May 6, 2021
More than skin: psoriatic disease and type 2 diabetes
People living with psoriatic disease are twice as likely to develop type 2 diabetes. Why is this happening and is there anything that can be done about it?
By Elisa Martini
People with diabetes are very familiar with the challenges of living with a chronic condition: time taken from work and personal life to attend medical appointments, unrequested health advice dispensed by people who are misinformed, judgmental looks from others. These situations are all familiar to people living with psoriatic disease.
It is commonly believed that psoriatic disease is just a skin disease that manifests itself in the form of dry skin or dandruff. It is in fact a disease partially written in a person’s genes that affects the whole body, caused by the immune system “acting up”. It is not contagious and cannot be cured. However, treatments exist that are effective in managing its symptoms.
Much like diabetes, psoriatic disease has a deeper impact for people affected that goes far beyond the skin. People living with psoriatic disease are at greater risk of developing other chronic conditions. They are two times more likely to develop type 2 diabetes compared to the general population.
Scientists are still wrapping their heads around this link and have provided several explanations. Genetics may be partially to blame, as similar versions of genes important in the development of metabolic syndrome have been identified in people with psoriatic disease. The overreacting immune system may be another culprit. This causes chronic inflammation and the production of inflammatory molecules that may predispose people to develop type 2 diabetes. A third factor is the presence of other risk factors for type 2 diabetes present in people living with psoriatic disease, particularly excess weight and obesity.
Much like diabetes, psoriatic disease has a deeper impact for people affected that goes far beyond the skin
Fortunately, type 2 diabetes and psoriatic disease share more than genetics, inflammation, and risk factors. They also share similar strategies to improve outcomes for people affected or at risk. Many of the things that people living with psoriatic disease can do to improve their life with the disease are very effective for preventing or managing type 2 diabetes. These include achieving and maintaining a healthy weight, regular physical activity and not smoking.
In view of the links between the two conditions, one might expect prevention and screening for type 2 diabetes to be a routine part of psoriatic disease management. This is not quite the case. Health systems across the world tend to treat diseases separately and thus screening and prevention of type 2 diabetes are rarely included in the care of psoriatic disease. Furthermore, many health professionals, particularly those working in primary care, are not well informed about the complexity of psoriatic disease and its impact on individuals. During a medical appointment, there is often no time to talk about preventing other conditions related to psoriatic disease, let alone address the worry and anxiety of managing multiple complicated conditions. Our environments also make it difficult for individuals to adopt the healthy habits that benefit general well-being. An enabling environment that fosters behavior changes for good health is just as important as individual will.
All of these issues may sound familiar to people living with diabetes. This is because the current model of care is built to take care of short-term, acute illnesses and not manage complex, chronic conditions. In a person-centered model of care, individuals accessing health services would receive care that is tailored to their needs. All services would be integrated to the benefit of individuals living with a condition and their carers. In this model of care, the person is the focus, not the condition.
We should view people living with chronic, non-communicable conditions as one community. When progress on access to medicine, better care or more affordable treatment is achieved for one condition, we all win.
Learn more about the links between psoriatic disease and diabetes in the report “Inside Psoriatic Disease: Diabetes”, produced by the International Federation of Psoriasis Associations (IFPA).
Elisa Martini is Advocacy and Policy Officer at the International Federation of Psoriasis Associations (IFPA). IFPA is an international non-governmental organization representing national and regional psoriatic disease patient associations, and is the global leader in fighting psoriatic disease.