Diabetes status is associated with greater disease severity in hidradenitis suppurativa

With the rising prevalence of endocrine conditions in the U.S., it is important to examine the relationship between diabetes mellitus and hidradenitis suppurativa (HS) severity. This retrospective, cross-sectional study evaluated whether diabetes status and HbA1c levels are associated with HS severity among 275 physician-diagnosed patients seen at an HS Specialty Clinic between June 2016 and January 2021. The primary outcome was HS severity measured by the International HS Severity Score System (IHS4); the secondary outcome was pain severity measured by the Numeric Pain Rating Scale (NRS).Among participants, 44.3% were non-diabetic, 35.3% pre-diabetic, and 20.4% diabetic. Median HbA1c levels were lowest in non-diabetic patients (5.3 [5.1, 5.5]) and highest in diabetic patients (6.9 [6.3, 8.4]). The NRS pain score was also highest in the diabetic cohort (5.0 [0.0-8.0]) compared to the non-diabetic (2.0 [0.0-5.0]) and pre-diabetic (4.0 [0.0-6.0]) groups (p = .005). A significant association was observed between HbA1c and IHS4 in univariate analysis (p = .004), with multivariable analysis approaching significance (p = .053) after adjusting for covariates. These findings suggest diabetes and higher HbA1c levels correlate with increased HS severity and pain. Prevention and management of diabetes may therefore modify the clinical course of HS.