients also being obese and very often having metabolic syndrome and acanthosis nigricans (dark, velvety patches on the skin).

Type 2 diabetes in young people needs very close monitoring and treatment because complications are two to three times higher than for young people with Type 1 diabetes, showed the ICMR registry data, which found that 56.1% of the registered young diabetics have been hospitalised at least once for acute diabetes-related complications. One in seven (14.1 %) had at least one complication or co-morbid condition, such as hypothyroidism, dyslipidaemia (unhealthy blood fats such as cholesterol and triglycerides), hypertension tuberculosis or sepsis.

Acne in young adults, especially when accompanied by acanthosis nigricans and benign hyperplasia (over-growth of sebaceous oil glands in the skin, usually on the forehead and cheeks) should be treated as an early sign of insulin resistance and endocrinologists should work closely with dermatologist to identify patients with common skin disorders who may be at risk for metabolic and androgen-mediated diseases, such as polycystic ovary syndrome in women.

A diagnosis of insulin resistance can not only help delay the onset of diabetes by adopting a healthier lifestyle, but can also help keep blood glucose levels within a healthy range after diagnosis to lower risk of complications such as blindness, kidney failure, heart disease, stroke and foot amputation.

Given that close to half (47.3%) of India’s 70 million diabetics are undiagnosed, visible signs such as acne could help diagnose thousands of young people at risk of diabetes in the future.