title: Psoriasis and risk of diabetes-associated microvascular and macrovascular complications.
abstract: BACKGROUND
  Psoriasis's effect on diabetes onset is well documented, but its effect on course of diabetes is poorly understood.
  
  
  OBJECTIVE
  We sought to compare risks of developing microvascular and macrovascular complications between diabetic patients with and without psoriasis.
  
  
  METHODS
  Adults with 2 or more diabetes diagnoses selected from MarketScan databases (Truven Health Analytics Inc, Ann Arbor, MI) (2000-2006) were classified into 2 cohorts: 2 or more psoriasis diagnoses and without psoriasis diagnosis. Patients with psoriasis were matched using propensity score, and exactly matched using age, sex, and diabetes characteristics with patients without psoriasis. Outcomes were compared between cohorts using Cox regression models.
  
  
  RESULTS
  In all, 6164 diabetic patients with psoriasis (27% moderate to severe) were matched to 6164 diabetic patients without psoriasis. Patients with psoriasis were significantly more likely to develop microvascular events than patients without psoriasis overall (hazard ratio [HR] 1.14, P < .001) and by psoriasis severity (mild: HR 1.13, P = .004; moderate to severe: HR 1.16, P = .038). Risk of macrovascular events was higher for patients without psoriasis overall (HR 1.13, P = .001) and those with mild psoriasis (HR 1.15, P = .003), but not for moderate to severe cases (HR 1.10, P = .210).
  
  
  CONCLUSIONS
  Psoriasis to diabetes association may be underestimated.
  
  
  CONCLUSIONS
  Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications. Greater psoriasis severity did not increase risk of diabetic complications.
authors: Department of Dermatology, University of Colorado, Aurora, Colorado. Electronic address: aprilarmstrong@post.harvard.edu.
authors: April W
authors: AW
authors: Armstrong
authors: Analysis Group Inc, Boston, Massachusetts.
authors: Annie
authors: A
authors: Guérin
authors: Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois.
authors: Murali
authors: M
authors: Sundaram
authors: Analysis Group Inc, Boston, Massachusetts.
authors: Eric Qiong
authors: EQ
authors: Wu
authors: Analysis Group Inc, Boston, Massachusetts.
authors: Elizabeth Sara
authors: ES
authors: Faust
authors: Analysis Group Inc, Boston, Massachusetts.
authors: Raluca
authors: R
authors: Ionescu-Ittu
authors: Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois.
authors: Parvez
authors: P
authors: Mulani
mesh_terms: D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D015331:Cohort Studies; D048909:Diabetes Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors
keywords: complications; diabetes; inflammation; macrovascular; microvascular; observational study; psoriasis