Acanthosis nigricans: A screening test for insulin resistance – An important risk factor for diabetes mellitus type-2

Abstract

Background:Acanthosis nigricans (AN) is one of the signs suggestive of high insulin resistance (IR). IR is one of the mechanisms involved in pathogenesis of diabetes mellitus type-2 (DM Type-2). Thus, early detection of IR in children may allow us time to intervene well before the development of DM Type-2. In this study, 62% of children having AN had high IR. In children having both, AN and high body mass index (BMI), the incidence of IR was about 80%. This suggests that these easily detectable parameters alone can be useful in screening children at high risk of developing DM Type-2 in future. These simple criteria thus hold promise for use in high throughput screening programs for diabetes.Context:A pilot study conducted by the authors showed that children with AN have a high incidence of IR. The detection of IR in children may allow us time to intervene well before the development of DM Type-2. Detection of DM Type-2 by hyperglycemia may be too late to prevent the onset of microvascular changes.Aims:This study aims to determine whether easily observable presence of AN can be used to screen for increased IR in children, and thereby to detect this important risk factor for DM Type-2.Settings and Design:Cross-sectional, observational study. Two schools, one with children belonging to average economic background and the other, a residential school with children of affluent parents. Selection of children was done randomly.Subjects and Methods:The study was conducted among 507 children in the age group of 10–18 years. Physical examination for the detection of AN, height and weight measurements, waist circumference, fasting plasma glucose, fasting plasma insulin, and lipid profile was done. Homeostatic model assessment of insulin resistance was calculated.Statistical Analysis Used:Data analysis was performed using descriptive statistics and inferential statistical methods. The association between categorical variables was done by Chi-square test.Results:The presence of AN positively correlated with high IR, and when combined with increased BMI, the incidence rate of IR is 80%.Conclusions:AN can be used as a screening method to identify children at risk of DM Type-2-since those who have high IR have a high possibility of having DM Type-2 in future. Hence, early screening and simple, but effective interventional strategies can be instituted at this age, which may prevent or delay diabetes in the long run.

Presence of Cutaneous Signs of Insulin Resistance with Central Obesity (CO-CSIR) in Asian Indians is a sensitive physical sign of Metabolic Syndrome (MetS)

“…Several previous studies from India have investigated association between these cutaneous signs of IR in isolation with different facets of MetS like anthropometric measures of obesity (i.e., BMI [32], waist circumference [37,38], W:H ratio), HOMA-IR [29,30,31,33], lipid parameters, diabetes and other diseases clustering with MetS [34,35,36]. They all nd an association between these cutaneous signs and the facets of MetS they investigated.…”

Acanthosis nigricans in the pediatric population: a narrative review of the current approach to management in primary care

“…Although most studies report that AN is a clinical indicator of underlying insulin resistance, some researchers believe that AN is not an independent marker and as such all children with a BMI standard deviation score above or equal to 3 should be screened for hyperinsulinemia ( 24 , 25 ). Numerous studies have suggested that in children with both AN and obesity, the incidence and positive predictive value of insulin resistance increases compared to either factor alone ( 19 , 26 , 27 ).…”

Acanthosis Nigricans in a Patient with Urothelial Carcinoma Treated with PD-L1 Inhibitor Avelumab, and Secondary Adrenal Insufficiency

“…Most cases of malignant AN (60%) are detected at the time of diagnosis, and to a lesser extent, before (20%) or after (20%) the diagnosis of cancer [ 1 , 5 ]. The onset of AN in metabolic causes is not well documented in the literature; however, its association with obesity and insulin resistance has been used to allow early intervention and prevent progression to type 2 diabetes [ 6 ]. The pathophysiology of AN is not fully understood, but it has been linked to a multifactorial combination of elevated levels of insulin-like growth factor and transforming growth factor alpha and its action on epidermal growth factor receptors on susceptible cells, leading to hyperproliferation of keratinocytes and fibroblasts [ 7 ].…”