Skin Characteristics Distinguishing Obesity with Prediabetes: PREVIEW Study Insights
Overview
This study identified horseshoe-like plantar hyperkeratosis (HSLPH) as a specific cutaneous marker associated with prediabetes in adults with overweight or obesity. Other common skin findings, including skin tags and xerosis, did not differentiate between those with and without prediabetes.
Background
Diabetes and impaired glucose metabolism manifest with various skin changes, often reflecting systemic disease progression. Overweight and obesity are major risk factors for type 2 diabetes, frequently preceding dysglycemia. Identifying visible skin markers linked to prediabetes could aid early clinical risk stratification, especially when laboratory testing is limited. Prior data on specific skin findings in prediabetes are lacking, prompting this investigation.
Horseshoe-like plantar hyperkeratosis (HSLPH) was significantly more frequent in adults with prediabetes (25.2%) compared to those without (10.0%).
HSLPH presence was associated with a threefold increased odds of prediabetes (OR 3.03, 95% CI 1.01–9.06).
HSLPH demonstrated high specificity (90%) but low sensitivity (25%) for identifying prediabetes.
Other common skin conditions such as skin tags, onychomycosis, and signs of chronic venous insufficiency showed no difference between groups.
Skin tag counts were not correlated with body weight or BMI in this cohort.
No significant differences were found in xerosis, pruritus, or yellowish skin tone between participants with and without prediabetes.
Clinical Implications
The presence of horseshoe-like plantar hyperkeratosis may serve as a visible clinical indicator prompting metabolic evaluation for prediabetes in adults with overweight or obesity. However, due to its low sensitivity, absence of HSLPH does not exclude dysglycemia. Other common obesity-related skin findings should not be relied upon for prediabetes risk stratification.
Conclusion
Horseshoe-like plantar hyperkeratosis is a specific but insensitive cutaneous marker associated with prediabetes in overweight or obese adults, offering a potential clinical red flag for early metabolic assessment. Other skin manifestations commonly linked to obesity do not discriminate prediabetes status.
by Razvigor Darlenski, Vesselina Mihaylova, Karen Manuelyan, Denitza Zheleva, Georgi Bogdanov, Ivan Bogdanov, Todor Kundurzhiev, Pavlina Gateva, Mikael Fogelholm, Anne Raben, Teodora Handjieva-Darlenska
