title: Increased risk of diabetes mellitus in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study.
abstract: BACKGROUND
  The association between psoriasis and diabetes mellitus (DM) has been explored previously. However, no studies have been reported regarding the severity of psoriasis, comorbidities, and concomitant medications on the risks of DM in patients with psoriasis.
  
  
  OBJECTIVE
  We sought to evaluate the impact of the severity of psoriasis, comorbidities, and concomitant medications on the risk of type 2 DM in patients with psoriasis.
  
  
  METHODS
  We conducted a cohort study with 14,158 adults with psoriasis and adults without psoriasis using data from the Taiwan National Health Insurance Research Database. Cox regression models using time-varying covariates were used.
  
  
  RESULTS
  After the comorbidities and concomitant medications were adjusted for, psoriasis was found to be independently associated with an increased risk of DM (severe: hazard ratio, 2.06 [95% confidence interval, 1.58-2.68] vs mild: hazard ratio, 1.28 [95% confidence interval, 1.05-1.55]). Other independent risk factors included age, Cushing disease, and the increased cumulative doses of the thiazide and methotrexate.
  
  
  CONCLUSIONS
  The National Health Insurance Research Database did not have information regarding the Psoriasis Area and Severity Index, diet, obesity, body mass index, exercise status, and family history of diabetes.
  
  
  CONCLUSIONS
  Patients with psoriasis have a higher risk of developing DM. The risks vary depending on the severity of psoriasis, comorbidities, and concomitant medications.
authors.affiliation: Department of Dermatology, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Meng-Sui
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Dermatology, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Ruey-Yi
authors.initials: RY
authors.lastname: Lin
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: mslai@ntu.edu.tw.
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013624:Taiwan / Q000453:epidemiology; D049971:Thiazides / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D049971:Thiazides; D008727:Methotrexate
keywords: National Health Insurance Research Database; diabetes mellitus; methotrexate; psoriasis; severity; thiazide