Screening Patients With Diabetes Mellitus for the Presence of Skin Disorder of Scleredema

Scleredema is a scleroderma-like skin disorder appearing in 2.5-14% among patients with type 1 or 2 diabetes mellitus. This is a single centre study to screen consecutive patients with diabetes mellitus for the presence of scleredema,and to compare the clinical-laboratory data of patients with and without scleredema. Metabolic and vascular complications of these patients will be focused on.

Scleredema adultorum of Buschke is a scleroderma-like skin disorder characterized by thickened skin with edema in patients' neck, shoulders and back. Graff described three types of scleredema. The first type occurs usually in children after an infection, the second type often associated with haematological malignancies and the third type usually develops in patients with long lasting uncontrolled diabetes mellitus. These patients with diabetes are often obese and have vascular complications. Based on two large cohorts, the prevalence of scleredema among patients with diabetes mellitus was 2.5-14.0% .

The aims of this study is to screen consecutive patients with diabetes mellitus for the presence of scleredema skin disorder and to investigate and compare the clinical-laboratory data of patients with and without scleredema. Both the vascular complications in case history and the parameters of lipid and carbohydrate metabolism will be focused on. All findings will also be compared to another cohort of scleredema-diabetes patients who already treated in our tertiary clinical centre of the University of Pécs in Hungary.

Participants and methods:

About 150 consecutive patients with diabetes mellitus are planned to be investigated. Scleredema skin disorder will be screened by palpation of skin on the nape of the neck, the whole trunk and the shoulders by at least two physicians. Newly recognized patients will be asked to give their consent for undergoing skin biopsy.

Planned clinical examinations and biochemical data collection are as follows:

Besides taking case history, patients will have a complete physical examination, and they will be asked to respond some standardized questions about their diabetes-related earlier vascular and neurological complications, as well as about their skin status.

Repeated blood pressure, measuring weight and their height for defining BMI, for the diagnosis of polyneuropathy neurological physical examination, electroneuronography and calibrated tuning-fork test will be done. Retinopathy will be considered based on ophthalmological examination.

Laboratory investigations are planned including blood count, routine chemistry, glycated haemoglobin (HbA1c), parameters of lipid metabolism as well as thyroid stimulating hormone (TSH) test, unless the patient already had results for these particular lab tests less than three months before. Significant nephropathy will be recorded based on values lower than 60 ml/min/1.73m2 of estimated glomerular filtration rate (eGFR) or the presence of microalbuminuria (\>300 mg/die). Calculating of Hepatic steatosis index (HSI) and Framingham steatosis index (FrSI) for define the presence of non-alcoholic fatty liver disease (NAFLD) are also planned.

Statistical analysis of the results will be performed: The distribution of variables planned to be evaluated based on Kolmogorov-Smirnov's test. Comparisons of the values of clinical data between groups will be performed by using a Kruskal-Wallis test for non-parametric data or a one-way ANOVA test for normally distributed continuous variables; Bonferonni's post hoc tests will be used in all cases. Chi-square test or Fisher's test will be used for categorical variables. Clinical-laboratory parameters associated with developing scleredema skin disorder are planned to defined by binary logistic regression with stepwise selection. Statistical analyses will be performed with IBM SPSS Statistics v 24.0 software package (IBM's Corporate, New York, USA).

Eligibility Criteria:
Inclusion Criteria:

Diagnosis of diabetes mellitus is based on the criteria of the World Health Organization (WHO), 2006.

The duration of diabetes mellitus must be longer than one year.

Exclusion Criteria:

Patients taking any forms of glucocorticoids in the previous year.