Risk of Diabetes Mellitus Remains High Among Patients With Pemphigus Vulgaris
Pemphigus represents a group of autoimmune blistering diseases that increase the risk of additional comorbidities that have an immune or inflammatory-mediated pathogenesis, such as rheumatoid arthritis or diabetes mellitus (DM). Patients are often treated with glucocorticoid therapy, which can lead to steroid-induced DM and an increased risk of mortality.
In a European study assessing the clinical importance of autoantibodies in pemphigus vulgaris patients who develop steroid-induced DM, 31 of 137 patients (22.62%) developed steroid-induced DM. The treatment duration between treatment initiation and the occurrence of steroid-induced DM was between 0.25 and 108 months, with a median value of 6 months and a mean value of 25 months. There was no correlation between steroid dosage and the development of DM. A comparison of patients who did and did not develop steroid-induced DM showed glutamic acid decarboxylase autoantibody (GADA) positivity in 25.75% and 20.75% of these patients, respectively; however, the difference did not reach statistical significance. Anti-desmoglein 1 and 3 antibodies were also found to be elevated in both cohorts.
The study showed that the risk of DM in patients with pemphigus remains high and is an important consideration when treating and monitoring patients. More studies on immunological markers for risk of developing DM in patients with pemphigus are needed.
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Dănescu AS, Bâldea I, Leucuţa DC, et al. Immunological markers as predictors of developing steroid-induced diabetes mellitus in pemphigus vulgaris patients: an observational study. Marzano. AV, ed. Medicine. 2018;97(17):e0463. doi:10.1097/MD.0000000000010463.