Diabetes mellitus (DM) is one of the most significant chronic metabolic disorders worldwide and represents a major public health challenge. Characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both, diabetes affects multiple organ systems and is associated with long-term microvascular and macrovascular complications (1). According to recent global estimates, India is among the countries with the highest burden of diabetes, often referred to as the “diabetes capital of the world.” The rising prevalence is attributed to rapid urbanization, sedentary lifestyle, dietary changes, genetic predisposition, and increasing life expectancy (2).

The skin is one of the most frequently involved organs in diabetes mellitus. Cutaneous manifestations may be the earliest clinical indicators of metabolic dysregulation and can sometimes precede the diagnosis of diabetes (3). It is estimated that nearly 30–70% of patients with diabetes develop skin manifestations at some stage of their disease. These dermatological changes may result from chronic hyperglycemia, microangiopathy, neuropathy, immune dysfunction, metabolic alterations, or adverse drug reactions (4).

The pathophysiological basis of skin involvement in diabetes is multifactorial. Persistent hyperglycemia leads to non-enzymatic glycosylation of proteins, formation of advanced glycation end products (AGEs), and microvascular damage (5). These changes impair collagen structure, reduce skin elasticity, and compromise wound healing. Additionally, diabetic neuropathy and peripheral vascular disease predispose patients to ulcerations and secondary infections. Immune dysfunction, particularly impaired neutrophil function and reduced cellular immunity, increases susceptibility to bacterial and fungal infections. Insulin resistance and hyperinsulinemia are also implicated in conditions such as acanthosis nigricans and skin tags (6,7).

Cutaneous manifestations in diabetes can be broadly categorized into:

1. Infections:
   Fungal infections (especially candidiasis and dermatophytosis) and bacterial infections (such as cellulitis, furunculosis, and impetigo) are common due to impaired immune response and hyperglycemic environment favoring microbial growth.
2. Diabetes-specific dermatoses:
   Conditions strongly associated with diabetes include diabetic dermopathy, necrobiosis lipoidica, diabetic bullae (bullosis diabeticorum), and diabetic cheiroarthropathy.
3. Manifestations of diabetic complications:
   Peripheral neuropathy and vascular insufficiency may lead to trophic ulcers, xerosis, and pruritus.
4. Markers of insulin resistance:
   Acanthosis nigricans and acrochordons (skin tags) are frequently observed in patients with type 2 diabetes.
5. Drug-related cutaneous reactions:
   Adverse effects of antidiabetic medications may also contribute to dermatological presentations.

Early recognition of these manifestations is clinically significant for several reasons. First, certain skin changes may serve as cutaneous markers of poor glycemic control. Second, they can act as indicators of underlying systemic complications. Third, prompt diagnosis and management of skin conditions can reduce morbidity, prevent secondary infections, and improve quality of life. In some cases, dermatological signs may even aid in the early diagnosis of undetected diabetes (8-10).

Despite the high prevalence of diabetes in India, regional data regarding the spectrum and frequency of cutaneous manifestations remain limited. Variations in climatic conditions, hygiene practices, socioeconomic factors, and healthcare access can influence the pattern of dermatological presentations. Therefore, localized prospective studies are essential to better understand the burden and distribution of these conditions (11,12).

The present prospective study was conducted over a six-month period (June 2025 – December 2025) at DY Patil University, School of Medicine, Ambi, Pune, with a sample size of 100 diabetic patients. The study aims to determine the prevalence and pattern of cutaneous manifestations among patients with diabetes mellitus and to assess their association with demographic factors, duration of disease, and glycemic control.

Understanding the dermatological profile of diabetic patients in this region will contribute to improved screening strategies, multidisciplinary management, and early intervention, ultimately enhancing patient outcomes and reducing disease-related complications.

Study Design

This study was designed as a prospective observational study conducted to evaluate the prevalence and spectrum of cutaneous manifestations in patients with diabetes mellitus.

Study Setting

The study was carried out at the Department of General Medicine in collaboration with the Department of Dermatology, DY Patil University, School of Medicine, Ambi, Pune, Maharashtra, India.

Study Duration

The study was conducted over a 6-month period from June 2025 to December 2025.

Study Population

The study population consisted of patients diagnosed with diabetes mellitus attending the Medicine outpatient department (OPD) and admitted patients (IPD) during the study period.

Sample Size

A total of 100 patients with confirmed diabetes mellitus were included in the study. Patients were selected using a consecutive sampling technique during the study period.

Inclusion Criteria

• Patients aged ≥18 years.
• Patients with a confirmed diagnosis of Type 1 or Type 2 Diabetes Mellitus, based on American Diabetes Association (ADA) criteria.
• Patients willing to participate and providing written informed consent.

