Abstract
Diabetes is undiagnosed disease and easy screening tools for it are warranted. Because foot complications are usual in diabetes, we aimed to test hypothesis that skin abnormalities are found already from patients who are not aware of having diabetes, by studying the possible association between unhealthy toe web skin and abnormal glucose metabolism. 1,849 cases without previously diagnosed diabetes participated to the 46-year follow-up study of the Northern Finland Birth Cohort. A skin investigation was performed for all, and abnormal skin findings in toe web spaces were taken as explanatory variables. Abnormal glucose tolerance was the main outcome and it was tested with an oral glucose tolerance test (OGTT), glycosylated haemoglobin fraction (HbA1c) Values are numbers (percentages) of sub and fasting blood glucose. The participants who had any abnormal skin findings in toe webs were associated with 2.5-fold (OR 2.5, 95% CI 1.3–4.9) and 6-fold (OR 6.2, 1.4–27.6) increased risk of having previously undiagnosed diabetes detected by a 2-hour OGTT and HbA1c, respectively. The predictive power of toe web findings was comparable with FINDRISC score. Abnormal skin findings in the toe webs show increased risk of occult diabetes, and may, thus serve as an additional sign of undiagnosed diabetes.
Highlights
Disrupted micro- and macrovascular architecture caused by abnormal glucose metabolism may result in increased complications in the feet of diabetes patients[1]
The central finding of our general population-based study was that, after adjusting for confounding variables, abnormal skin findings in the toe web spaces were associated with an elevated risk of having SDM
To best of our knowledge, this is the first study to investigate the association between skin changes in the toe web spaces and prediabetes or undiagnosed diabetes using clinical skin examinations and an oral glucose tolerance tests (OGTT) as well as blood tests
Summary
Disrupted micro- and macrovascular architecture caused by abnormal glucose metabolism may result in increased complications in the feet of diabetes patients[1]. Foot complications are one of the most common reasons for hospitalization of patients with diabetes[2, 3]. Based on the high incidence of foot problems in diabetes patients per se it is reasonable to hypothesize that abnormalities of the foot skin might be found in individuals who are not yet aware of having diabetes or prediabetes stage. We tested this hypothesis – by first performing comprehensive clinical investigations of foot skin and oral glucose tolerance tests (OGTT), and recording fasting plasma glucose (FPG) and glycosylated. Haemoglobin fraction (HbA1c) in birth cohort participants - to determine any association between skin findings in the toe web spaces and previously undiagnosed diabetes or prediabetes
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