title: Association between antidiabetic drugs and psoriasis risk in diabetic patients: results from a nationwide nested case-control study in Taiwan.
abstract: BACKGROUND
  The risk of psoriasis in diabetic patients has rarely been explored.
  
  
  OBJECTIVE
  We sought to investigate the association between antidiabetic therapies and psoriasis.
  
  
  METHODS
  The incidence of psoriasis was compared between a representative diabetic cohort and a matched nondiabetic cohort. We next conducted a nationwide cohort study with 1,659,727 diabetic patients using the National Health Insurance Research Database of Taiwan 1997 through 2011. Multivariate conditional logistic regression was used for nested case-control analyses.
  
  
  RESULTS
  Incidence rates of psoriasis among diabetic patients and nondiabetic matched control subjects were 70.2 (95% confidence interval [CI] 59.5-80.9) and 42.3 (95% CI 39.5-45.5) per 100,000 person-years, respectively (P < .0001). Frequent insulin use was associated with higher risk of incident psoriasis (adjusted odds ratio 1.29, 95% CI 1.18-1.42) after adjusting for comorbidities, disease duration, and number of hospital visits. Among diabetic patients without history of insulin use, frequent use of thiazolidinedione was associated with lower risk of psoriasis (adjusted odds ratio 0.87, 95% CI 0.77-0.99).
  
  
  CONCLUSIONS
  The National Health Insurance Research Database did not contain information regarding disease severity, diet, body mass index, lifestyle, or family history.
  
  
  CONCLUSIONS
  Among diabetic patients, regular insulin use is associated with psoriasis development. Frequent use of thiazolidinedione may be associated with modest reduction in psoriasis risk.
authors.affiliation: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health and Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan; Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan.
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
authors.forename: Jeng-Jer
authors.initials: JJ
authors.lastname: Shieh
authors.affiliation: Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan; Center for General Education, Feng-Chia University, Taichung, Taiwan.
authors.forename: Jui-Lung
authors.initials: JL
authors.lastname: Shen
authors.affiliation: Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yi-Ya
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yun-Ting
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: yjchenmd@vghtc.gov.tw.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003875:Drug Eruptions / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced* / Q000453:epidemiology*; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents
keywords: diabetes mellitus; insulin; metformin; psoriasis; thiazolidinedione