Exclusion Criteria

• Patients with gestational diabetes mellitus.
• Patients with known chronic dermatological disorders unrelated to diabetes prior to diagnosis.
• Patients on systemic immunosuppressive therapy.
• Patients unwilling to provide consent.

Ethical Considerations

• Ethical clearance was obtained from the Institutional Ethics Committee of DY Patil University, School of Medicine, Ambi, Pune prior to commencement of the study.
• Written informed consent was obtained from all participants.
• Confidentiality of patient information was maintained throughout the study

Study Procedure

Clinical Evaluation

Each enrolled patient underwent:

1. Detailed Medical History

• Age, gender
• Duration of diabetes
• Type of diabetes
• Treatment modality (oral hypoglycemic agents/insulin/both)
• History of glycemic control
• Associated comorbidities (hypertension, dyslipidemia, neuropathy, nephropathy)
• History of dermatological complaints (itching, lesions, infections, ulcers)

1. General Physical Examination

• Vital parameters
• Body mass index (BMI)
• Signs of diabetic complications

1. Dermatological Examination

• Detailed examination of skin, scalp, hair, nails, and mucous membranes
• Identification and documentation of:
  • Infectious dermatoses (fungal, bacterial, viral)
  • Diabetes-specific dermatoses (diabetic dermopathy, necrobiosis lipoidica, bullosis diabeticorum)
  • Markers of insulin resistance (acanthosis nigricans, skin tags)
  • Neuropathic and vascular ulcers
  • Xerosis and pruritus
• Lesions were classified based on clinical morphology and distribution.

Where required, diagnostic investigations such as:

• KOH mount for fungal infections
• Gram staining
• Skin biopsy (if indicated)
  were performed to confirm the diagnosis.

Laboratory Investigations

The following investigations were recorded:

• Fasting Blood Sugar (FBS)
• Postprandial Blood Sugar (PPBS)
• Glycated Hemoglobin (HbA1c)
• Lipid profile
• Renal function tests (if indicated)

Glycemic control was categorized as:

• Good control: HbA1c < 7%
• Poor control: HbA1c ≥ 7%

Outcome Measures

Primary Outcome

• Prevalence of cutaneous manifestations in patients with diabetes mellitus.

Secondary Outcomes

• Distribution of various types of skin manifestations.
• Association between cutaneous manifestations and:
• Duration of diabetes
• Glycemic control (HbA1c levels)
• Age and gender

Data Collection and Recording

All patient data were recorded in a structured predesigned case record form. Photographic documentation was performed where necessary with patient consent.

Statistical Analysis

• Data were entered into Microsoft Excel and analyzed using SPSS software version 26.0.
• Descriptive statistics were used:
• Mean and standard deviation (SD) for continuous variables.
• Frequencies and percentages for categorical variables.
• Chi-square test was used to assess association between categorical variables.
• A p-value < 0.05 was considered statistically significant.

A total of 100 patients with confirmed diabetes mellitus were included in this prospective study conducted between June 2025 and December 2025 at DY Patil University, School of Medicine, Ambi, Pune.

1.Demographic Characteristics

Table 1: Age and Gender Distribution of Study Participants (n = 100)

The majority of patients belonged to the 41–50 years age group (30%), followed by 51–60 years (26%). The study showed a slight male predominance (58%) compared to females (42%). Most cases were observed in middle-aged and elderly individuals.

2. Duration of Diabetes

Table 2: Distribution According to Duration of Diabetes

The majority of patients (40%) had diabetes for 5–10 years, while 32% had diabetes for more than 10 years, indicating a substantial proportion with long-standing disease.

3. Glycemic Control (HbA1c Levels)

Table 3: Glycemic Control Among Study Participants

Poor glycemic control (HbA1c ≥7%) was observed in 62% of patients, suggesting suboptimal diabetes management in a majority of cases.

4. Overall Prevalence of Cutaneous Manifestations

Table 4: Prevalence of Cutaneous Manifestations

Cutaneous manifestations were observed in 76% of diabetic patients, indicating a high prevalence in the study population.

5. Spectrum of Cutaneous Manifestations

Table 5: Distribution of Various Cutaneous Manifestations (n=76)

Among patients with skin manifestations, infectious dermatoses were the most common, particularly fungal infections (36.8%). Diabetic dermopathy (18.4%) was the most common diabetes-specific dermatosis. Necrobiosis lipoidica was rare (2.6%).

6. Association Between Glycemic Control and Cutaneous Manifestations

Table 6: Association of Skin Manifestations with HbA1c Levels

A statistically significant association was found between poor glycemic control (HbA1c ≥7%) and presence of cutaneous manifestations (p = 0.001). Patients with uncontrolled diabetes were more likely to develop skin disorders.

7. Association with Duration of Diabetes

Table 7: Cutaneous Manifestations According to Duration of Diabetes

The prevalence of cutaneous manifestations increased with longer duration of diabetes. Patients with diabetes duration greater than 10 years showed the highest prevalence (93.7%), indicating a strong correlation between chronicity and dermatological involvement.

