Elsevier

Endocrine Practice

Volume 10, Issue 2, March 2004, Pages 101-106
Endocrine Practice

Original Article
Prevalence of Acanthosis Nigricans in Newly-Diagnosed Type 2 Diabetes

https://doi.org/10.4158/EP.10.2.101Get rights and content

ABSTRACT

Objective

To determine the prevalence of acanthosis nigricans in a population of patients with newly-diagnosed type 2 diabetes mellitus.

Methods

Chart review of men and women treated for newly diagnosed type 2 diabetes at the University Diabetes Treatment Center at Parkland Health and Hospital System in Dallas, Texas between January 1998 and December 1999. The presence of acanthosis nigricans was evaluated on the posterior neck of each individual.

Results

Of 216 patients identified with newly diagnosed type 2 diabetes, 78 individuals (36.1%) presented with acanthosis nigricans involving the back of the neck. Most subjects were obese, with the mean BMI of the subject population at 32.7 ± 5.8 kg/m2 (mean ± SD). Prevalence of acanthosis nigricans increased with degree of obesity, with fully 54.1% of the population with a BMI of > 30 kg/m2 manifesting the skin lesion. The prevalence of acanthosis nigricans differed notably among ethnic groups, as the lesion occurred in 50 (52.6%) of 95 African-American subjects and 28 (35.9%) of 78 Latin-American subjects. Patients with acanthosis nigricans required markedly higher insulin doses (82.3 ± 7.2 units/day) to achieve euglycemia compared to those without the disorder (50.2 ± 5.7 units/day).

Conclusion

These results suggest that acanthosis nigricans is a readily visible marker of hyperinsulinemia and is frequently encountered in patients with type 2 diabetes. Prevalence of acanthosis nigricans is influenced by ethnicity and BMI in this patient population. (Endocr Pract. 2004;2:101-106)

Section snippets

INTRODUCTION

Acanthosis nigricans (AN) is a skin lesion that manifests as hyperpigmented brown velvety plaques in body areas of increased friction, most commonly the posterior neck, axillae, and medial thighs. The physiological mechanisms underlying AN are unclear, but probably involve local cutaneous growth factors and may be due to stimulation of insulin receptors or insulin-like growth factor receptors on epidermal and melatonin-containing dermal cells (1).

The medical significance of AN lies in its

METHODS

A retrospective review of medical records identified adult men and women over 18 years of age with newly diagnosed type 2 diabetes, as defined by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (8). These patients were admitted to the University Diabetes Treatment Center, an ADA-certified 11-bed inpatient unit of Parkland Memorial Hospital in Dallas, Texas, between January 1998 and December 1999.

All patients were examined by attending medical faculty for presence

RESULTS

Of 216 patients newly diagnosed with diagnosed type 2 diabetes, 78 (36.1%) were found to have AN involving the posterior neck. Of these 78 affected patients, 36 (46.1%) were men and 42 (53.9%) were women, compared to 129 men (59.7%) and 87 women (40.3%) in the overall subject group. Patient ages were normally distributed about a mean of 35.5 ± 11.8 years. Additional clinical characteristics of the two subject groups are summarized in Table 1.

The mean BMI of the total sample population was 32.7

DISCUSSION

AN typically presents clinically as a darkening and thickening of the skin and is usually found in characteristic body areas. The lesion is associated with various systemic diseases, including some insulin resistance syndromes.

AN may appear in obese patients, and a metabolic basis for this association has been recently identified. Kahn et al noted AN as a consistent finding among patients with hyperinsulinemia caused by various forms of tissue resistance to insulin (9). Disorders associated

ACKNOWLEDGMENT

We thank the staff at the University Diabetes Treatment Center at Parkland Memorial Hospital for their invaluable help in the collection of data.

REFERENCES (23)

  • R.C. Kahn et al.

    The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man

    N Engl J Med.

    (1976)
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