Hidradenitis suppurativa and diabetes mellitus: updated systematic review and adjusted meta‐analysis

Abstract

Summary Background Hidradenitis suppurativa (HS) is a debilitating and distressing chronic inflammatory skin disease. There is also evolving evidence supporting the association between HS and cardiovascular risk factors, including smoking, obesity, hyperlipidaemia and metabolic syndrome. Notably, these are clinical features and risk factors that are closely associated with type 2 diabetes mellitus (DM). Aims We performed a pooled adjusted meta‐analysis of comparative studies to investigate the relationship between HS and DM. Methods A systematic review and meta‐analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. OR was used as the summary effect size. Results From pooled analysis of unadjusted data from 12 studies, we found a significantly higher proportion of DM in HS cases compared with non‐HS healthy controls (16.1% vs. 15.7%; OR = 2.17; 95% CI 1.85–2.55; P < 0.001). Adjusted effect sizes from five studies were also pooled. A significantly higher proportion of DM was found for HS compared with healthy controls, although the effect size was attenuated compared with unadjusted analyses (OR 1.69; 95% CI 1.50–1.91; P < 0.001). Conclusions To our knowledge, our systematic review and meta‐analysis is the first to pool adjusted effect sizes. We found that HS was associated with a 1.69‐fold increased odds of diabetes; however, the absolute risk difference was small (16.1% vs. 15.7%) and is probably not clinically relevant. Treating clinicians should be aware of this association, but there may not be an urgent need to perform screening for impaired glucose tolerance or diabetes.

Hidradenitis suppurativa epidemiology: from the first Italian registry in 2009 to the most recent epidemiology updates – Italian Registry Hidradenitis Suppurativa project 2

“…5 Information on other different epidemiological aspects of the disease, like gender, age of onset, family history, physical characteristics, behavioural habits and comorbidities, has been published. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] In order to collect reliable data on relevant issues of a disease, like epidemiology, safety and effectiveness of treatments, it is essential to establish a registry.…”

Hidradenitis suppurativa and diabetes: big data bias masks a true association

“…In Clinical and Experimental Dermatology , Phan et al . recently presented an updated meta‐analysis of the association between hidradenitis suppurativa (HS) and Type 2 diabetes mellitus (T2DM), which demonstrated a statistically significant elevation in the odds ratio (OR) for DM in patients with HS compared with healthy controls (HCs) (OR = 2.17; 95% CI 1.85–2.55; P < 0.001) .…”

“…In Clinical and Experimental Dermatology , Phan et al . recently presented an updated meta‐analysis of the association between hidradenitis suppurativa (HS) and Type 2 diabetes mellitus (T2DM), which demonstrated a statistically significant elevation in the odds ratio (OR) for DM in patients with HS compared with healthy controls (HCs) (OR = 2.17; 95% CI 1.85–2.55; P < 0.001) . The authors astutely highlight that the risk difference of 0.4% between patients with HS and HCs (16.1% vs 15.7%) implies that this result is clinically nonsignificant, which is quite at odds with clinical experience, data from existing studies and the remainder of the article, which discusses the importance of DM awareness in patients with HS and possible mechanistic links between DM and HS.…”

“…In the current study, the analysis from the paper was replicated, using the same methodology, but with the additional step of assessing studies for external bias and threats to generalizability . Visualization of data in a L'Abbé plot (Fig.…”

“…) demonstrates lack of clustering on the x axis, indicating violation of the assumption of one underlying baseline risk . Examining risks to external bias in the original analysis, four of the studies mentioned (Garg, Kirby, Gold and Shalom) are population‐based studies that use claims‐based insurance data. Concerns have been raised (particularly in USA claims‐based data analyses) that such data are not indicative of the general population .…”