This prospective study evaluated the prevalence and spectrum of cutaneous manifestations in 100 patients with diabetes mellitus over a 6-month period (June 2025–December 2025) at DY Patil University, School of Medicine, Ambi, Pune. Our findings demonstrate that cutaneous manifestations are highly prevalent in diabetic patients (76%), consistent with multiple reports in the literature.

Comparison with Other Studies

Overall Prevalence

In this study, the overall prevalence of cutaneous manifestations was 76%, which is comparable to previous Indian studies. Sharma et al. (4) reported a prevalence of 70.5% among 150 diabetic patients in North India, while Kumar et al. (7) documented a prevalence of 73.3% in a similar cohort. Internationally, Bhat et al. (5) from Egypt reported a prevalence of 68% among diabetic patients, suggesting a consistently high prevalence across different populations. These similarities reinforce the concept that skin involvement is a common aspect of diabetes regardless of geographic location.

Infectious Dermatoses

In our study, fungal infections were the most common cutaneous finding, present in 36.8% of affected patients. This is in line with Kumar et al. (7), who reported fungal infections in 34% of diabetic patients in their Indian cohort. Fungal infections are often associated with hyperglycemia-mediated immune dysfunction, facilitating Candida and dermatophyte growth. Bacterial infections accounted for 15.8%, which aligns with the 14.2% reported by Rao et al. (8) and Chowdhury SS et al. (13). The high frequency of infections highlights the need for routine screening and early management to prevent complications.

Diabetic Dermopathy

Diabetic dermopathy was seen in 18.4% of our patients. This is moderately comparable with Ghosh et al. (9) who reported dermopathy in 16.5% of diabetic subjects. Dermopathy is considered a marker of microangiopathy, correlating with longer disease duration and suboptimal glycemic control.

Xerosis and Pruritus

Dry skin and pruritus were seen in 13.2% of patients in our study, which aligns with Singh and Sharma (10) that documented xerosis in 12.8% of cases. Pruritus and dry skin may result from altered skin hydration and microvascular changes in diabetic patients.

Acanthosis Nigricans / Markers of Insulin Resistance

Acanthosis nigricans was observed in 7.9%, similar to Patel et al. (11) who reported a prevalence of 8.6%. These lesions are typically associated with insulin resistance and obesity, conditions commonly accompanying type 2 diabetes.

Diabetic Foot Ulcers

Foot ulceration was present in 5.3% of study participants. Although lower than rates reported in tertiary referral centers (~10–15%), this finding underscores the significance of neuropathy and vascular disease as contributors to ulcer formation. Early detection and preventive foot care education remain essential.

Rare Manifestations

Necrobiosis lipoidica was rare (2.6%), consistent with its low prevalence reported in the literature (commonly <5%) across multiple cohorts.

Glycemic Control and Cutaneous Manifestations

A statistically significant association was found between poor glycemic control (HbA1c ≥7%) and the presence of skin manifestations (p = 0.001). Patients with poor glycemic control had a prevalence of cutaneous changes of 90.3%, compared with 52.6% in those with HbA1c <7%. This is consistent with Lee HY et al (15), which reported that poorly controlled diabetic patients had a cutaneous involvement rate of 88% versus 45% in controlled cases. Chronic hyperglycemia impairs neutrophil function, alters cytokine profiles, and disrupts cutaneous microcirculation—mechanisms that clearly support this association.

Duration of Diabetes

Cutaneous manifestations increased with longer disease duration. Among patients with >10 years of diabetes, 93.7% had skin involvement compared to 57.1% in those with <5 years. Similar findings were reported by Chowdhury et al. (13), where long-standing diabetic patients showed a statistically higher prevalence (p < 0.05). This supports the notion that cumulative metabolic stress and complications such as neuropathy and microangiopathy develop progressively with time.

Clinical Implications

The high prevalence and diverse spectrum of cutaneous manifestations observed in this study highlight the critical role of regular dermatological evaluation in diabetic care. Many skin findings serve not only as markers of disease burden but also as indicators of glycemic control. Early recognition and management can reduce morbidity, improve patient quality of life, and potentially signal poor systemic control that warrants intensified diabetes management (16,17).

This prospective study at DY Patil University, School of Medicine, Ambi, Pune showed that 76% of diabetic patients had cutaneous manifestations, with infectious dermatoses (especially fungal infections) being the most common. There was a significant association between poor glycemic control and increased prevalence of dermatological changes. Cutaneous involvement also correlated with longer duration of diabetes. These findings emphasize that:

• Regular skin examination should be an integral part of diabetes care.
• Healthcare providers should maintain a high index of suspicion for skin disorders in diabetic patients.

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