Cutaneous Fungal Infections Associated with Pediatric-onset Diabetes: A Case-control Study in the All of Us Research Program

Abstract

Introduction: With the rapidly increasing incidence of pediatric diabetes mellitus (DM) in the United States, an understanding of the risk of long-term cutaneous consequences, particularly the risk of cutaneous fungal infections, is important. In this study, we evaluate the association between pediatric-onset Type 1 diabetes (T1D) and Type 2 diabetes (T2D) with the later development of cutaneous fungal infections. Methods: Through the All of Us electronic health record database, 300 de-identified participants with a diagnosis of T1D or T2D before the age of 18 were selected at random. These 300 participants, composing our pediatric-onset diabetes cohort, were diagnosed with T1D and/or T2D before the age of 18 and developed cutaneous fungal infections between less than 1 and 24 years later. Each case was age-, race-, and sex-matched to four control participants without T1D or T2D diagnoses, and we compared cutaneous fungal infections between pediatric-onset diabetic cases and controls. Results: Compared to the control cohort, participants with pediatric-onset diabetes were significantly more likely to present in adulthood with candidiasis of the mouth, onychomycosis, pityriasis versicolor, candidiasis of urogenital sites, and unspecified superficial mycosis, as well as dermatophytosis of the body, feet, and perianal regions than their non-diabetic counterparts. Conclusion: With the increasing incidence of pediatric DM, it will be important for clinicians to monitor the long-term cutaneous complications, including the risk of fungal infections, to improve dermatology patient outcomes. Further research is warranted to investigate the role of childhood diabetes intervention and glycemic control in mitigating dermatologic fungal complications through adulthood.