Vol 9, No 6 (2020)
Research paper
Published online: 2020-11-13

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Prevalence and factors associated with cutaneous manifestations of type 2 diabetes mellitus

Saadah Rasid1, Leelavathi Muthupalaniappen1, Adawiyah Jamil1
Clin Diabetol 2020;9(6):461-468.


Background. Type 2 diabetes mellitus (T2DM) is known to cause multiple systemic manifestations. However, there are limited studies describing cutaneous manifestation among T2DM in Malaysia. The objective of this study was to determine the prevalence of cutaneous manifestation among T2DM patients, types of lesions and its associated factors. Methods. A cross-sectional study was conducted among 271 T2DM patients at a primary care clinic in Kuala Lumpur. Results. More than one third (63.5%) of patients were found to have cutaneous manifestations of T2DM. The most common manifestation was infections (34.7%) followed by Skin Diseases with Weak to Strong Association with Diabetes (SDWSAD) (31.7%), Skin Manifestation of Diabetic Complication (SMDC) (2.2%) and others cutaneous lesions (22.1%). Among the infections, onychomycosis was the commonest type of infection (27.7%) while diabetic dermopathy was the commonest lesion of SDWSAD (29.7%). Males had almost two times the odds of developing cutaneous manifestations of T2DM, compared to females (adjusted odds ratio [AOR]: 1.871, 95% CI: 1.108–3.160; P = 0.019). There was no association between glycemic control and cutaneous manifestations. However, males and those with T2DM duration of five years and more had 2.6 times the odds of developing SDWSAD (AOR: 2.646, 95% CI: 1.506–4.648 P = 0.001) and (AOR: 2.635, 95% CI: 1.107–6.268, P = 0.028) respectively. Those with diabetic neuropathy and peripheral vascular disease (PVD) had very high odds of developing SMDC such as diabetic foot and trophic ulcers (AOR: 23.259, 95% CI: 1.191–454.2, P = 0.038) and (AOR: 102.36, 95% CI: 4.013–2610, P = 0.005), respectively. Conclusion. The knowledge of these cutaneous manifestations increases physician’s awareness and prompts early screening to reduce morbidity improve quality of life.

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  1. Nanditha A, Ma RCW, Ramachandran A, et al. Diabetes in Asia and the Pacific: Implications for the Global Epidemic. Diabetes Care. 2016; 39(3): 472–485.
  2. Feisul MI, Azmi S. (Eds). National Diabetes Registry Report, Volume 1, 2009-2012. Ministry of Health Malaysia; Kuala Lumpur; 2013.
  3. Miller J, Marks H, James G. Lookingbill and Marks' Principles of Dermatology. 6th Ed. Elsevier; 2019, doi.org/10.1016/C2015-0-00881-4.
  4. Behm B, Schreml S, Landthaler M, et al. Skin signs in diabetes mellitus. J Eur Acad Dermatol Venereol. 2012; 26(10): 1203–1211.
  5. de Macedo GM, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol Metab Syndr. 2016; 8(1): 63.
  6. Bustan RS, Wasim D, Yderstræde KB, et al. Specific skin signs as a cutaneous marker of diabetes mellitus and the prediabetic state - a systematic review. Dan Med J. 2017; 64(1).
  7. Mahmood T, ul Bari A, Agha H. Cutaneous manifestations of diabetes mellitus. J Pak Assoc Dermatol. 2016; 15(3): 227–232.
  8. Khoharo HK, Ansari S, Qureshi F. Frequency of skin manifestations in 120 type 2 diabetics presenting at tertiary care hospital. J Liaquat Uni Med Sci. 2009; 8: 12–5.
  9. Rao S, Naga M, Lakshmi PV, et al. 2015. A prospective study of cutaneous abnormalitis in patients with diabetes mellitus. Int J Pharm, Chem & Biol Sci. 2015; 5(1): 276–286.
  10. Majeed M, Iqbal F, Mehboob A. Frequency and association of cutaneous manifestations of diabetes mellitus with HbA1c . Postgrad Med Inst . 2004; 18(2): 85–89.
  11. Niaz F, Bashir F, Shams N, et al. Cutaneous manifestations of diabetes mellitus type 2: prevalence and association with glycemic control. J Pak Assoc Dermatol. 2016; 26(1): 4–11.
  12. Kamaruddin, N, Omar A. Clinical practice guideline on management of type 2 diabetes mellitus. 5th Edition; Ministry of Health Malaysia; Kuala Lumpur; 2015. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/3a.pdf.
  13. Ferringer T, Miller OF. Cutaneous manifestations of diabetes mellitus. Dermatologic clinics. 2002; 20(3): 483-492, doi. org/10 1016/S0733. 8635; 02: 00018–9.
  14. Callen JP, Jorizzo JL, Zone JJ, et al. Dermatological signs of systemic disease. 5th Ed; Elsevier, 2016.
  15. Gupta V, Kudyar RP, Bhat Y. Cutaneous manifestations of diabetes mellitus. Int J Diab Dev Ctries. 2006; 26(4): 152–155.
  16. Yeung SW, Chan PF, Lai K, et al. The Prevalence and the Associated Factors of Cutaneous Manifestations in Chinese Patients with Type II Diabetes Mellitus in a Primary Care Diabetes Clinic in Hong Kong. J Diab Res Ther. 2018; 4(1).
  17. Chang SJ, Hsu SC, Tien KJ, et al. Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus. Int J Dermatol. 2008; 47(5): 467–472.
  18. Fatima K, Naheed A, Khan SA. Skin manifestations of diabetes mellitus. Journal of Rawalpindi Medical College (JRMC). 2018; 22(3): 252–255.
  19. Galdeano F, Zaccaria S, Parra V. Cutaneous manifestations of diabetes mellitus: clinical meaning. Dermatol Argent . 2010; 16(2): 117–121.
  20. Mendes AL, Miot HA, Haddad V. Diabetes mellitus and the skin. An Bras Dermatol. 2017; 92(1): 8–20.
  21. Dao H, Kazin R. Gender differences in skin: A review of the literature. Gender Medicine. 2007; 4(4): 308–328.
  22. Chatterjee N, Chattopadhyay C, Sengupta N, et al. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India. Indian J Endocrinol Metab. 2014; 18(2): 217–220.
  23. Timshina DK, Thappa DM, Agrawal A. A clinical study of dermatoses in diabetes to establish its markers. Indian J Dermatol. 2012; 57(1): 20–25.
  24. Rayfield EJ, Ault MJ, Keusch GT. Infection and diabetes: The case for glucose control. Am J Med. 1982; 72(439): 450.
  25. Khan Y, Khan M, Jain A, et al. A study of association of Diabetic Foot Ulcers and Peripheral Vascular Disease. International Journal of Advances in Medicine. 2018; 5(6): 1454.
  26. Crawford F, Cezard G, Chappell FM, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. 2015; 19(57): 1–210.
  27. Ab Rahman NK, Abd Aziz A, Mohammad W, et al. Prognostic factors of major amputation among hospitalized diabetic foot patients in a tertiary teaching hospital. Malaysian Journal of Public Health Medicine. 2016; 16 (2): 41–47.
  28. Morgan AJ, Schwartz RA. Diabetic dermopathy: A subtle sign with grave implications. J Am Acad Dermatol. 2008; 58(3): 447–451.